Guest Editorial
WADEM Position Statement: Accurate Reporting of Public Health Information
- Board of Directors, World Association for Disaster and Emergency Medicine
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- Published online by Cambridge University Press:
- 01 June 2018, p. 229
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Original Research
Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study
- Felicia M. Mix, Martin D. Zielinski, Lucas A. Myers, Kathy S. Berns, Anurahda Luke, James R. Stubbs, Scott P. Zietlow, Donald H. Jenkins, Matthew D. Sztajnkrycer
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- Published online by Cambridge University Press:
- 19 April 2018, pp. 230-236
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Introduction
Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).
MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).
ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.
ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.
,Mix FM ,Zielinski MD ,Myers LA ,Berns KS ,Luke A ,Stubbs JR ,Zietlow SP ,Jenkins DH .Sztajnkrycer MD Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study . Prehosp Disaster Med.2018 ;33 (3 ):230 –236 .
Needle Thoracostomy: Does Changing Needle Length and Location Change Patient Outcome?
- Lori A. Weichenthal, Scott Owen, Geoffory Stroh, John Ramos
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- Published online by Cambridge University Press:
- 19 April 2018, pp. 237-244
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Background
Needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma. The purpose of this study is to compare outcomes, efficacy, and complications after a change in policy related to NT in a four-county Emergency Medical Services (EMS) system with a catchment area of greater than 1.6 million people.
MethodsThis is a before and after observational study of all patients who had NT performed in the Central California (USA) EMS system. The before, anterior midclavicular line (MCL) group consisted of all patients who underwent NT from May 7, 2007 through February 28, 2013. The after, midaxillary line (MAL) axillary group consisted of all patients who underwent NT from March 1, 2013 through January 30, 2016, after policy revisions changed the timing, needle size, and placement location for NT. All prehospital and hospital records where NT was performed were queried for demographics, mechanism of injury, initial status and post-NT clinical change, reported complications, and final outcome. The trauma registry was accessed to obtain Injury Severity Scores (ISS). Information was manually abstracted by study investigators and examined utilizing univariate and multivariate analyses.
ResultsThree-hundred and five trauma patients treated with NT were included in this study, of which, 169 patients (the MCL group) were treated with a 14-guage intravenous (IV) catheter at least 5.0-cm long at the second intercostal space (ICS), MCL after being placed in the ambulance; and 136 patients (the MAL group) were treated with a 10-guage IV catheter at least 9.5-cm long at the fifth ICS, MAL on scene. The mean ISS was lower in the MAL cohort (64.5 versus 69.2; P=.007). The mortality rate was 79% in both groups. The multivariate model with regard to survival supported that a lower ISS (P<.001) and reported clinical change after NT (P=.003) were significant indicators of survival. No complications from NT were reported.
ConclusionsChanging the timing, length of needle, and location of placement did not change mortality in patients requiring NT. Needle thoracostomy was used more frequently after the change in policy, and the MAL cohort was less injured. No increase in reported complications was noted.
,Weichenthal LA ,Owen S ,Stroh G .Ramos J Needle Thoracostomy: Does Changing Needle Length and Location Change Patient Outcome? Prehosp Disaster Med.2018 ;33 (3 ):237 –244 .
Weekly Checks Improve Real-Time Prehospital ECG Transmission in Suspected STEMI
- Nicole T. D’Arcy, Nichole Bosson, Amy H. Kaji, Quang T. Bui, William J. French, Joseph L. Thomas, Yvonne Elizarraraz, Natalia Gonzalez, Jose Garcia, James T. Niemann
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- Published online by Cambridge University Press:
- 30 April 2018, pp. 245-249
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Introduction
Field identification of ST-elevation myocardial infarction (STEMI) and advanced hospital notification decreases first-medical-contact-to-balloon (FMC2B) time. A recent study in this system found that electrocardiogram (ECG) transmission following a STEMI alert was frequently unsuccessful.
HypothesisInstituting weekly test ECG transmissions from paramedic units to the hospital would increase successful transmission of ECGs and decrease FMC2B and door-to-balloon (D2B) times.
