Original Research
High School Allied Health Students and Their Exposure to the Profession of EMS
- Joshua B. Holloman, Michael W. Hubble
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- Published online by Cambridge University Press:
- 07 June 2012, pp. 245-251
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Introduction
Ensuring a stable Emergency Medical Services (EMS) workforce is a growing concern, and effective recruiting strategies are needed to expose young adults to the EMS profession. The objective of this study was to assess the exposure of high school allied health students to EMS as a career option, as well as measure their attitudes and beliefs about the EMS profession.
HypothesisFew high school allied health students are exposed to EMS educational and career opportunities.
MethodsA convenience sample of allied health students in a rural high school system was surveyed about exposure to EMS, career intentions, factors impacting career decisions, and attitudes and beliefs about EMS. Descriptive statistics were calculated, and intention to pursue an EMS career was modeled using logistic regression.
ResultsOf 171 students enrolled in allied health courses across six high schools, 135 (78.9%) agreed to participate; 85.2% were female. Almost all (92.6%) respondents intended to pursue a health career, but only 43.0% reported that their allied health course exposed them to EMS as a profession. Few participants (37.7%) were knowledgeable about EMS associate degree or baccalaureate degree (27.4%) programs. Only 20.7% of the respondents intended to pursue EMS as a career, although 46.0% wanted to learn more about the profession. Most (68.2%) students expressed interest in an emergency medical technician (EMT) course if one were offered, and 80.0% were interested in a ride-along program. Independent predictors of pursuing an EMS career included exposure to EMS outside of high school (OR = 7.4, 95% CI = 1.7-30.4); media influence on career choice (OR = 9.6, 95% CI = 1.8-50.1); and the belief that EMS was mentally challenging (OR = 15.9, 95% CI = 1.1-216.6). Negative predictors included the beliefs that an EMS career was stimulating (OR = 0.05, 95% CI = 0.00-0.53) and physically challenging (OR = 0.06, 95% CI = 0.00-0.63); as well as prior exposure to an EMS job advertisement (OR = 0.14, 0.03-0.53).
ConclusionsOverall, there was a lack of exposure to career and educational options in EMS among allied health students in the school system studied, and few students intended to pursue an EMS career after graduation. However, the majority of students indicated they would like to learn more about EMS, and would enroll in an EMT course and ride-along program if available. These findings suggest that, with exposure to the profession, more allied health students could choose EMS as a career.
Holloman JB, Hubble MW. High school allied health students and their exposure to the profession of EMS. Prehosp Disaster Med. 2012;27(3):1-7.
Prehospital Trauma System Reduces Mortality in Severe Trauma: A Controlled Study of Road Traffic Casualties in Iraq
- Mudhafar Karim Murad, Dara B. Issa, Farhad M. Mustafa, Hlwa O. Hassan, Hans Husum
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- Published online by Cambridge University Press:
- 19 March 2012, pp. 36-41
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Introduction: In low-resource communities with long prehospital transport times, most trauma deaths occur outside the hospital. Previous studies from Iraq demonstrate that a two-tier network of rural paramedics with village-based first helpers reduces mortality in land mine and war-injured from 40% to 10%. However, these studies of prehospital trauma care in low-income countries have been conducted with historical controls, thus the results may be unreliable due to differences in study contexts. The aim of this study was to use a controlled study design to examine the effect of a two-tier prehospital rural trauma system on road traffic accident trauma mortality.
Methods: A single referral surgical hospital was the endpoint in a single-blinded, non-randomized cohort study. The catchment areas consisted of some districts with no formal Emergency Medical Services (EMS) system, and other districts where 95 health center paramedics had been trained and equipped to provide advanced life support, and 5,000 laypersons had been trained to give on-site first aid. The hospital staff registered trauma mortality and on-admission physiological severity blindly. Assuming that prehospital care would have no significant impact on mortality in moderate injuries, only road traffic accident (RTA) casualties with an Injury Severity Score (ISS) ≥9 were selected for study.
