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High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young
- Michelle J. White, Emefah C. Loccoh, Monica M. Goble, Sunkyung Yu, Folafoluwa O. Odetola, Mark W. Russell
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 3 / June 2017
- Published online by Cambridge University Press:
- 20 February 2017, pp. 269-272
- Print publication:
- June 2017
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Introduction
Sudden cardiac death (SCD) is responsible for 5%-10% of all deaths among children 5-19 years-of-age. The incidence of SCD in youth in Michigan (USA) and nationwide is higher in racial/ethnic minorities and in certain geographic areas. School cardiac emergency response plans (CERPs) increase survival after cardiac arrest. However, school cardiac emergency preparedness remains variable. Studying population-level factors associated with school cardiac emergency preparedness and incidence of SCD in the young may improve understanding of disparities in the incidence of SCD.
Hypothesis/ProblemThe objective of this pilot study was to determine the association of elements of high school cardiac emergency preparedness, including Automated External Defibrillator (AED) distribution and the presence of CERPs with county sociodemographic characteristics and county incidence of SCD in the young.
MethodsSurveys were sent to representatives from all public high schools in 30 randomly selected Michigan counties. Counties with greater than 50% response rate were included (n=19). Association of county-level sociodemographic characteristics with incidence of SCD in the young and existence of CERPs were evaluated using Spearman correlation coefficient.
ResultsFactors related to the presence of AEDs were similar across counties. Schools in counties of lower socioeconomic status (SES; lower-median income, lower per capita income, and higher population below poverty level) were less likely to have a CERP than those with higher SES (all P<.01). Lack of a CERP was associated with a higher incidence of SCD in youth (r=-0.71; P=.001). Overall incidence of SCD in youth was higher in lower SES counties (r=-0.62 in median income and r=0.51 in population below poverty level; both P<.05).
ConclusionCounty SES is associated with the presence of CERPs in schools, suggesting a link between school cardiac emergency preparedness and county financial resources. Additionally, counties of lower SES demonstrated higher incidence of SCD in the young. Statewide and national studies are required to further explore the factors relating to geographic and socioeconomic differences in cardiac emergency preparedness and the incidence of SCD in the young.
White MJ Loccoh EC Goble MM Yu S Odetola FO Russell MW High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young . Prehosp Disaster Med.2017 ;32 (3 ):269 –272 .
Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center
- Folafoluwa O. Odetola, N. Clay Mann, Kristine W. Hansen, Susan L. Bratton
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 1 / February 2016
- Published online by Cambridge University Press:
- 27 November 2015, pp. 4-9
- Print publication:
- February 2016
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Objective
The goal of this study was to test the hypothesis that the prehospital time between injury and arrival at a trauma center for critically injured children is associated with patient injury severity and mode of transport.
MethodsSecondary analysis of prospectively collected data on children 0-17 years of age admitted with traumatic injuries to a designated Level I pediatric trauma center from January 1, 2006 through September 30, 2007 was conducted. Multivariate regression methods were used to assess for factors independently associated with prehospital time.
ResultsOf 1,175 admissions during the study period, only 355 (30%) had a prehospital time within 60 minutes of injury. Prehospital time within 60 minutes of injury was associated with higher frequency of coma, higher mean injury severity scores (ISS), and greater frequency of admission to the intensive care unit when compared with prehospital time beyond 60 minutes of injury. Children who arrived at the trauma center within 60 minutes versus beyond 60 minutes were 13-fold (odds ratio [OR]: 12.9; 95% Confidence Interval [CI], 7.6-22.0) more likely to be transported via air ambulance than a private vehicle, and had 4.8-fold greater odds (95% CI, 2.2-10.3) of transport via ground ambulance than private vehicle. For each kilometer of distance between the injury zip code and the trauma center, the odds of arrival within 60 minutes versus beyond 60 minutes decreased by 15% (OR: 0.85; 95% CI, 0.79-0.91).
ConclusionField triage and decision making appeared to correlate with severity of patient injury with expeditious transport of the most severely injured children to definitive trauma care. This finding serves as important groundwork that might enable further study into factors that influence triage and overall prehospital care for critically injured children.
,Odetola FO ,Mann NC ,Hansen KW .Bratton SL Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center . Prehosp Disaster Med.2016 ;31 (1 ):4 –9 .
Developing Consensus on Appropriate Standards of Disaster Care for Children
- Robert K. Kanter, John S. Andrake, Nancy M. Boeing, James Callahan, Arthur Cooper, Christine A. Lopez-Dwyer, James P. Marcin, Folafoluwa O. Odetola, Anne E. Ryan, Thomas E. Terndrup, Joseph R. Tobin
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 3 / Issue 1 / March 2009
- Published online by Cambridge University Press:
- 08 April 2013, pp. 27-32
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Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.
Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process. Interventions were chosen such that workload per staff member would not exceed the previously validated maximum according to the Therapeutic Intervention Scoring System. Based on published models, it was assumed that the usual numbers of staff would care for a disaster surge of 4 times the usual number of intensive care and non–intensive care hospital patients.
Results: Using a single set of assumptions on constrained resources and overwhelming needs, the panel ranked and agreed on essential interventions. A number of standard interventions would exceed crisis workload constraints, including detailed recording of vital signs and fluid balance, administration of vasoactive agents, invasive monitoring of pressures (central venous, intraarterial, intracranial), dialysis, and tube feedings.
Conclusions: The quantitative methodology and consensus development process described in the present report may have utility in future planning. Groups with appropriate expertise must develop action plans according to authority within each jurisdiction, addressing likely disaster scenarios, according to the needs in each medical service region, using available regional resources, and accounting for the capabilities of each institution. (Disaster Med Public Health Preparedness. 2009;3:27–32)