MethodsThis was a natural experiment of consecutive patients with field-identified STEMI transported to a single percutaneous coronary intervention (PCI)-capable hospital in a regional STEMI system before and after implementation of scheduled test ECG transmissions. In November 2014, paramedic units began weekly test transmissions. The mobile intensive care nurse (MICN) confirmed the transmission, or if not received, contacted the paramedic unit and the department’s nurse educator to identify and resolve the problem. Per system-wide protocol, paramedics transmit all ECGs with interpretation of STEMI. Receiving hospitals submit patient data to a single registry as part of ongoing system quality improvement. The frequency of successful ECG transmission and time to intervention (FMC2B and D2B times) in the 18 months following implementation was compared to the 10 months prior. Post-implementation, the time the ECG transmission was received was also collected to determine the transmission gap time (time from ECG acquisition to ECG transmission received) and the advanced notification time (time from ECG transmission received to patient arrival).
ResultsThere were 388 patients with field ECG interpretations of STEMI, 131 pre-intervention and 257 post-intervention. The frequency of successful transmission post-intervention was 73% compared to 64% prior; risk difference (RD)=9%; 95% CI, 1-18%. In the post-intervention period, the median FMC2B time was 79 minutes (inter-quartile range [IQR]=68-102) versus 86 minutes (IQR=71-108) pre-intervention (P=.3) and the median D2B time was 59 minutes (IQR=44-74) versus 60 minutes (IQR=53-88) pre-intervention (P=.2). The median transmission gap was three minutes (IQR=1-8) and median advanced notification time was 16 minutes (IQR=10-25).
ConclusionImplementation of weekly test ECG transmissions was associated with improvement in successful real-time transmissions from field to hospital, which provided a median advanced notification time of 16 minutes, but no decrease in FMC2B or D2B times.
,D’Arcy NT ,Bosson N ,Kaji AH ,Bui QT ,French WJ ,Thomas JL ,Elizarraraz Y ,Gonzalez N ,Garcia J .Niemann JT Weekly Checks Improve Real-Time Prehospital ECG Transmission in Suspected STEMI . Prehosp Disaster Med.2018 ;33 (3 ):245 –249 .
Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls
- Mark Levitan, Madelyn P. Law, Richard Ferron, Karen Lutz-Graul
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- Published online by Cambridge University Press:
- 06 May 2018, pp. 250-255
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Introduction
According to Ontario, Canada’s Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.
ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs?
MethodsThis project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data.
ResultsThirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics’ ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment.
ConclusionThese findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard.
,Levitan M ,Law MP ,Ferron R .Lutz-Graul K Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls . Prehosp Disaster Med.2018 ;33 (3 ):250 –255 .
Assessment of Behavioral Health Concerns in the Community Affected by the Flint Water Crisis — Michigan (USA) 2016
- Gamola Z. Fortenberry, Patricia Reynolds, Sherry L. Burrer, Vicki Johnson-Lawrence, Alice Wang, Amy Schnall, Price Pullins, Stephanie Kieszak, Tesfaye Bayleyegn, Amy Wolkin
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- Published online by Cambridge University Press:
- 19 April 2018, pp. 256-265
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Objectives
The Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply.
MethodsA Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview.
ResultsOne-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey.
ConclusionsThe following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety.
,Fortenberry GZ ,Reynolds P ,Burrer SL ,Johnson-Lawrence V ,Wang A ,Schnall A ,Pullins P ,Kieszak S ,Bayleyegn T .Wolkin A Assessment of Behavioral Health Concerns in the Community Affected by the Flint Water Crisis — Michigan (USA) 2016 . Prehosp Disaster Med.2018 ;33 (3 ):256 –265 .
Skills and Core Competencies of Pharmacists in Humanitarian Assistance
- Hamaspyur Vardanyan, Gabriela Bittencourt Gonzalez Mosegui, Elaine Silva Miranda
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- Published online by Cambridge University Press:
- 27 April 2018, pp. 266-272
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Background
Pharmacists’ participation in health care within multi-disciplinary teams in Humanitarian Assistance (HA) shall be encouraged. Limited literature exists on their role in the humanitarian context. The objective of this paper is to evidence the skill-specific, comprehensive core competencies that pharmacists must demonstrate working in humanitarian interventions.