Results: During a three-month study period, 205 patients were selected for study (128 in the treatment group and 77 in the control group). The mean prehospital transit time was approximately two hours. The two groups were comparable with regards to demographic characteristics, distribution of wounds and injuries, and mean anatomical severity. The mortality rate was eight percent in the treatment group, compared to 44% in the control group (95% CI, 25%–48%). Adjusted for severity differences between the treatment and control groups, prehospital care was a significant contributor to survival.
Conclusion: Where prehospital transport time is long, a two-tier prehospital system of trained paramedics and layperson first responders reduces trauma mortality in severe RTA injuries. The findings may be valid for civilian Emergency Medical Services interventions in other low-resource countries.
An International Expert Delphi Study to Determine Research Needs in Major Incident Management
- Kevin Mackway-Jones, Simon Carley
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- Published online by Cambridge University Press:
- 19 July 2012, pp. 351-358
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Objective
To collate the opinions of experts and to reach consensus about the research priorities in the management of major incidents.
DesignA three-round e-Delphi study was conducted using an international panel of experts drawn from active researchers and active educators in major incident management. General areas for consideration were derived from the literature analysis undertaken as part of the overall project.
ResultsExperts generated 221 statements in 11 topic areas in the first round. Fifty-one of these statements reached consensus in Round 2. A further 23 statements reached consensus in Round 3, leaving 147 statements that did not reach consensus.
ConclusionsAn international expert panel reached consensus on 74 topics of research priority in major incidents management. The strongest themes within these topics were education and training, planning, and communication.
Mackway-Jones K, Carley S. An international expert Delphi study to determine research needs in major incident management. Prehosp Disaster Med. 2012;27(4):1-8.
Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death
- Anders Bremer, Karin Dahlberg, Lars Sandman
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- Published online by Cambridge University Press:
- 20 March 2012, pp. 42-52
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Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members.
Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death.
Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden.
Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs was essential. It was dependent on the EMS personnel’s balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel’s own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence.
Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.
Disaster Mobile Health Technology: Lessons from Haiti
- David W. Callaway, Christopher R. Peabody, Ari Hoffman, Elizabeth Cote, Seth Moulton, Amado Alejandro Baez, Larry Nathanson
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- Published online by Cambridge University Press:
- 16 May 2012, pp. 148-152
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Introduction
Mobile health (mHealth) technology can play a critical role in improving disaster victim tracking, triage, patient care, facility management, and theater-wide decision-making.
ProblemTo date, no disaster mHealth application provides responders with adequate capabilities to function in an austere environment.
MethodsThe Operational Medicine Institute (OMI) conducted a qualitative trial of a modified version of the off-the-shelf application iChart at the Fond Parisien Disaster Rescue Camp during the large-scale response to the January 12, 2010 earthquake in Haiti.
ResultsThe iChart mHealth system created a patient log of 617 unique entries used by on-the-ground medical providers and field hospital administrators to facilitate provider triage, improve provider handoffs, and track vulnerable populations such as unaccompanied minors, pregnant women, traumatic orthopedic injuries and specified infectious diseases.
ConclusionThe trial demonstrated that even a non-disaster specific application with significant programmatic limitations was an improvement over existing patient tracking and facility management systems. A unified electronic medical record and patient tracking system would add significant value to first responder capabilities in the disaster response setting.
Callaway DW, Peabody CR, Hoffman A, Cote E, Moulton S, Baez AA, Nathanson L. Disaster mobile health technology: lessons from Haiti. Prehosp Disaster Med. 2012;27(2):1-5.
Research Report
Triage During Mass Gatherings
- Sheila A. Turris, Adam Lund
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- Published online by Cambridge University Press:
- 02 October 2012, pp. 531-535
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Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.
In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.
The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.
In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.
