3 results
A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States
- Aaron B. Klassen, S. Brent Core, Christine M. Lohse, Matthew D. Sztajnkrycer
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 2 / April 2018
- Published online by Cambridge University Press:
- 13 March 2018, pp. 165-170
- Print publication:
- April 2018
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Study Objectives
Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database.
MethodsThis study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states. Code E09_02 1200 specifically identifies care provided by law enforcement prior to EMS arrival.
ResultsA total of 25,835,729 unique events were reported. Of events in which pre-arrival care was documented, 2.0% received prior aid by law enforcement. Patients receiving law enforcement care prior to EMS arrival were more likely to be younger (52.8 [SD=23.3] years versus 58.7 [SD=23.3] years), male (54.8% versus 46.7%), and white (80.3% versus 77.5%). Basic Life Support (BLS) EMS response was twice as likely in patients receiving prior aid by law enforcement. Multiple-casualty incidents were five times more likely with prior aid by law enforcement. Compared with prior aid by other services, law enforcement pre-arrival care was more likely with motor vehicle accidents, firearm assaults, knife assaults, blunt assaults, and drug overdoses, and less likely at falls and childbirths. Cardiac arrest was significantly more common in patients receiving prior aid by law enforcement (16.5% versus 2.6%). Tourniquet application and naloxone administration were more common in the law enforcement prior aid group.
ConclusionWhere noted, law enforcement pre-arrival care occurs in 2.0% of EMS patient encounters. The majority of cases involve cardiac arrest, motor vehicle accidents, and assaults. Better understanding of the nature of law enforcement care is required in order to identify potential barriers to care and to develop appropriate training and policy recommendations.
,Klassen AB ,Core SB ,Lohse CM .Sztajnkrycer MD A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States . Prehosp Disaster Med.2018 ;33 (2 ):165 –170 .
A Descriptive Analysis of Prehospital Response to Hazardous Materials Events
- Ashley J. Martin, Christine M. Lohse, Matthew D. Sztajnkrycer
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 5 / October 2015
- Published online by Cambridge University Press:
- 01 September 2015, pp. 466-471
- Print publication:
- October 2015
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Objective
Little is known about the overall frequency of hazardous materials (HazMat) events in the United States and the nature of prehospital care for those exposed. The purpose of the current study was to perform a descriptive analysis of Emergency Medical Services (EMS) activations reported to a national EMS database.
MethodsAnalysis of the 2012 National EMS Information System (NEMSIS) Public Release Research Data Set v.2.2.1, containing EMS emergency response data submitted by 41 states, was conducted. Mandatory data elements E0207 (Type of Response Delay), E0208 (Type of Scene Delay), and E0209 (Type of Transport Delay) contained specific codes for HazMat events and were used to identify specific EMS activation records for subsequent analysis. Overlapping data elements were identified and combined in order to prevent duplicate entries. Descriptive analyses were generated from the NEMSIS Research Data Set.
ResultsA total of 17,479,328 EMS activations were reported, of which 2,527 unique activations involved HazMat response. Mass-casualty incident was coded for 5.6% of activations. The most common level of prehospital care present on scene was Basic Life Support (BLS; 51.1%); 2.1% required aggressive Advanced Life Support (ALS) response. The most common locations for HazMat activations were homes (36.2%), streets or highways (26.3%), and health care facilities (11.6%). The primary symptoms observed by EMS personnel were pain (29.6%), breathing problems (12.2%), and change in responsiveness (9.6%). Two percent of HazMat activations involved cardiac arrest, with 21.7% occurring after EMS arrival. Delays in patient care included response delay, scene delay, and transport delay.
ConclusionHazardous materials events are rare causes of EMS activation in the United States. The majority occur in non-industrial venues and involve two or fewer patients. Scene time frequently is delayed due to multiple barriers. Cardiac arrest is rare but occurred after EMS arrival in one-fifth of patients.
,Martin AJ ,Lohse CM .Sztajnkrycer MD A Descriptive Analysis of Prehospital Response to Hazardous Materials Events . Prehosp Disaster Med.2015 ;30 (5 ):466 –471 .
Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study
- Sara J. Aberle, Benjamin J. Sandefur, Kharmene L. Sunga, Ronna L. Campbell, Christine M. Lohse, Henrique Alecastro Puls, Sarah Laudon, Matthew D. Sztajnkrycer
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 3 / June 2015
- Published online by Cambridge University Press:
- 11 May 2015, pp. 259-263
- Print publication:
- June 2015
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Introduction
Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.
MethodsPost-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.
ResultsTwenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.
ConclusionThe time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.
,Aberle SJ ,Sandefur BJ ,Sunga KL ,Campbell RL ,Lohse CM ,Alecastro Puls H ,Laudon S .Sztajnkrycer MD Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study . Prehosp Disaster Med.2015 ;30 (3 ):1 –5 .