Editorial
WADEM Climate Change Position Statement
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- The World Association for Disaster and Emergency Medicine
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- 27 July 2017, p. 351
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Original Research
Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment
- Sami Yousif, Jason T. Machan, Yasser Alaska, Selim Suner
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- 20 March 2017, pp. 352-356
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Introduction
Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control.
Hypothesis/ProblemThe objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.
MethodsIn this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited. Following standardized training in PPE use and specific training in the use of airway devices, subjects in Level C PPE were observed while performing endotracheal intubation on a stock airway in a Laerdal Resusci-Anne manikin system (Laerdal Medical; Stavanger, Norway) using one of three laryngoscopic devices in randomized order: a Macintosh direct laryngoscope (Welch Allyn Inc.; New York USA), a GlideScope Ranger video laryngoscope (Verathon Medical; Bothell, Washington USA), and a King Vision video laryngoscope (King Systems; Noblesville, Indiana USA). The primary outcome was time to intubation (TTI), and the secondary outcome was participant perception of the ease of use for each device.
ResultsA total of 20 prehospital providers participated in the study: 18 (90%) paramedics and two (10%) Emergency Medical Technicians-Cardiac. Participants took significantly longer when using the GlideScope Ranger [35.82 seconds (95% CI, 32.24-39.80)] to achieve successful intubation than with the Macintosh laryngoscope [25.69 seconds (95% CI, 22.42-29.42); adj. P<.0001] or the King Vision [29.87 seconds (95% CI, 26.08-34.21); adj. P=.033], which did not significantly differ from each other (adj. P=.1017). Self-reported measures of satisfaction evaluated on a 0% to 100% visual analog scale (VAS) identified marginally greater subject satisfaction with the King Vision [86.7% (SD=76.4-92.9%)] over the GlideScope Ranger [73.0% (SD=61.9-81.8%); P=.04] and the Macintosh laryngoscope [69.9% (SD=57.9-79.7%); P=.05] prior to adjustment for multiplicity. The GlideScope Ranger and the Macintosh laryngoscope did not differ themselves (P=.65), and the differences were not statistically significant after adjustment for multiplicity (adj. P=.12 for both comparisons).
ConclusionUse of video laryngoscopes by prehospital providers in Level C PPE did not result in faster endotracheal intubation than use of a Macintosh laryngoscope. The King Vision video laryngoscope, in particular, performed at least as well as the Macintosh laryngoscope and was reported to be easier to use.
,Yousif S ,Machan JT ,Alaska Y .Suner S Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment . Prehosp Disaster Med.2017 ;32 (4 ):352 –356 .
Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data
- Francisca Dussaillant, Mauricio Apablaza
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- 20 March 2017, pp. 357-367
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Background
After a major earthquake, the assignment of scarce mental health emergency personnel to different geographic areas is crucial to the effective management of the crisis. The scarce information that is available in the aftermath of a disaster may be valuable in helping predict where are the populations that are in most need.
ObjectiveThe objectives of this study were to derive algorithms to predict posttraumatic stress (PTS) symptom prevalence and local distribution after an earthquake and to test whether there are algorithms that require few input data and are still reasonably predictive.
MethodsA rich database of PTS symptoms, informed after Chile’s 2010 earthquake and tsunami, was used. Several model specifications for the mean and centiles of the distribution of PTS symptoms, together with posttraumatic stress disorder (PTSD) prevalence, were estimated via linear and quantile regressions. The models varied in the set of covariates included.
ResultsAdjusted R2 for the most liberal specifications (in terms of numbers of covariates included) ranged from 0.62 to 0.74, depending on the outcome. When only including peak ground acceleration (PGA), poverty rate, and household damage in linear and quadratic form, predictive capacity was still good (adjusted R2 from 0.59 to 0.67 were obtained).
ConclusionsInformation about local poverty, household damage, and PGA can be used as an aid to predict PTS symptom prevalence and local distribution after an earthquake. This can be of help to improve the assignment of mental health personnel to the affected localities.
,Dussaillant F .Apablaza M Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data . Prehosp Disaster Med.2017 ;32 (4 ):357 –367 .
Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States
- Ritu R. Sarin, Srihari Cattamanchi, Abdulrahman Alqahtani, Majed Aljohani, Mark Keim, Gregory R. Ciottone
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- 20 March 2017, pp. 368-373
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Background
The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals.
HypothesisThis study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place.
MethodsThe authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training.
ResultsOut of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars.
ConclusionThere are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine.
Sarin RR Cattamanchi S Alqahtani A Aljohani M Keim M Ciottone GR Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States . Prehosp Disaster Med.2017 ;32 (4 ):368 –373 .
Self-Perception of Medical Students’ Knowledge and Interest in Disaster Medicine: Nine Years After the Approval of the Curriculum in German Universities
- Robert Wunderlich, Luca Ragazzoni, Pier Luigi Ingrassia, Francesco Della Corte, Jan Grundgeiger, Jens Werner Bickelmayer, Bernd Domres
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- 05 April 2017, pp. 374-381
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Background
Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and interest of medical students nine years later.
ProblemThe aim of this study was to assess the self-perception of medical students’ knowledge and interest in disaster medicine nine years after the implementation of a standardized disaster medicine curriculum in German medical schools.
MethodsThis prospective, cross-sectional, observational study was conducted with medical students in Germany using a web-based, purpose-designed questionnaire consisting of 27 mandatory and 11 optional questions.
ResultsNine hundred ninety-two students from 36 of 37 medical schools in Germany participated. More than one-half of medical students were aware of the field of disaster medicine. One hundred twenty-one students undertook training internally within their university and 307 undertook training externally at other institutions. Only a small content of the curriculum was taught. A difference in self-perception of knowledge between trained and untrained participants was found, despite the level of training being low in both groups. Participants were generally highly motivated to learn disaster medicine in a variety of institutions.
ConclusionGerman students are still largely not well educated regarding disaster medicine, despite their high motivation. The curriculum of 2006 was not implemented as originally planned and the number of trained students still remains low as the self-perception of knowledge. Currently, there is no clear and standardized training concept in place. A renewal in the agreement of implementation of the curriculum at medical schools should be targeted in order to follow the recommendation of WADEM.
Wunderlich R Ragazzoni L Ingrassia PL Della Corte F Grundgeiger J Bickelmayer JW .Domres B Self-Perception of Medical Students’ Knowledge and Interest in Disaster Medicine: Nine Years After the Approval of the Curriculum in German Universities . Prehosp Disaster Med.2017 ;32 (4 ):374 –381 .
Toward a Better Nutritional Aiding in Disasters: Relying on Lessons Learned during the Bam Earthquake
- Mahmoud Nekouie Moghadam, Mohammadreza Amiresmaieli, Mohammad Hassibi, Farideh Doostan, Sajad Khosravi
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- 27 March 2017, pp. 382-386
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Introduction
Examining various problems in the aftermath of disasters is very important to the disaster victims. Managing and coordinating food supply and its distribution among the victims is one of the most important problems after an earthquake. Therefore, the purpose of this study was to recognize problems and experiences in the field of nutritional aiding during an earthquake.
MethodsThis qualitative study was of phenomenological type. Using the purposive sampling method, 10 people who had experienced nutritional aiding during the Bam Earthquake (Iran; 2003) were interviewed. Colaizzi’s method of analysis was used to analyze interview data.
ResultsThe findings of this study identified four main categories and 19 sub-categories concerning challenges in the nutritional aiding during the Bam Earthquake. The main topics included managerial, aiding, infrastructural, and administrative problems.
ConclusionsThe major problems in nutritional aiding include lack of prediction and development of a specific program of suitable nutritional pattern and nutritional assessment of the victims in critical conditions. Forming specialized teams, educating team members about nutrition, and making use of experts’ knowledge are the most important steps to resolve these problems in the critical conditions; these measures are the duties of the relevant authorities.
,Nekouie Moghadam M ,Amiresmaieli M ,Hassibi M ,Doostan F .Khosravi S Toward a Better Nutritional Aiding in Disasters: Relying on Lessons Learned during the Bam Earthquake . Prehosp Disaster Med.2017 ;32 (4 ):382 –386 .