. ,Turris SA .Lund A Triage During Mass Gatherings . Prehosp Disaster Med.2012 ;27 (6 ):1-5
Original Research
The Accuracy of Emergency Medical Dispatcher-Assisted Layperson-Caller Pulse Check Using the Medical Priority Dispatch System Protocol
- Greg Scott, Jeff Clawson, Mark Rector, Dave Massengale, Mike Thompson, Brett Patterson, Christopher H.O. Olola
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- Published online by Cambridge University Press:
- 05 July 2012, pp. 252-259
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Introduction
Knowing the pulse rate of a patient in a medical emergency can help to determine patient acuity and the level of medical care required. Little evidence exists regarding the ability of a 911 layperson-caller to accurately determine a conscious patient's pulse rate.
HypothesisThe hypothesis of this study was that, when instructed by a trained emergency medical dispatcher (EMD) using the scripted Medical Priority Dispatch System (MPDS) protocol Pulse Check Diagnostic Tool (PCDxT), a layperson-caller can detect a carotid pulse and accurately determine the pulse rate in a conscious person.
MethodsThis non-randomized and non-controlled prospective study was conducted at three different public locations in the state of Utah (USA). A healthy, mock patient's pulse rate was obtained using an electrocardiogram (ECG) monitor. Layperson-callers, in turn, initiated a simulated 911 phone call to an EMD call-taker who provided instructions for determining the pulse rate of the patient. Layperson accuracy was assessed using correlations between the layperson-caller's finding and the ECG reading.
ResultsTwo hundred sixty-eight layperson-callers participated; 248 (92.5%) found the pulse of the mock patient. There was a high correlation between pulse rates obtained using the ECG monitor and those found by the layperson-callers, overall (94.6%, P < .001), and by site, gender, and age.
ConclusionsLayperson-callers, when provided with expert, scripted instructions by a trained 911 dispatcher over the phone, can accurately determine the pulse rate of a conscious and healthy person. Improvements to the 911 instructions may further increase layperson accuracy.
Scott G, Clawson J, Rector M, Massengale D, Thompson M, Patterson B, Olola CHO. The accuracy of emergency medical dispatcher-assisted layperson-caller pulse check using the Medical Priority Dispatch System protocol. Prehosp Disaster Med. 2012;27(3):1-8.
Willingness to Participate in Disaster Management Among Indian Dental Graduates
- G. Rajesh, Mithun B.H. Pai, Ramya Shenoy, Harsh Priya
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- Published online by Cambridge University Press:
- 09 August 2012, pp. 439-444
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Introduction
India has been the focal point of various disasters, and has suffered considerable losses due to the same. Manpower shortage can impede disaster management; hence, including dental professionals in disaster management in India can be crucial.
Hypothesis/ProblemTo assess willingness to participate in disaster management among Indian dental graduates; to assess the objective knowledge, attitude, behavior and perceived knowledge regarding disaster management among Indian dental graduates.
MethodsAll the interns in Manipal College of Dental Sciences, Mangalore, Karnataka were included in the present study. Their willingness to participate in disaster management and their objective knowledge, attitude, behavior and perceived knowledge related to disaster management were assessed using a questionnaire.
ResultsA total of 86 study subjects participated. A majority (98.8%) of respondents were willing to participate in disaster management. Mean objective knowledge, attitude, behavior and perceived knowledge scores were 48.65%, 80.26%, 29.85% and 60.80% respectively. Males reported higher perceived knowledge than females (P = .008), and respondents residing in hostels reported higher perceived knowledge than those not residing in hostels (P = .02). Gender showed significant correlations with attitude (r = 4.076, P = .044) and behavior (r = 3.722, P = .054), and residence with behavior of respondents (r = 5.690, P = .017).
ConclusionsA high degree of willingness to provide assistance during disasters was observed among undergraduate dental students. High attitude coupled with low knowledge and behavior scores regarding disaster management was also observed. Gender was associated with attitude and behavior, and residence with behavior of respondents regarding disaster management. Including disaster management in dental curricula and involvement of dental professionals in disaster management might be crucial for disaster management in India.
,Rajesh G ,Pai MBH ,Shenoy R .Priya H Willingness to Participate in Disaster Management Among Indian Dental Graduates . Prehosp Disaster Med.2012 ;27 (5 ):1 -6 .