MethodsThe literature search laid the groundwork for the development of interview guides and further analysis of the data. Semi-structured interviews were conducted with expatriate pharmacists and medical coordinators, all of whom have worked in the field of HA. The interviews were recorded, transcribed, and analyzed using a content analysis methodology.
ResultsThree pharmacists and three medical coordinators were interviewed, who had worked in a combined 32 humanitarian missions. The main functions of pharmacists were focused on stock management and supply of medicinal products. However, pharmacists in HA did not perform many functions related to the provision of effective medication therapy management (MTM). A core competency framework for pharmacists working in the humanitarian field was created, which reflects the personal and technical competencies that are essential to work in HA.
ConclusionSelf-management in a pressured and changing environment, the ability to adapt to changing situations, and planning, prioritizing, and performing tasks well under pressure are the skills required for pharmacists and for any other humanitarian health worker. The results highlight great efforts being dedicated to pharmaceutical product supply and management by pharmacists working in HA.
,Vardanyan H ,Mosegui GBG .Miranda ES Skills and Core Competencies of Pharmacists in Humanitarian Assistance . Prehosp Disaster Med.2018 ;33 (3 ):266 –272 .
Comparison of Electronic Versus Manual Mass-Casualty Incident Triage
- Claudie Bolduc, Nisreen Maghraby, Patrick Fok, The Minh Luong, Valerie Homier
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- Published online by Cambridge University Press:
- 17 April 2018, pp. 273-278
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Introduction
Mass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.
Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.
MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.
ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”
ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.
,Bolduc C ,Maghraby N ,Fok P ,Luong TM .Homier V Comparison of Electronic Versus Manual Mass-Casualty Incident Triage . Prehosp Disaster Med.2018 ;33 (3 ):273 –278 .
Comparison of Thermal Manikin Modeling and Human Subjects’ Response During Use of Cooling Devices Under Personal Protective Ensembles in the Heat
- Tyler Quinn, Jung-Hyun Kim, Yongsuk Seo, Aitor Coca
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- Published online by Cambridge University Press:
- 19 April 2018, pp. 279-287
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Introduction
Personal protective equipment (PPE) recommended for use in West Africa during the Ebola outbreak increased risk for heat illness, and countermeasures addressing this issue would be valuable.
Hypothesis/ProblemThe purpose of this study was to examine the physiological impact and heat perception of four different personal cooling devices (PCDs) under impermeable PPE during low-intensity exercise in a hot and humid environment using thermal manikin modeling and human testing.
MethodsSix healthy male subjects walked on a treadmill in a hot/humid environment (32°C/92% relative humidity [RH]) at three metabolic equivalents (METs) for 60 minutes wearing PPE recommended for use in West Africa and one of four different personal cooling devices (PCDs; PCD1, PCD2, PCD3, and PCD4) or no PCD for control (CON). The same ensembles were tested with thermal manikin modeling software in the same conditions to compare the results.
ResultsAll PCDs seemed to reduce physiological heat stress characteristics when worn under PPE compared to CON. Both the manikin and human testing provided similar results in core temperature (Tc) and heat sensation (HS) in both magnitude and relationship. While the manikin and human data provided similar skin temperature (Tsk) characterization, Tsk estimation by the manikin seemed to be slightly over-estimated. Weight loss, as estimated by the manikin, was under-estimated compared to the human measurement.
ConclusionPersonal cooling device use in conjunction with impermeable PPE may be advantageous in mitigating physiological and perceptual burdens of heat stress. Evaluation of PCDs worn under PPE can be done effectively via human or manikin testing; however, Tsk may be over-estimated and weight loss may be under-estimated. Thermal manikin testing of PCDs may provide fast and accurate information to persons recommending or using PCDs with PPE.
,Quinn T ,Kim JH ,Seo Y .Coca A Comparison of Thermal Manikin Modeling and Human Subjects’ Response During Use of Cooling Devices Under Personal Protective Ensembles in the Heat . Prehosp Disaster Med.2018 ;33 (3 ):279 –287 .