Rural Community Disaster Preparedness and Risk Perception in Trujillo, Peru
- Matthew Stewart, Bridget Grahmann, Ariel Fillmore, L. Scott Benson
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- 11 April 2017, pp. 387-392
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Introduction
Disasters will continue to occur throughout the world and it is the responsibility of the government, health care systems, and communities to adequately prepare for potential catastrophic scenarios. Unfortunately, low-and-middle-income countries (LMICs) are especially vulnerable following a disaster. By understanding disaster preparedness and risk perception, interventions can be developed to improve community preparedness and avoid unnecessary mortality and morbidity following a natural disaster.
ProblemThe purpose of this study was to assess disaster preparedness and risk perception in communities surrounding Trujillo, Peru.
MethodsAfter designing a novel disaster preparedness and risk perception survey based on guidelines from the International Federation of Red Cross and Red Crescent Societies (IFRC; Geneva, Switzerland), investigators performed a cross-sectional survey of potentially vulnerable communities surrounding Trujillo, Peru. Data were entered and analyzed utilizing the Research Electronic Data Capture (REDCap; Harvard Catalyst; Boston, Massachusetts USA) database.
ResultsA total of 230 study participants were surveyed, composed of 37% males, 63% females, with ages ranging from 18-85 years old. Those surveyed who had previously experienced a disaster (41%) had a higher perception of future disaster occurrence and potential disaster impact on their community. Overall, the study participants consistently perceived that earthquakes and infection had the highest potential impact of all disasters. Twenty-six percent of participants had an emergency supply of food, 24% had an emergency water plan, 24% had a first aid kit at home, and only 20% of the study participants had an established family evacuation plan.
ConclusionNatural and man-made disasters will remain a threat to the safety and health of communities in all parts of the world, especially within vulnerable communities in LMICs; however, little research has been done to identify disaster perception, vulnerability, and preparedness in LMIC communities. The current study established that selected communities near Trujillo, Peru recognize a high disaster impact from earthquakes and infection, but are not adequately prepared for potential future disasters. By identifying high-risk demographics, targeted public health interventions are needed to prepare vulnerable communities in the following areas: emergency food supplies, emergency water plan, medical supplies at home, and establishing evacuation plans.
,Stewart M ,Grahmann B ,Fillmore A .Benson LS Rural Community Disaster Preparedness and Risk Perception in Trujillo, Peru . Prehosp Disaster Med.2017 ;32 (4 ):387 –392 .
The Epidemiology of Operation Stress during Continuing Promise 2011: A Humanitarian Response and Disaster Relief Mission aboard a US Navy Hospital Ship
- William T. Scouten, Melissa L. Mehalick, Elizabeth Yoder, Andrea McCoy, Tracy Brannock;, Mark S. Riddle
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- 20 March 2017, pp. 393-402
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Introduction
Operational stress describes individual behavior in response to the occupational demands and tempo of a mission. The stress response of military personnel involved in combat and peace-keeping missions has been well-described. The spectrum of effect on medical professionals and support staff providing humanitarian assistance, however, is less well delineated. Research to date concentrates mainly on shore-based humanitarian missions.
ProblemThe goal of the current study was to document the pattern of operational stress, describe factors responsible for it, and the extent to which these factors impact job performance in military and civilian participants of Continuing Promise 2011 (CP11), a ship-based humanitarian medical mission.
MethodsThis was a retrospective study of Disease Non-Battle Injury (DNBI) data from the medical sick-call clinic and from weekly self-report questionnaires for approximately 900 US military and civilian mission participants aboard the USNS COMFORT (T-AH 20). The incidence rates and job performance impact of reported Operational Stress/Mental Health (OS/MH) issues and predictors (age, rank, occupation, service branch) of OS/MH issues (depression, anxiety) were analyzed over a 22-week deployment period.
ResultsIncidence rates of OS/MH complaints from the sick-call clinic were 3.7% (4.5/1,000 persons) and 12.0% (53/1,000 persons) from the self-report questionnaire. The rate of operational stress increased as the mission progressed and fluctuated during the mission according to ship movement. Approximately 57% of the responders reported no impact on job performance. Younger individuals (enlisted ranks E4-6, officer ranks O1-3), especially Air Force service members, those who had spent only one day off ship, and those who were members of specific directorates, reported the highest rates of operational stress.