Special Report
Identification of Current Priorities for Research in Humanitarian Action: Proceedings of the First Annual UN OCHA Policy and Research Conference
- Mark P. Foran, Paul G. Greenough, Andrew Thow, Daniel Gilman, Andreas Schütz, Rahul Chandran, Allegra Baiocchi
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- Published online by Cambridge University Press:
- 12 June 2012, pp. 260-266
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On December 12-13, 2011, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) hosted a humanitarian policy and research conference on the theme of “Risk, Adaptation and Innovation in Humanitarian Action.” The four sessions of the conference covered humanitarian action in a changing world, adaptation and innovation in humanitarian action, humanitarian action in protracted and violent conflict, and effective humanitarian action. This special report contains summaries of presentations in each session and the conclusions resulting from the discussions throughout. Through a process of open discussion, debate, and a closing survey, the conference participants identified four top priorities in humanitarian research for the coming years: evidence-driven humanitarian decision-making; accountability and transparency; risk and agility; and partnership. In addition to plans for a 2nd Annual Research and Policy conference in December of 2012, specific outcomes of the conference include a series of regional workshops in 2012 and 2013, launching with Asia, Africa and the Middle East; creation of Policy Working Groups (PWG) for each research priority identified; and a new flagship OCHA publication, to be launched in late 2012 or early 2013, which will share the progress made on the research priorities identified.
Foran MP, Greenough PG, Thow A, Gilman D, Schütz A, Chandran R, Baiocchi A. Identification of current priorities for research in humanitarian action: proceedings of the First Annual UN OCHA Policy and Research Conference. Prehosp Disaster Med. 2012;27(3):1-7.
Original Research
Disaster Metrics: Quantitative Estimation of the Number of Ambulances Required in Trauma-Related Multiple Casualty Events
- Jamil D. Bayram, Shawki Zuabi, Mazen J. El Sayed
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- Published online by Cambridge University Press:
- 21 August 2012, pp. 445-451
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Introduction
Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task.
Hypothesis/ProblemEmergency medical services (EMS) regions in the United States have varying “best practices” for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients.
MethodsThe main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity.
ResultsThe minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients.
ConclusionA new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability.
,Bayram JD ,Zuabi S .El Sayed MJ Disaster Metrics: Quantitative Estimation of the Number of Ambulances Required in Trauma-Related Multiple Casualty Events . Prehosp Disaster Med.2012 ;27 (5 ):1 -7 .
A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq
- Ross I. Donaldson, Patrick Shanovich, Pranav Shetty, Emma Clark, Sharaf Aziz, Melinda Morton, Tariq Hasoon, Gerald Evans
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- Published online by Cambridge University Press:
- 17 May 2012, pp. 153-161
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Introduction
There has been limited research on the perspectives and needs of national caregivers when confronted with large-scale societal violence. In Iraq, although the security situation has improved from its nadir in 2006-2007, intermittent bombings, and other hostilities continue. National workers remain the primary health resource for the affected populace.
ProblemTo assess the status and challenges of national physicians working in the Emergency Departments of an active conflict area.
MethodsThis study was a survey of civilian Iraqi doctors working in Emergency Departments (EDs) across Iraq, via a convenience sample of physicians taking the International Medical Corps (IMC) Doctor Course in Emergency Medicine, given in Baghdad from December 2008 through August 2009.
ResultsThe 148 physician respondents came from 11 provinces and over 50 hospitals in Iraq. They described cardiovascular disease, road traffic injuries, and blast and bullet injuries as the main causes of death and reasons for ED utilization. Eighty percent reported having been assaulted by a patient or their family member at least once within the last year; 38% reported they were threatened with a gun. Doctors reported seeing a median of 7.5 patients per hour, with only 19% indicating that their EDs had adequate physician staffing. Only 19% of respondents were aware of an established triage system for their hospital, and only a minority had taken courses covering ACLS- (16%) or ATLS-related (24%) material. Respondents reported a wide diversity of prior training, with only 3% having some type of specialized emergency medicine degree.