Analysis of Medical Responses in Mass Gatherings: The Commemoration Ceremonies for the 100th Anniversary of the Battle of Gallipoli
- Hüseyin Koçak, Cüneyt Çalışkan, Mehmet Şerafettin Sönmezler, Kenan Eliuz, Fatih Küçükdurmaz
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- Published online by Cambridge University Press:
- 25 April 2018, pp. 288-292
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Introduction
Mass crowds outside the routine population create a burden of disease on Emergency Medical Services (EMS). The need for EMS in various mass-crowd events may vary. It is especially important to determine the EMS requirement that emerges during the historic commemoration ceremonies in Çanakkale (Turkey).
Hypothesis/ProblemThis study aims to determine the unique challenges in the planning of EMS responses provided for people from various countries at the commemoration ceremony for a 100-year-old war and to identify the medical provision of those services.
MethodsThis descriptive study examined the patient applications in the Çanakkale EMS at the commemoration ceremonies for the 100th anniversary of Gallipoli Wars (Çanakkale Amphibious Wars – Turkey) on April 24-25, 2015.
ResultsA total of 221 cases were handled by 112 EMS in the ceremony area. Of those, 87.3% of the cases applied to a mobile operating room (MOR) stationed in the ceremony area while 12.7% of them applied directly to the health care team in a large area in the ceremony area. Overall, 13.1% of the cases were transferred to the hospital for further evaluation and treatment. Patient presentation rate (PPR) of the patients who were treated during the two days was 4.42, and transfer to hospital rate (TTHR) of the cases transferred to the hospital was calculated to be 0.58.
ConclusionFurther studies may create models in regard to the estimations on mass and needs based on the data of previous organizations.
,Koçak H ,Çalışkan C ,Sönmezler MS ,Eliuz K .Küçükdurmaz F Analysis of Medical Responses in Mass Gatherings: The Commemoration Ceremonies for the 100th Anniversary of the Battle of Gallipoli . Prehosp Disaster Med.2018 ;33 (3 ):288 –292 .
Orthopedic Knowledge and Need in the Provincial Philippines: Pilot Study of a Population-Based Survey
- Christopher S. Courtney, Thomas D. Kirsch
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- Published online by Cambridge University Press:
- 23 April 2018, pp. 293-298
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Introduction
Interventions to reduce disability from acute orthopedic injuries require a primary assessment of knowledge and need. There are no previous studies to assess this need in the remote provincial islands of the Philippines, an area recurrently affected by natural disaster.
ProblemA preliminary assessment of orthopedic knowledge and need was performed to be expanded for regional or national implementation.
MethodsTwo independent surveys were conducted of households and mid-level providers who represent the first contact of care. The goal of the survey was to describe the local health care system, to identify barriers to care, and to assess gaps in knowledge for acute traumatic orthopedic injuries. Both surveys were conducted in June of 2015.
Population proportional sampling assessed a total of 100 households from 25 local Barangay communities. Questions focused on existing knowledge of acute traumatic orthopedic injuries and barriers to care.
The mid-level provider survey focused on knowledge and barriers to care regarding acute traumatic orthopedic injuries. A total of 10 school nurses and Barangay midwives representing 25 local Barangay were surveyed.
ResultsIn the household population survey, 84% of respondents reported cost was either always or sometimes a barrier to care; 73% cited transportation as a barrier to care. A total of 68% of respondents reported that they would seek care at the provincial hospital for a suspected broken bone; 28% percent of respondents did not believe broken bones making an arm or leg crooked could be corrected without surgery. Only 55% percent believed care should be sought within six hours of injury, and 37% stated that more than three days after an injury was an appropriate timeframe to seek care.
Of the mid-level providers surveyed, 90% reported that they would refer possible broken bones to a higher level of care. Aggregate ranking of barriers to care from greatest to least were: cost, transportation, knowledge of time sensitive nature of treatment, religious beliefs, and other (not specified). In all, 100% reported that an education initiative regarding acute orthopedic injuries would increase the number of patients seeking care within 12 hours.