ConclusionThe overall incidence of OS/MH complaints was low in participants of CP11 but was under-estimated by clinic-based reporting. The OS/MH complaints increased as the mission progressed, were more prevalent in certain groups, and appeared to be related to ship’s movement. These findings document the pattern of operational stress in a ship-based medical humanitarian mission and confirm unique ship-based stressors. This information may be used by planners of similar missions to develop mitigation strategies for known stressors and by preventive medicine, behavioral health specialists, and mission leaders to develop sensitive surveillance tools to better detect and manage operational stress while on mission.
,Scouten WT ,Mehalick ML ,Yoder E ,McCoy A ,Brannock T .Riddle MS The Epidemiology of Operation Stress during Continuing Promise 2011: A Humanitarian Response and Disaster Relief Mission aboard a US Navy Hospital Ship . Prehosp Disaster Med.2017 ;32 (4 ):393 –402 .
Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals
- Erin Hulland, Ritam Chowdhury, Stefanie Sarnat, Howard H. Chang, Kyle Steenland
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- 31 March 2017, pp. 403-413
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Background
Injury mortality data for adults in the United States and other countries consistently show higher mortality for those with lower socioeconomic status (SES). Data are sparse regarding the role of SES among adult, non-fatal US injuries. The current study estimated non-fatal injury risk by household income using hospital emergency department (ED) visits.
MethodsA total of 1,308,892 ED visits at 10 Atlanta (Georgia USA) hospitals from 2001-2004 (347,866 injuries) were studied. The SES was based on US census-block group income, with subjects assigned to census blocks based on reported residence. Logistic regression was used to determine risk by SES for injuries versus all other ED visits, adjusting for demographics, hospital, and weather. Supplemental analyses using hospital data from 2010-2013, without data on SES, were conducted to determine whether earlier patterns by race, age, and gender persisted.
ResultsRisk for many injury categories increased with higher income. Odds ratio by quartiles of increasing income (lowest quartile as referent, 95% confidence interval [CI] given for upper most quartile) were 1.00, 1.23, 1.34, 1.40 (95% CI 1.36-1.45) for motor vehicle accidents; 1.00, 1.03, 1.11, 1.24 (95% CI 1.20-1.29) for being struck by objects; 1.00. 0.99, 1.04, 1.12 (95% CI 1.00-1.25) for suicide; and 1.00, 1.03, 1.05, 1.12 (95% CI 1.09-1.15) for falls. In contrast, decreased injury risk with increased household income was seen for assaults (1.00, 0.83, 0.73, 0.67 [95% CI 0.63-0.72], by increasing quartiles). These trends by income did not differ markedly by race and gender. Whites generally had less risk of injuries, with the exception of assaults and motor vehicle accidents. Males had higher risk of injury than females, with the exception of falls and suicide attempts. Patterns of risk for race, age, and gender were consistent between 2001-2004 and 2010-2013.
ConclusionFor most non-fatal injuries, those with higher income had more risk of ED visits, although the opposite was true for assault.
,Hulland E ,Chowdhury R ,Sarnat S ,Chang HH .Steenland K Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals . Prehosp Disaster Med.2017 ;32 (4 ):403 –413 .
Near-Infrared Spectroscopy: A Promising Prehospital Tool for Management of Traumatic Brain Injury
- Joost Peters, Bas Van Wageningen, Nico Hoogerwerf, Edward Tan
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- 29 March 2017, pp. 414-418
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Introduction
Early identification of traumatic brain injury (TBI) is essential. Near-infrared spectroscopy (NIRS) can be used in prehospital settings for non-invasive monitoring and the diagnosis of patients who may require surgical intervention.
MethodsThe handheld NIRS Infrascanner (InfraScan Inc.; Philadelphia, Pennsylvania USA) uses eight symmetrical scan points to detect intracranial bleeding. A scanner was tested in a physician-staffed helicopter Emergency Medical Service (HEMS). The results were compared with those obtained using in-hospital computed tomography (CT) scans. Scan time, ease-of-use, and change in treatment were scored.
ResultsA total of 25 patients were included. Complete scans were performed in 60% of patients. In 15 patients, the scan was abnormal, and in one patient, the scan resulted in a treatment change. Compared with the results of CT scanning, the Infrascanner obtained a sensitivity of 93.3% and a specificity of 78.6%. Most patients had severe TBI with indication for transport to a trauma center prior to scanning. In one patient, the scan resulted in a treatment change. Evaluation of patients with less severe TBI is needed to support the usefulness of the Infrascanner as a prehospital triage tool.