ConclusionsThe results of this study describe some of the challenges faced by national health workers providing emergency care to a violence-stricken populace. Study findings demonstrate high levels of violent behavior directed toward doctors in Iraqi Emergency Departments, as well as staffing shortages and a lack of formal training in emergency medical care.
Donaldson RI, Shanovich P, Shetty P, Clark E, Aziz S, Morton M, Hasoon T, Evans G. A survey of national physicians working in an active conflict zone: the challenges of emergency medical care in Iraq. Prehosp Disaster Med. 2012;27(2):1-9.
Psychological Consequences of Indirect Exposure to Disaster Due to the Haiti Earthquake
- James M. Shultz, Avi Besser, Fiona Kelly, Andrea Allen, Susan Schmitz, Vicky Hausmann, Louis Herns Marcelin, Yuval Neria
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- Published online by Cambridge University Press:
- 19 July 2012, pp. 359-368
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Introduction
Few studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti.
MethodsTwo months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status.
ResultsHaitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti.
ConclusionsConsideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.
Shultz JM, Besser A, Kelly F, Allen A, Schmitz S, Hausmann V, Marcelin LH, Neria Y. Psychological consequences of indirect exposure to disaster due to the Haiti earthquake. Prehosp Disaster Med. 2012;27(4):1-10.
Theoretical Discussion
Prehospital Trauma Care Systems: Potential Role Toward Reducing Morbidities and Mortalities from Road Traffic Injuries in Nigeria
- Davies Adeloye
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- Published online by Cambridge University Press:
- 02 October 2012, pp. 536-542
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Introduction
Road traffic injuries (RTIs) and attendant fatalities on Nigerian roads have been on an increasing trend over the past three decades. Mortality from RTIs in Nigeria is estimated to be 162 deaths/100,000 population. This study aims to compare and identify best prehospital trauma care practices in Nigeria and some other African countries where prehospital services operate.
MethodsA review of secondary data, grey literature, and pertinent published articles using a conceptual framework to assess: (1) policies; (2) structures; (3) first responders; (4) communication facilities; (5) transport and ambulance facilities, and (6) roadside emergency trauma units.
ResultsThere is no national prehospital trauma care system (PTCS) in Nigeria. The lack of a national emergency health policy is a factor in this absence. The Nigerian Federal Road Safety Corps (FRSC) mainly has been responsible for prehospital services. South Africa, Zambia, Kenya, and Ghana have improved prehospital services in Africa.
ConclusionsCommercial drivers, laypersons, military, police, a centrally controlled communication network, and government ambulance services are feasible delivery models that can be incorporated into the Nigerian prehospital system. Prehospital trauma services have been useful in reducing morbidities and mortalities from traffic injuries, and appropriate implementation of this study's recommendations may reduce this burden in Nigeria.
. .Adeloye D Prehospital Trauma Care Systems: Potential Role Toward Reducing Morbidities and Mortalities from Road Traffic Injuries in Nigeria . Prehosp Disaster Med.2012 ;27 (6 ):1-7
Original Research
Protection against Cold in Prehospital Care: Evaporative Heat Loss Reduction by Wet Clothing Removal or the Addition of a Vapor Barrier—A Thermal Manikin Study
- Otto Henriksson, Peter Lundgren, Kalev Kuklane, Ingvar Holmér, Peter Naredi, Ulf Bjornstig
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- Published online by Cambridge University Press:
- 23 March 2012, pp. 53-58
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Introduction: In the prehospital care of a cold and wet person, early application of adequate insulation is of utmost importance to reduce cold stress, limit body core cooling, and prevent deterioration of the patient’s condition. Most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recommend the use of a waterproof vapor barrier to reduce evaporative heat loss. However, there is little scientific evidence of the effectiveness of these measures.