ConclusionThe survey describes perceived barriers to care and gaps in knowledge for acute orthopedic injuries. With some modification, this survey tool could be expanded and utilized on a regional or national level to assess gaps in knowledge and barriers to acute orthopedic care.
,Courtney CS .Kirsch TD Orthopedic Knowledge and Need in the Provincial Philippines: Pilot Study of a Population-Based Survey . Prehosp Disaster Med.2018 ;33 (3 ):293 –298 .
Comprehensive Review
Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review
- Marcus Hards, Andrew Brewer, Gareth Bessant, Sumitra Lahiri
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- Published online by Cambridge University Press:
- 01 June 2018, pp. 299-307
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Introduction
Femoral fractures are painful injuries frequently encountered by prehospital practitioners. Systemic opioids are commonly used to manage the pain after a femoral fracture; however, regional techniques for providing analgesia may provide superior targeted pain relief and reduce opioid requirements. Fascia Iliaca Compartment Block (FICB) has been described as inexpensive and does not require special skills or equipment to perform, giving it the potential to be a suitable prehospital intervention.
ProblemThe purpose of this systematic review is to summarize published evidence on the prehospital use of FICB in patients of any age suffering femoral fractures; in particular, to investigate the effects of a prehospital FICB on pain scores and patient satisfaction, and to assess the feasibility and safety of a prehospital FICB, including the success rates, any delays to scene time, and any documented adverse effects.
MethodsA literature search of MEDLINE/PubMED, Embase, OVID, Scopus, the Cochrane Database, and Web of Science was conducted from January 1, 1989 through February 1, 2017. In addition, reference lists of review articles were reviewed and the contents pages of the British Journal of Anaesthesia (The Royal College of Anaesthetists [London, UK]; The College of Anaesthetists of Ireland [Dublin, Ireland]; and The Hong Kong College of Anaesthesiologists [Aberdeen, Hong Kong]) 2016 along with the journal Prehospital Emergency Care (National Association of Emergency Medical Service Physicians [Overland Park, Kansas USA]; National Association of State Emergency Medical Service Officials [Falls Church, Virginia USA]; National Association of Emergency Medical Service Educators [Pittsburgh, Pennsylvania USA]; and the National Association of Emergency Medical Technicians [Clinton, Mississippi USA]) 2016 were hand searched. Each study was evaluated for its quality and its validity and was assigned a level of evidence according to the Oxford Centre for Evidence-Based Medicine (OCEBM; Oxford, UK).
ResultsSeven studies involving 699 patients were included (one randomized controlled trial [RCT], four prospective observational studies, one retrospective observational study, and one case report). Pain scores reduced after prehospital FICB across all studies, and some achieved a level of significance to support this. Out of a total of 254 prehospital FICBs, there was a success rate of 90% and only one adverse effect reported. Few studies have investigated the effects of prehospital FICB on patient satisfaction or scene time delays.
Conclusions and Relevance:The FICB is suitable for use in the prehospital environment for the management of femoral fractures. It has few adverse effects and can be performed with a high success rate by practitioners of any background. Studies suggest that FICB is a useful analgesic technique, although further research is required to investigate its effectiveness compared to systemic opioids.
,Hards M ,Brewer A ,Bessant G .Lahiri S Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review . Prehosp Disaster Med.2018 ;33 (3 ):299 -307 .
Special Reports
Defining Disaster-Related Health Risk: A Primer for Prevention
- Mark Keim
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- Published online by Cambridge University Press:
- 01 June 2018, pp. 308-316
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Effective disaster risk management requires not only management of the immediate problem (disaster-related injuries and disease), but also of the patient’s risk factors and of the underlying health determinants. This requires an accurate and well-validated process for assessment of the determinants of disease.
Ideally, disaster risk management is based on a prioritization process. Once hazards have been identified, they are assessed in terms of the probability and impact in terms of losses. The hazards associated with the greatest probability and impact loss are prioritized. In addition to prioritization, risk assessment also offers a process for ongoing research involving the interaction of health determinants, risk, and protective factors that may contribute to future adverse health outcomes.