ConclusionPromising results were obtained using the InfraScan NIRS device in prehospital screening for intracranial hematomas in TBI patients. High sensitivity and good specificity were found. Further research is necessary to determine the beneficial effects of enhanced prehospital screening on triage, survival, and quality of life in TBI patients.
,Peters J ,Van Wageningen B ,Hoogerwerf N .Tan E Near-Infrared Spectroscopy: A Promising Prehospital Tool for Management of Traumatic Brain Injury . Prehosp Disaster Med.2017 ;32 (4 ):414 –418 .
A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway
- Christopher Stein, Louis Gerber, Denis Curtin, Nicole Oberem, Mike Wells
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- 06 April 2017, pp. 419-423
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Aim
The goal of this study was to compare the relative effectiveness of three adjunctive maneuvers – head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) – on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.
MethodsTwenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.
ResultsHead elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.
ConclusionsThis study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators.
,Stein C ,Gerber L ,Curtin D ,Oberem N .Wells M A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway . Prehosp Disaster Med.2017 ;32 (4 ):419 –423 .
Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care
- Nasiru A. Ibrahim, Abdul Wahab O. Ajani, Ibrahim A. Mustafa, Rufai A. Balogun, Mobolaji A. Oludara, Olufemi E. Idowu, Babatunde A. Solagberu
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- 02 May 2017, pp. 424-430
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Introduction
Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital.
MethodsA three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16.
ResultsA total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients (1.9%) died in the emergency room while 235 bodies were brought in dead.
ConclusionLess than three percent among the victims of road crashes had formal prehospital care and shorter hospital arrival time. Current facilities for emergency prehospital care in Lagos are inadequate and require improvement. Training lay first-responders, who bring the majority of the injured to hospital, in basic first-aid may improve prehospital care in Lagos.
,Ibrahim NA ,Ajani AWO ,Mustafa IA ,Balogun RA ,Oludara MA ,Idowu OE .Solagberu BA Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care . Prehosp Disaster Med.2017 ;32 (4 ):424 –430 .
Border Injuries: An Analysis of Prehospital Demographics, Mechanisms, and Patterns of Injuries Encountered by USBP EMS Agents in the El Paso (Texas USA) Sector
- Russell A. Baker
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- 02 May 2017, pp. 431-436
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Study Objective
The aim of this study was to evaluate Emergency Medical Services (EMS), use, injury mechanisms, prehospital assessments, and injuries among those receiving aid from the United States Border Patrol (USBP) in the El Paso (Texas USA) Sector.
DesignThis is a time-series, retrospective analysis of all prehospital data for injuries among patients receiving care from USBP EMS on the US Mexico border in the El Paso sector from February 6, 2014 to February 6, 2016.
ResultsA total of 473 documented EMS encounters occurred in this two-year period and demonstrated a male gender predominance (male 63%; female 37%) with the most prominent ages between 22-40 years old. The most prevalent EMS call types were medical (55%) and trauma (42%). The most common chief complaints were an injured or painful extremity (35%) and rash (13%). The most common USBP EMS provider primary impression was traumatic injury (34%), followed by fever/infection (17%) and extremity injury (7%); however, the most common secondary impression was also extremity injury (20%). The most common mechanism of injury was fall (26%) and motor vehicle accident (MVA; 22%). The USBP EMS was the first provider on scene in 96% of the MVAs.
Conclusion:The author reports on injury patterns, mechanisms, chief complaints, EMS impressions, as well as demographics of patients reporting to USBP EMS. A knowledge of these injury patterns will be useful to EMS administrators and physicians along the US Mexico border.
.Baker RA Border Injuries: An Analysis of Prehospital Demographics, Mechanisms, and Patterns of Injuries Encountered by USBP EMS Agents in the El Paso (Texas USA) Sector . Prehosp Disaster Med.2017 ;32 (4 ):431 –436 .