Objective: Using a thermal manikin with wet clothing, this study was conducted to determine the effect of wet clothing removal or the addition of a vapor barrier on thermal insulation and evaporative heat loss using different amounts of insulation in both warm and cold ambient conditions.
Methods: A thermal manikin dressed in wet clothing was set up in accordance with the European Standard for assessing requirements of sleeping bags, modified for wet heat loss determination, and the climatic chamber was set to -15 degrees Celsius (°C) for cold conditions and +10°C for warm conditions. Three different insulation ensembles, one, two or seven woollen blankets, were chosen to provide different levels of insulation. Five different test conditions were evaluated for all three levels of insulation ensembles: (1) dry underwear; (2) dry underwear with a vapor barrier; (3) wet underwear; (4) wet underwear with a vapor barrier; and (5) no underwear. Dry and wet heat loss and thermal resistance were determined from continuous monitoring of ambient air temperature, manikin surface temperature, heat flux and evaporative mass loss rate.
Results: Independent of insulation thickness or ambient temperature, the removal of wet clothing or the addition of a vapor barrier resulted in a reduction in total heat loss of 19-42%. The absolute heat loss reduction was greater, however, and thus clinically more important in cold environments when little insulation is available. A similar reduction in total heat loss was also achieved by increasing the insulation from one to two blankets or from two to seven blankets.
Conclusion: Wet clothing removal or the addition of a vapor barrier effectively reduced evaporative heat loss and might thus be of great importance in prehospital rescue scenarios in cold environments with limited insulation available, such as in mass-casualty situations or during protracted evacuations in harsh conditions.
Assessing EMS Scope of Practice for Utility and Risk: the New Mexico EMS Interventions Assessment Project, Phase One Results
- Marc-David Munk, Lynne Fullerton, Laura Banks, Sarah Morley, Robert McDaniels, Stuart Castle, Kyle Thornton, Michael E. Richards
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- Published online by Cambridge University Press:
- 13 August 2012, pp. 452-457
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Introduction
Few emergency medical services (EMS) interventions in New Mexico have been assessed for efficacy, potential harm, or potential benefit. There is concern that many interventions added over the years may be outdated, harmful, or ineffective in the EMS setting. A formal process for reviewing the state EMS scope of practice using literature review and expert consensus is discussed. In Phase One of the project, interventions in the New Mexico EMS scope of practice were prioritized for further review by surveying a national cadre of EMS experts to evaluate EMS interventions using a utilitarian harm/benefit metric.
MethodsAn electronic survey based on the 2010 New Mexico EMS Scope of Practice statute was administered from March through June, 2011. A national cadre of 104 respondents was identified. Respondents were either State EMS medical directors or EMS fellowship directors. Respondents were asked to rate the potential harm and the potential benefit of specific EMS interventions on a 5-point ordinal scale. Median harm and benefit scores were calculated.
ResultsA total of 88 completed surveys were received following 208 emailed invitations to 104 respondents (43% response rate). Twenty-two (22) highest-priority interventions (those with a harm/benefit median score ratio of >1) were identified. Seven additional second-priority interventions were also identified. These interventions will be advanced for formal literature review and expert consensus.
ConclusionsThe New Mexico EMS Interventions Project offers a novel model for assessing a prehospital scope of practice.
,Munk MD ,Fullerton L ,Banks L ,Morley S ,McDaniels R ,Castle S ,Thornton K .Richards ME Assessing EMS Scope of Practice for Utility and Risk: the New Mexico EMS Interventions Assessment Project, Phase One Results . Prehosp Disaster Med.2012 ;27 (5 ):1 -6 .
The Impact of Stress on Paramedic Performance During Simulated Critical Events
- Vicki R LeBlanc, Cheryl Regehr, Walter Tavares, Aristathemos K. Scott, RN, Russell MacDonald, Kevin King
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- Published online by Cambridge University Press:
- 25 July 2012, pp. 369-374
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Objectives
Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics’ ability to care for patients during stressful events. In this study, we examined paramedics’ acute stress responses and performance during simulated high-stress scenarios.