Recently, assessments of health risk have become an integral part of local, state, and national emergency preparedness programs. One of the strengths of these assessments is the convening of multi-sectoral input for public health decision making and plans. However, this diversity of input also creates challenges in development of a common nomenclature for assessing and communicating the characteristics of this risk. Definitions remain ambiguous for many of the key indicators of disaster risk, especially those applied to health risk.
This report is intended as a primer for defining disaster-related health risk. This framework is discussed within a nomenclature that is consistent with international standards for risk management and public health prevention.
.Keim M Defining Disaster-Related Health Risk: A Primer for Prevention . Prehosp Disaster Med.2018 ;33 (3 ):308 -316 .
Assessing Disaster-Related Health Risk: Appraisal for Prevention
- Mark Keim
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- Published online by Cambridge University Press:
- 01 June 2018, pp. 317-325
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Risk assessment is a key component of public health interventions intended to prevent or reduce adverse health effects. Health risk assessments are widely used to guide public health programming, as well as multi-sectoral studies of environmental impact and developmental decision making. Analytical risk assessment is a well-validated tool that is routinely used among certain subsets of public health, including those for chemical, radiological, and microbiological risk assessment. However, this is not the case for risk assessments involving disasters in general, or more specifically, for public health emergencies involving environmental hazards (eg, technological, hydro-meteorological, and seismic).
There remains a need for a reproducible, well-validated, disaster-related health risk assessment process that is suitable for accommodating the current gaps in certainty. This report is intended to offer a practical framework and nomenclature for assessing disaster-related health risk that is: (1) accurate; (2) based upon historical evidence; (3) quantifiable in public health terms; and (4) inclusive of uncertainty.
.Keim M Assessing Disaster-Related Health Risk: Appraisal for Prevention . Prehosp Disaster Med.2018 ;33 (3 ):317 -325 .
Managing Disaster-Related Health Risk: A Process for Prevention
- Mark Keim
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- Published online by Cambridge University Press:
- 01 June 2018, pp. 326-334
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In 1994, the first World Conference on Natural Disaster Reduction held in Yokohama, Japan affirmed that “Disaster prevention, mitigation, and preparedness are better than disaster response in achieving the goals and objectives of the decade. Disaster response alone is not sufficient, as it yields only temporary results in a very high cost.” Since then, disaster risk reduction has become the mainstay for international development related to disasters.
According to the National Research Council (Washington, DC USA), “Disaster research, which has focused historically on emergency response and recovery, is incomplete without the simultaneous study of the societal hazards and risks associated with disasters, which includes data on the vulnerability of people living in hazard prone areas.” Despite over 25 years of global policy development, the National Academies of Sciences, Engineering, and Medicine (Washington, DC USA) recently noted that, “while some disaster management and public health preparedness programming may be viewed as tangentially related, a multi-sectoral and inter-disciplinary national platform for coordination and policy guidance on involving disaster risk reduction in the United States does not exist.” Today, one of the world’s “seven targets in seven years” as agreed upon in the Sendai Framework for Disaster Risk Reduction is to substantially reduce global mortality by 2030. Significant reductions in health risk (including mortality) have historically required a comprehensive approach for disease management that includes both a preventive and a curative approach. Disaster risk management has arisen as a primary means for the world’s populations to address disaster losses, including those related to health. Prevention has been proven as an effective approach for managing health risk. This report describes the role of disease prevention in managing health risk due to disasters.
.Keim M Managing Disaster-Related Health Risk: A Process for Prevention . Prehosp Disaster Med.2018 ;33 (3 ):326 -334 .
