3 results
Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?
- Nicole McKenzie, Carolina Wishner, Martha Sexton, Danielle Saevig, Brian Fink, Paul Rega
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 14 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 July 2019, pp. 173-177
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Objective:
The aim of this study was to explore the clinical decisions that health care students would make if faced with an active shooter event while providing patient care.
Methods:A cross-sectional study design was used to survey 245 students from 6 different professional programs. Participants read 4 case-based scenarios, selected 1 of 4 actions in a multiple-choice format, and responded to an open-ended question. Demographic questions asked whether participants had been a victim of violence and whether they have taken a certified active shooter course. Statistical analysis included descriptive statistics and chi-square testing.
Results:For each case, most students chose “patient-centric” versus “provider-centric” actions (range: 66%–94% and 4%–17%, respectively). The gender of the patient made no difference in actions. Those who attended a certified active shooter course tended to act with more “provider-centric” concerns than those who did not take such a course.
Conclusion:A significant majority of interprofessional health care students, when presented with specific case-scenarios, declared they would act to protect themselves and their patients during an active shooter event. This “patient-centric” attitude transcends the oversimplified “Run-Hide-Fight” axiom and must be addressed by all health care educational institutions.
Hemorrhage-control Tourniquets: How Intuitive are They?
- Nicole Ochs, Martha Sexton, Nicole McKenzie, Paul Rega, Jonathon Ziehr, Brent Parquette, Brian Fink
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- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, p. s91
- Print publication:
- May 2019
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Introduction:
According to the Federal Bureau of Investigation (FBI), there were fifty active shooter incidents in 2016 and 2017. In the first five months of 2018, there have been 23 school shootings where someone was injured or killed. Hemorrhage-control tourniquets have proven their life-saving capability in the military and civilian EMS. Now, they are being advocated for use by civilians – the true “first responders.” Since Combat Application Tourniquets (CATs) are strap-and-windlass devices, the question remains whether a naïve population can intuitively apply them efficaciously.
Aim:To determine the efficacy (speed, correct placement) of a CAT by an interprofessional group of healthcare students naïve to tourniquet hemorrhage control.
Methods:Consenting students attempted to apply a CAT to a standardized patient with a simulated hemorrhaging brachial artery. No instruction was given except for the directions included in the package. Timing began upon removal of the tourniquet from the package and ended when the participants stated they completed their attempt. Errors in application were documented. Afterward, students received education and an opportunity to properly re-apply the tourniquet. The completion times of the students were compared to ten emergency medical technicians (EMT-P), serving as subject matter experts. Errors in application were categorized.
Results:50 students from the following professions participated: Medicine, Nursing, Public Health, and Respiratory Therapy. The mean time of tourniquet application was 96.16 seconds (range: 25.12-226.31). This was statistically different from the EMT-Ps’ time of 42.83 seconds (range: 23.89-82.94). Additionally, only five (10%) placed the tourniquet correctly. Errors included improper location and windlass misuse or non-use. The instructions were frequently critiqued for being difficult to read and containing confusing graphics.
Discussion:Provision of commercial tourniquets in public access areas must be accompanied by civilian education and the creation of CAT instructions that are simplistic, comprehensible, and suitably graphic.
START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student?
- Brian N. Fink, Paul P. Rega, Martha E. Sexton, Carolina Wishner
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 13 July 2018, pp. 381-386
- Print publication:
- August 2018
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Introduction
While the art and science of disaster triage continue to evolve, the education of the US health care student in matters pertaining to disaster preparedness and response remains stifled. Unfortunately, these students will be assuming major decision-making responsibilities regarding catastrophes that will be complicated by climate change, nuclear threats, global terrorism, and pandemics. Meanwhile, Sort, Assess, Life-Saving Interventions, Treatment, and/or Transport (SALT) triage is being advocated over the globally popular Simple Triage and Rapid Treatment (START) algorithm for multiple reasons: (1) it’s an all-hazard approach; (2) it has four medical interventions; and (3) it has an additional triage color for victims with non-survivable injuries.
Hypothesis/ProblemAs present-day threats become more ominous and health care education emphasizes the needs of vulnerable populations and palliative care, the authors hypothesize that, when given a choice, health care students will prefer SALT triage.
MethodsA convenience sample of 218 interprofessional, disaster-naïve health care students received just-in-time, unbiased education on both START and SALT triage systems. Students then completed a survey asking them to decide which triage system they believe would be most effective in their community.
ResultsA total of 123 health care students (56.4%) preferred SALT while 95 (43.6%) preferred START; however, only the physician assistant students showed a statistically significantly preference (28 versus six, respectively; P=.042). Interestingly, there was also a statistically significant difference in preference by gender (Chi-square=5.02; P=.025) of the observed distribution versus expected distribution in SALT and START. The females preferred SALT (61.0%) while the males preferred START (55.9%).
Among those who preferred START, START being easier to learn was the most important reason cited. Among those who preferred SALT, the most important reason cited was that the number of patient triage categories seemed more logical, comprehensible, and consistent with traditional medical care.
Conclusion:While SALT’s preference among females and physician assistant students was based on the addition of medical interventions and the provision of palliative care, START’s preference was related to expediency. Based on this research, incorporating disaster concepts into US health care students’ curricula encourages thoughtful consideration among the future health care leaders about the most effective approach to triage care. It is critical that further research be completed to determine, without reservation, which triage system will not only save the most lives but provide the most humane care to victims.
Fink BN, Rega PP, Sexton ME, Wishner C. START versus SALT triage: which is preferred by the 21st century health care student? Prehosp Disaster Med. 2018;33(4):381–386