MethodsTwenty-two advanced care paramedics participated in simulated low-stress and high-stress clinical scenarios. The paramedics provided salivary cortisol samples and completed an anxiety questionnaire at baseline and following each scenario. Clinical performance was videotaped and scored on a checklist of specific actions and a global rating of performance. The paramedics also completed patient care documentation following each scenario.
ResultsThe paramedics demonstrated greater increases in anxiety (P < .05) and salivary cortisol levels (P < .05) in response to the high-stress scenario compared to the low-stress scenario. Global rating scores were significantly lower in the high-stress scenario than in the low-stress scenario (P < .05). Checklist scores were not significantly different between the two scenarios (P = .12). There were more errors of commission (reporting information not present in the scenario) in the patient care documentation following the high-stress scenario than following the low-stress scenario (P < .05). In contrast, there were no differences in omission errors (failing to recall information present in the scenario) between the two scenarios (P = .34).
ConclusionClinical performance and documentation appear vulnerable to the impact of acute stress. This highlights the importance of developing systems and training interventions aimed at supporting and preparing emergency workers who face acute stressors as part of their every day work responsibilities.
LeBlanc VR, Regehr C, Tavares W, Scott AK, MacDonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012;27(4):1-6.
Comprehensive Review
Minimum Data Set for Mass-Gathering Health Research and Evaluation: A Discussion Paper
- Jamie Ranse, Alison Hutton
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- Published online by Cambridge University Press:
- 19 September 2012, pp. 543-550
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This paper discusses the need for consistency in mass-gathering data collection and biomedical reporting. Mass gatherings occur frequently throughout the world, and having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial and biomedical domains influence the usage of health services at mass gatherings. The biomedical domain includes the categorization of presenting injury or illness, and rates such as patient presentation rate, transferred to hospital rate and referred to hospital rate. These rates provide insight into the usage of onsite health services, prehospital ambulance services. and hospital emergency department services.
Within the literature, these rates are reported in a manner that is varied, haphazard and author dependent. This paper proposes moving away from an author-dependent practice of collection and reporting of data. An expert consensus approach is proposed as a means of further developing mass-gathering theory and moving beyond the current situation of reporting on individual case studies. To achieve this, a minimum data set with a data dictionary is proposed in an effort to generate conversation about a possible agreed minimum amount and type of information that should be collected consistently for research and evaluation at mass gatherings. Finally, this paper outlines future opportunities that will emerge from the consistent collection and reporting of mass-gathering data, including the possibility for meta-analysis, comparison of events across societies and modeling of various rates to inform health services.
,Ranse J .Hutton A Minimum Data Set for Mass-Gathering Health Research and Evaluation: A Discussion Paper . Prehosp Disaster Med.2012 ;27 (6 ):1-8.
Original Research
Decontamination of Human and Rabbit Skin Experimentally Contaminated with 99mTc Radionuclide Using the Active Components of “Shudhika”—a Skin Decontamination Kit
- Sudha Rana, Mita Dutta, Nakshe L. Soni, Mahendra K. Chopra, Vinod Kumar, Rajeev Goel, Aseem Bhatnagar, Sarwat Sultana, Rakesh Kumar Sharma
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- Published online by Cambridge University Press:
- 16 May 2012, pp. 162-166
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Introduction
Radioactive contamination can occur as a result of accidental or intentional release of radioactive materials (RM) into the environment. RM may deposit on clothing, skin, or hair. Decontamination of contaminated persons should be done as soon as possible to minimize the deleterious health effects of radiation. The goal of this study was to evaluate the decontamination efficiency (for residual contaminant) of the active components of “Shudhika,” an indigenously developed skin decontamination kit. The study kit is for external radioactive decontamination of intact skin.
MethodsDecontamination efficiency was evaluated on the skin surface of rabbit (n = 6) and human volunteers (n = 13). 99mTc sodium pertechnetate (200-250 μCi) was used as the radio-contaminant. Skin surface area (5 × 5 cm2) of thoracic abdominal region of the rabbit and the forearm and the palm of human volunteers were used for the study. Decontamination was performed by using cotton swabs soaked with chemical decontamination agents of the kit.
