Prehospital and disaster medicine
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Introduction Emergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported. Hypothesis/Objective The objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system. ⋯ Emergency Medical Service personnel transport more than one-third of patients presenting to the ED with syncope. Documentation of key elements of the history (witnesses, prodrome, predisposing factors, and post-event symptoms) and physical examination were not recorded consistently. Long BJ , Serrano LA , Cabanas JG , Bellolio MF . Opportunities for Emergency Medical Services (EMS) care of syncope. Prehosp Disaster Med. 2016;31(4):349-352.
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Prehosp Disaster Med · Aug 2016
Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study.
Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs). ⋯ Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.
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Prehosp Disaster Med · Aug 2016
Comparative StudyA Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock.
Introduction Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function. Hypothesis/Problem There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock. ⋯ While significantly longer to infuse 5% albumin by the TIO route, the longer TIO infusion time may be negated as IO devices can be placed more quickly compared to repeated IV attempts. The lack of significant difference between the TIO and IV routes relative to hemodynamic measures indicate the TIO route is a viable route for the infusion of 5% albumin in a swine model of Class III hemorrhage. Muir SL , Sheppard LB , Maika-Wilson A , Burgert JM , Garcia-Blanco J , Johnson AD , Coyner JL . A comparison of the effects of intraosseous and intravenous 5% albumin on infusion time and hemodynamic measures in a swine model of hemorrhagic shock. Prehosp Disaster Med. 2016;31(4):436-442.
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Prehosp Disaster Med · Aug 2016
A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters.
Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters. ⋯ The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed. Carr BG , Walsh L , Williams JC , Pryor JP , Branas CC . A geographic simulation model for the treatment of trauma patients in disasters. Prehosp Disaster Med. 2016;31(4):413-421.
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Prehosp Disaster Med · Aug 2016
The Promise of Direct-to-Consumer Telehealth for Disaster Response and Recovery.
Telehealth has great promise to improve and even revolutionize emergency response and recovery. Yet telehealth in general, and direct-to-consumer (DTC) telehealth in particular, are underutilized in disasters. Direct-to-consumer telehealth services allow patients to request virtual visits with health care providers, in real-time, via phone or video conferencing (online video or mobile phone applications). ⋯ Uscher-Pines L , Fischer S , Chari R. The promise of direct-to-consumer telehealth for disaster response and recovery. Prehosp Disaster Med. 2016;31(4):454-456.