3 results
A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures
- Laurel O’Connor, Sepahrad Zamani, Xinyi Ding, Nicolette McGeorge, Susan Latiff, Cindy Liu, Jorge Acevedo Herman, Matthew LoConte, Andrew Milsten, Michael Weiner, Timothy Boardman, Martin Reznek, Michael Hall, John P. Broach
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- Journal:
- Prehospital and Disaster Medicine , First View
- Published online by Cambridge University Press:
- 07 May 2024, pp. 1-9
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Introduction:
Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care.
Study Objective:The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures.
Methods:Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables.
Results:Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02).
Conclusions:This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR’s promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.
Patient Outcomes Following Ketamine Administration for Acute Agitation with a Decreased Dosing Protocol in the Prehospital Setting
- Cassidy Cunningham, Karen Gross, John P. Broach, Laurel O’Connor
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- Journal:
- Prehospital and Disaster Medicine / Volume 36 / Issue 3 / June 2021
- Published online by Cambridge University Press:
- 08 March 2021, pp. 276-282
- Print publication:
- June 2021
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Background:
Agitated behaviors are frequently encountered in the prehospital setting and require emergent treatment to prevent harm to patients and prehospital personnel. Chemical sedation with ketamine works faster than traditional pharmacologic agents, though it has a higher incidence of adverse events, including intubation. Outcomes following varying initial doses of prehospital intramuscular (IM) ketamine use have been incompletely described.
Objective:To determine whether using a lower dose IM ketamine protocol for agitation is associated with more favorable outcomes.
Methods:This study was a pre-/post-intervention retrospective chart review of prehospital care reports (PCRs). Adult patients who received chemical sedation in the form of IM ketamine for agitated behaviors were included. Patients were divided into two cohorts based on the standard IM ketamine dose of 4mg/kg and the lower IM dose of 3mg/kg with the option for an additional 1mg/kg if required. Primary outcomes included intubation and hospital admission. Secondary outcomes included emergency department (ED) length of stay, additional chemical or physical restraints, assaults on prehospital or ED employees, and documented adverse events.
Results:The standard dose cohort consisted of 211 patients. The lower dose cohort consisted of 81 patients, 17 of whom received supplemental ketamine administration. Demographics did not significantly differ between the cohorts (mean age 35.14 versus 35.65 years; P = .484; and 67.8% versus 65.4% male; P = .89). Lower dose subjects were administered a lower ketamine dose (mean 3.24mg/kg) compared to the standard dose cohort (mean 3.51mg/kg). There was no statistically significant difference between the cohorts in intubation rate (14.2% versus 18.5%; P = .455), ED length of stay (14.31 versus 14.88 hours; P = .118), need for additional restraint and sedation (P = .787), or admission rate (26.1% versus 25.9%; P = .677). In the lower dose cohort, 41.2% (7/17) of patients who received supplemental ketamine doses were intubated, a higher rate than the patients in this cohort who did not receive supplemental ketamine (8/64, 12.5%; P <.01).
Conclusion:Access to effective, fast-acting chemical sedation is paramount for prehospital providers. No significant outcomes differences existed when a lower dose IM ketamine protocol was implemented for prehospital chemical sedation. Patients who received a second dose of ketamine had a significant increase in intubation rate. A lower dose protocol may be considered for an agitation protocol to limit the amount of medication administered to a population of high-risk patients.
Ambulatory Care by Disaster Responders in the Tent Camps of Port-au-Prince, Haiti, January 2010
- John P. Broach, Mariah McNamara, Katherine Harrison
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 4 / Issue 2 / June 2010
- Published online by Cambridge University Press:
- 08 April 2013, pp. 116-121
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On January 12, 2010, a magnitude 7.0 earthquake occurred approximately 10 miles west of Port-au-Prince, Haiti, and created one of the worst humanitarian disasters in history. The purpose of this report is to describe the types of illness experienced by people living in tent camps around the city in the immediate aftermath of this event. The data were collected by a team of medical personnel working with an international nongovernmental organization and operating in the tent camps surrounding the city from day 15 to day 18 following the earthquake. In agreement with the existing literature describing patterns of illness in refugee and internally displaced populations, the authors note a preponderance of pediatric illness, with 53% of cases being patients younger than 20 years old and 25% younger than 5 years old. The most common complaints noted by category were respiratory (24.6%), gastrointestinal (16.9%), and genitourinary (10.9%). Another important feature of illness among this population was the observed high incidence of malnutrition among pediatric patients. This report should serve as a guide for future medical interventions in refugee and internally displaced people situations and reinforces the need for strong nutritional support programs in disaster relief operations of this kind.
(Disaster Med Public Health Preparedness. 2010;4:116-121)