Special Reports
The Event Chain of Survival in the Context of Music Festivals: A Framework for Improving Outcomes at Major Planned Events
- Adam Lund, Sheila Turris
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- 20 March 2017, pp. 437-443
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Despite the best efforts of event producers and on-site medical teams, there are sometimes serious illnesses, life-threatening injuries, and fatalities related to music festival attendance. Producers, clinicians, and researchers are actively seeking ways to reduce the mortality and morbidity associated with these events. After analyzing the available literature on music festival health and safety, several major themes emerged. Principally, stakeholder groups planning in isolation from one another (ie, in silos) create fragmentation, gaps, and overlap in plans for major planned events (MPEs).
The authors hypothesized that one approach to minimizing this fragmentation may be to create a framework to “connect the dots,” or join together the many silos of professionals responsible for safety, security, health, and emergency planning at MPEs. Adapted from the well-established literature regarding the management of cardiac arrests, both in and out of hospital, the “chain of survival” concept is applied to the disparate groups providing services that support event safety in the context of music festivals. The authors propose this framework for describing, understanding, coordinating and planning around the integration of safety, security, health, and emergency service for events. The adapted Event Chain of Survival contains six interdependent links, including: (1) event producers; (2) police and security; (3) festival health; (4) on-site medical services; (5) ambulance services; and (6) off-site medical services.
The authors argue that adapting and applying this framework in the context of MPEs in general, and music festivals specifically, has the potential to break down the current disconnected approach to event safety, security, health, and emergency planning. It offers a means of shifting the focus from a purely reactive stance to a more proactive, collaborative, and integrated approach. Improving health outcomes for music festival attendees, reducing gaps in planning, promoting consistency, and improving efficiency by reducing duplication of services will ultimately require coordination and collaboration from the beginning of event production to post-event reporting.
,Lund A .Turris SA The Event Chain of Survival in the Context of Music Festivals: A Framework for Improving Outcomes at Major Planned Events . Prehosp Disaster Med.2017 ;32 (4 ):437 –443 .
Methodological Challenges in Studies Comparing Prehospital Advanced Life Support with Basic Life Support
- Timmy Li, Courtney M. C. Jones, Manish N. Shah, Jeremy T. Cushman, Todd A. Jusko
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- 03 April 2017, pp. 444-450
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Determining the most appropriate level of care for patients in the prehospital setting during medical emergencies is essential. A large body of literature suggests that, compared with Basic Life Support (BLS) care, Advanced Life Support (ALS) care is not associated with increased patient survival or decreased mortality. The purpose of this special report is to synthesize the literature to identify common study design and analytic challenges in research studies that examine the effect of ALS, compared to BLS, on patient outcomes. The challenges discussed in this report include: (1) choice of outcome measure; (2) logistic regression modeling of common outcomes; (3) baseline differences between study groups (confounding); (4) inappropriate statistical adjustment; and (5) inclusion of patients who are no longer at risk for the outcome. These challenges may affect the results of studies, and thus, conclusions of studies regarding the effect of level of prehospital care on patient outcomes should require cautious interpretation. Specific alternatives for avoiding these challenges are presented.
,Li T ,Jones CMC ,Shah MN ,Cushman JT .Jusko TA Methodological Challenges in Studies Comparing Prehospital Advanced Life Support with Basic Life Support . Prehosp Disaster Med.2017 ;32 (4 ):444 –450 .
Use of a Novel, Portable, LED-Based Capillary Refill Time Simulator within a Disaster Triage Context
- Todd P. Chang, Genevieve Santillanes, Ilene Claudius, Phung K. Pham, James Koved, John Cheyne, Marianne Gausche-Hill, Amy H. Kaji, Saranya Srinivasan, J. Joelle Donofrio, Cynthia Bir
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- 27 March 2017, pp. 451-456
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Introduction
A simple, portable capillary refill time (CRT) simulator is not commercially available. This device would be useful in mass-casualty simulations with multiple volunteers or mannequins depicting a variety of clinical findings and CRTs. The objective of this study was to develop and evaluate a prototype CRT simulator in a disaster simulation context.