International Emergency Medical Teams Training Workshop Special Report
- Anthony Albina, Laura Archer, Marlène Boivin, Hilarie Cranmer, Kirsten Johnson, Gautham Krishnaraj, Anali Maneshi, Lisa Oddy, Lynda Redwood-Campbell, Rebecca Russell
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- Published online by Cambridge University Press:
- 26 April 2018, pp. 335-338
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The World Health Organization’s (WHO; Geneva, Switzerland) Emergency Medical Team (EMT) Initiative created guidelines which define the basic procedures to be followed by personnel and teams, as well as the critical points to discuss before deploying a field hospital. However, to date, there is no formal standardized training program established for EMTs before deployment. Recognizing that the World Association of Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) Congress brings together a diverse group of key stakeholders, a pre-Congress workshop was organized to seek out collective expertise and to identify key EMT training competencies for the future development of training programs and protocols. The future of EMT training should include standardization of curriculum and the recognition or accreditation of selected training programs. The outputs of this pre-WADEM Congress workshop provide an initial contribution to the EMT Training Working Group, as this group works on mapping training, competencies, and curriculum. Common EMT training themes that were identified as fundamental during the pre-Congress workshop include: the ability to adapt one’s professional skills to low-resource settings; context-specific training, including the ability to serve the needs of the affected population in natural disasters; training together as a multi-disciplinary EMT prior to deployment; and the value of simulation in training.
,Albina A ,Archer L ,Boivin M ,Cranmer H ,Johnson K ,Krishnaraj G ,Maneshi A ,Oddy L ,Redwood-Campbell L .Russell R International Emergency Medical Teams Training Workshop Special Report . Prehosp Disaster Med.2018 ;33 (3 ):335 –338 .
US Emergency Medical Services Fellows
- Brian Clemency, Christian Martin-Gill, Nicole Rall, Dipesh Patel, Jeffery Myers
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- Published online by Cambridge University Press:
- 18 April 2018, pp. 339-341
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Introduction
The 2015-2016 academic year was the fourth year since the Accreditation Council for Graduate Medical Education (ACGME; Chicago, Illinois USA) accredited Emergency Medical Services (EMS) fellowships, and the first year an in-training examination was given. Soon, ACGME-accredited fellowship education will be the sole path to EMS board certification when the practice pathway closes after 2019. This project aimed to describe the current class of EMS fellows at ACGME-accredited programs and their current educational opportunities to better understand current and future needs in EMS fellowship education.
MethodsThis was a cross-sectional survey of EMS fellows in ACGME-accredited programs in conjunction with the first EMS In-Training Examination (EMSITE) between April and June 2016. Fellows completed a 14-question survey composed of multiple-choice and free-response questions. Basic frequency statistics were performed on their responses.
ResultsFifty fellows from 35 ACGME-accredited programs completed the survey. The response rate was 100%. Forty-eight (96%) fellows reported previous training in emergency medicine. Twenty (40%) were undergoing fellowship training at the same institution as their prior residency training. Twenty-five (50%) fellows performed direct patient care aboard a helicopter during their fellowship. Thirty-three (66%) fellows had a dedicated physician response vehicle for fellows. All fellows reported using the National Association of EMS Physicians (NAEMSP; Overland Park, Kansas USA) textbooks as their primary reference. Fellows felt most prepared for the Clinical Aspects questions and least prepared for Quality Management and Research questions on the board exam.
ConclusionThese data provide insight into the characteristics of EMS fellows in ACGME-accredited programs.
,Clemency B ,Martin-Gill C ,Rall N ,Patel D .Myers J US Emergency Medical Services Fellows . Prehosp Disaster Med.2018 ;33 (3 ):339 –341 .
Brief Report
Dispatcher CPR Instructions Across the Age Continuum
- Kristi L. Weinmeister, E. Brooke Lerner, Clare E. Guse, Khalid A. Ateyyah, Ronald G. Pirrallo
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- Published online by Cambridge University Press:
- 26 April 2018, pp. 342-345
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Background
Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities.
ObjectivesThe aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community.
MethodsThis was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group.
ResultsDuring the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01).
ConclusionsThe rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve.
,Weinmeister KL ,Lerner EB ,Guse CE ,Ateyyah KA .Pirrallo RG Dispatcher CPR Instructions Across the Age Continuum . Prehosp Disaster Med.2018 ;33 (3 ):342 –345 .
Front Cover (OFC, IFC) and matter
PDM volume 33 issue 3 Cover and Front matter
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- Published online by Cambridge University Press:
- 01 June 2018, pp. f1-f7
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Back Cover (OBC, IBC) and matter
PDM volume 33 issue 3 Cover and Back matter
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- Published online by Cambridge University Press:
- 01 June 2018, pp. b1-b2
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