ResultsDecontamination efficiency (% of the contaminant removed) was calculated for each component of the study. Overall effectiveness of the kit was calculated to be 85% ± 5% in animal and 92% ± 3% in human skin surfaces. Running water and liquid soap with water was able to decontaminate volunteers' hand and animal skin up to 70% ± 5%. Chemical decontamination agents were applied only for trace residues (30% ± 5%). Efficiency of all the kit components was found up to be 20% ± 3% (animal) and 28% ± 2 (human), respectively. Residual contamination after final decontamination attempt for both the models was observed to be 12% ± 3% and 5% ± 2%. After 24 and 48 hours of the decontamination procedure, skin was found to be normal (no redness, erythema and edema were observed).
ConclusionDecontaminants of the study kit were effective in removal of localized radioactive skin contamination when water is ineffective for further decontamination. By using the chemical decontaminants of the study kit, the use of water and radioactive waste generation could be reduced. Cross-contamination could also be avoided. During radiologic emergencies where water may be radioactively contaminated, the study kit could be used.
Rana S, Dutta M, Soni NL, Chopra MK, Kumar V, Goel R, Bhatnagar A, Sultana S, Sharma RK. Decontamination of human and rabbit skin experimentally contaminated with 99mTc radionuclide using the active components of “Shudika”—a skin decontamination kit. Prehosp Disaster Med. 2012;27(2):1-5.
Special Report
The Development and Implementation of a Hospital Emergency Response Team (HERT) for Out-of-Hospital Surgical Care
- Christopher Scott, Brant Putnam, Scott Bricker, Laura Schneider, Stephanie Raby, William Koenig, Marianne Gausche-Hill
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- Published online by Cambridge University Press:
- 12 June 2012, pp. 267-271
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Over the past two decades, Los Angeles County has implemented a Hospital Emergency Response Team (HERT) to provide on-scene, advanced surgical care of injured patients as an element of the local Emergency Medical Services (EMS) system. Since 2008, the primary responsibility of the team has been to perform surgical procedures in the austere field setting when prolonged extrication is anticipated. Following the maxim of “life over limb,” the team is equipped to provide rapid amputation of an entrapped extremity as well as other procedures and medical care, such as anxiolytics and advanced pain control. This report describes the development and implementation of a local EMS system HERT.
Scott C, Putnam B, Bricker S, Schneider L, Raby S, Koenig W, Gausche-Hill M. The development and implementation of a Hospital Emergency Response Team (HERT) for out-of-hospital surgical care. Prehosp Disaster Med. 2012;27(3):1-5.
Original Research
Post-Traumatic Stress Disorder and Job Stress among Firefighters of Urban Japan
- Yasuaki Saijo, Takeji Ueno, Yoshihiro Hashimoto
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- Published online by Cambridge University Press:
- 19 March 2012, pp. 59-63
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Introduction: Post-traumatic stress disorder (PTSD) is a common condition among Japanese firefighters. The purpose of this study was to clarify the relationship of PTSD scores to job stress, social support, and depressive stress among Japanese firefighters.
Methods: A total of 1,667 Japanese firefighters working for the local government completed a questionnaire that was used to gather information pertaining to age, gender, job type, job class, marital status, and smoking and drinking habits. Questionnaires from the Center for Epidemiologic Studies Depression Scale (CES-D), the Japanese version of the U.S. National Institute for Occupational Safety and Health (NIOSH) Generic Job Stress Questionnaire, and the IES-R were also used.
Results: After adjustment for age and gender, subjects in the PTSD-positive group had significantly higher scores for inter-group conflict, role ambiguity, and CES-D, as well as significantly lower scores for social support from their supervisors compared to those in the PTSD-negative group.
Conclusions: High inter-group conflict and role ambiguity, as well as low social support from supervisors and the presence of depressive symptoms, may influence the development of PTSD among Japanese firefighters.