MethodsA CRT prototype simulator was developed by embedding a pressure-sensitive piezo crystal, and a single red light-emitting diode (LED) light was embedded, within a flesh-toned resin. The LED light was programmed to turn white proportionate to the pressure applied, and gradually to return to red on release. The time to color return was adjustable with an external dial. The prototype was tested for feasibility among two cohorts: emergency medicine physicians in a tabletop exercise and second year medical students within an actual disaster triage drill. The realism of the simulator was compared to video-based CRT, and participants used a Visual Analog Scale (VAS) ranging from “completely artificial” to “as if on a real patient.” The VAS evaluated both the visual realism and the functional (eg, tactile) realism. Accuracy of CRT was evaluated only by the physician cohort. Data were analyzed using parametric and non-parametric statistics, and mean Cohen’s Kappas were used to describe inter-rater reliability.
ResultsThe CRT simulator was generally well received by the participants. The simulator was perceived to have slightly higher functional realism (P=.06, P=.01) but lower visual realism (P=.002, P=.11) than the video-based CRT. Emergency medicine physicians had higher accuracy on portrayed CRT on the simulator than the videos (92.6% versus 71.1%; P<.001). Inter-rater reliability was higher for the simulator (0.78 versus 0.27; P<.001).
ConclusionsA simple, LED-based CRT simulator was well received in both settings. Prior to widespread use for disaster triage training, validation on participants’ ability to accurately triage disaster victims using CRT simulators and video-based CRT simulations should be performed.
,Chang TP ,Santillanes G ,Claudius I ,Pham PK ,Koved J ,Cheyne J ,Gausche-Hill M ,Kaji AH ,Srinivasan S ,Donofrio JJ .Bir C Use of a Novel, Portable, LED-Based Capillary Refill Time Simulator within a Disaster Triage Context . Prehosp Disaster Med.2017 ;32 (4 ):451 –456 .
Assessment of Risks Posed to VAD Patients During Disasters
- Katherine J Davis, Genevieve O’Shea, Michael Beach
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- Published online by Cambridge University Press:
- 06 April 2017, pp. 457-461
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Ventricular assist devices (VADs) are an Advanced Life Support for patients with heart failure. These patients are particularly vulnerable in the event of a disaster. A hazard vulnerability analysis (HVA) was conducted to determine areas of susceptibility for these patients. Lack of electrical power, limited access to medications and anticoagulation, dehydration, extreme temperature and weather environments, conditions which predispose to infection, and evacuation transport are all identified circumstances that place these patients at an increased risk for harm and death. Future preparations in disaster planning are needed to address and mitigate these risks.
,Davis KJ ,O’Shea G .Beach M Assessment of Risks Posed to VAD Patients During Disasters . Prehosp Disaster Med.2017 ;32 (4 ):457 –461 .
Emergency Physician Disaster Deployment: Issues to Consider and a Model Policy
- Christopher A. Kahn, Kristi L. Koenig, Carl H. Schultz
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- Published online by Cambridge University Press:
- 02 May 2017, pp. 462-464
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Disaster responders are frequently emergency physicians (EPs). Effective response is enhanced by the strong support of home institutions and clear policies for backfill of regular duties. A group of disaster medicine responders and researchers worked with an academic department of emergency medicine to create a policy that addresses concerns of deploying physicians, colleagues remaining at the home institution, and administrators. This article describes the process and content of this policy development work.
,Kahn CA ,Koenig KL .Schultz CH Emergency Physician Disaster Deployment: Issues to Consider and a Model Policy . Prehosp Disaster Med.2017 ;32 (4 ):462 –464 .
Brief Report
Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis
- Steven G. Schauer, Michael D. April, Erica Simon, Joseph K. Maddry, Robert Carter III, Robert A. Delorenzo
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- Published online by Cambridge University Press:
- 03 May 2017, pp. 465-468
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Background
Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines.
MethodsCases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included.
DataFifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as “routine.” Follow-up data were available for 36 of the subjects and 97% were discharged alive.
ConclusionsThe most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines.
,Schauer SG ,April MD ,Simon E ,Maddry JK ,Carter R III .Delorenzo RA Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis . Prehosp Disaster Med.2017 ;32 (4 ):465 –468 .
Corrigendum
Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies-CORRIGENDUM
- Diana F. Wong, Caroline Spencer, Lee Boyd, Frederick M. Burkle, Jr., Frank Archer
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- Published online by Cambridge University Press:
- 27 July 2017, p. 469
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