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Prehospital Airway Management Examined at Two Pediatric Emergency Centers
- Jefferson Tweed, Taylor George, Cynthia Greenwell, Lori Vinson
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 5 / October 2018
- Published online by Cambridge University Press:
- 31 October 2018, pp. 532-538
- Print publication:
- October 2018
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Introduction
Routine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.
Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes.
MethodsRetrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality.
ResultsIn total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021).
ConclusionWith exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS.
,Tweed J ,George T ,Greenwell C Vinson L. Prehospital Airway Management Examined at Two Pediatric Emergency Centers . Prehosp Disaster Med.2018 ;33 (5 ):532 –538 .
Retrospective Analysis of Mosh-Pit-Related Injuries
- Andrew M. Milsten, Joseph Tennyson, Stacy Weisberg
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 6 / December 2017
- Published online by Cambridge University Press:
- 03 July 2017, pp. 636-641
- Print publication:
- December 2017
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Objectives
Moshing is a violent form of dancing found world-wide at rock concerts, festivals, and electronic dance music events. It involves crowd surfing, shoving, and moving in a circular rotation. Moshing is a source of increased morbidity and mortality. The goal of this study was to report epidemiologic information on patient presentation rate (PPR), transport to hospital rate (TTHR), and injury patterns from patients who participated in mosh-pits.
Materials and MethodsSubjects were patrons from mosh-pits seeking medical care at a single venue. The events reviewed were two national concert tours which visited this venue during their tour. The eight distinct events studied occurred between 2011 and 2014. Data were collected retrospectively from prehospital patient care reports (PCRs). A single Emergency Medical Service (EMS) provided medical care at this venue. The following information was gathered from each PCR: type of injury, location of injury, treatment received, alcohol or drug use, Advanced Life Support/ALS interventions required, age and gender, disposition, minor or parent issues, as well as type of activity engaged in when injured.
ResultsAttendance for the eight events ranged from 5,100 to 16,000. Total patient presentations ranged from 50 to 206 per event. Patient presentations per ten thousand (PPTT) ranged from 56 to 130. The TTHR per 10,000 ranged from seven to 20. The mean PPTT was 99 (95% CI, 77-122) and the median was 98. The mean TTHR was 16 (95% CI, 12-29) and the median TTHR was 17. Patients presenting from mosh-pits were more frequently male (57.6%; P<.004). The mean age was 20 (95% CI, 19-20). Treatment received was overwhelmingly at the Basic Life Support (BLS) level (96.8%; P<.000001). General moshing was the most common activity leading to injury. Crowd surfing was the next most significant, accounting for 20% of presentations. The most common body part injured was the head (64% of injuries).
ConclusionsThis retrospective review of mosh-pit-associated injury patterns demonstrates a high rate of injuries and presentations for medical aid at the evaluated events. General moshing was the most commonly associated activity and the head was the most common body part injured.
,Milsten AM ,Tennyson J ,Weisberg S Retrospective Analysis of Mosh-Pit-Related Injuries . Prehosp Disaster Med.2017 ;32 (6 ):636 –641 .
Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study
- Lori Weichenthal, Desiree Hansen Crane, Luke Rond, Conal Roche
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 4 / August 2015
- Published online by Cambridge University Press:
- 08 July 2015, pp. 397-401
- Print publication:
- August 2015
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Introduction
The use of prehospital needle thoracostomy (NT) is controversial. Some studies support its use; however, concerns exist regarding misplacement, inappropriate patient selection, and iatrogenic injury. Even less is known about its efficacy in situations where there is a delay to definitive care.
Hypothesis/AimTo determine any differences in survival of patients who underwent NT in the setting of prolonged versus short transport times, and to describe differences in mechanisms and complications between the two groups.
MethodsThis was a retrospective, matched, case-control study of trauma patients in a four county Emergency Medical Service (EMS) system from April 1, 2007 through April 1, 2013. This system serves an urban, rural, and wilderness catchment area. A prehospital database was queried for all patients in whom NT was performed, identifying 182 patients. When these calls were limited to those with prolonged transport times, the search was narrowed to 32 cases. A matched control group, based on age and gender, with short transport times was then created as a comparison. Data collected from prehospital and hospital records included: demographics; mechanism of injury; call status; response to NT; and final outcome. Univariate and multivariate analyses were conducted, as appropriate, to assess the primary outcome of survival and to further elucidate the descriptive data.
ResultsThere was no difference in survival between the case and control groups, either when evaluated with univariate (34% vs 25%; P=.41) or multivariate (odds ratio=0.99; 95% CI, 0.96-1.02; P=.57) analyses. Blunt trauma was the most common mechanism in both groups, but penetrating trauma was more common in the control group (30% vs 9%; P=.003). Patients in the control group were also more likely to have no vital signs on initial assessment (62% vs 31%; P=.003). More patients in the case group were described as having clinical improvement after NT (34% vs 19%; P=.03). No complications of NT were reported in either group.
ConclusionsThere was no significant difference in survival between patients with prolonged versus short transport times who underwent NT. Patients with prolonged transport times were more likely to have sustained blunt trauma, have vital signs on EMS arrival, and to have clinical improvement after NT.
,Weichenthal L ,Crane DH ,Rond L .Roche C Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study . Prehosp Disaster Med.2015 ;30 (4 ):1 –5 .
Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data
- Elizabeth L. Seaman, Mathew J. Levy, J. Lee Jenkins, Cassandra Chiras Godar, Kevin G. Seaman
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 5 / October 2014
- Published online by Cambridge University Press:
- 04 August 2014, pp. 468-472
- Print publication:
- October 2014
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Introduction
Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.
Hypothesis/ProblemThis study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness.
MethodsDeidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone.
ResultsThe primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business.
ConclusionAll three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions.
. ,Seaman EL ,Levy MJ ,Jenkins JL ,Godar CC .Seaman KG Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data . Prehosp Disaster Med.2014 ;29 (4 ):1 -6
Reduction in STEMI Transfer Times Utilizing a Municipal “911” Ambulance Service
- Joseph C. Tennyson, Mark R. Quale
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 1 / February 2014
- Published online by Cambridge University Press:
- 22 January 2014, pp. 50-53
- Print publication:
- February 2014
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Introduction
The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality.
HypothesisIt is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the “911” ALS ambulance.
MethodsQuality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite.
ResultsDuring the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance.
ConclusionIn the appropriate setting, the use of the municipal “911” ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.
. ,Tennyson JC .Quale MR Reduction in STEMI Transfer Times Utilizing a Municipal “911” Ambulance Service . Prehosp Disaster Med.2014 ;29 (1 ):1 -4
A Prospective Observational Analysis of Ambulation After Motor Vehicle Collisions
- Mark A. Merlin, Colleen Ciccosanti, Matthew D. Saybolt, Olivia Bockoff, Michael Mazzei, Adam Shiroff
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 1 / February 2013
- Published online by Cambridge University Press:
- 19 October 2012, pp. 76-78
- Print publication:
- February 2013
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Objectives
Predicting injury patterns of patients based only on mechanism of injury is difficult and is well described in the literature. Characteristics of patients on-scene immediately following injury(ies) may lead to predicting injury patterns. Although reported frequently, the significance of victim ambulation after a motor vehicle crash is poorly understood. It was hypothesized that ambulation at the scene is not predictive of injury severity following a motor vehicle crash (MVC).
MethodsA prospective, cohort study of 117 consecutive injured patients who were ambulatory after MVCs were enrolled. Paramedics in a large urban Emergency Medical Services (EMS) system were mandated to document “ambulatory” or “nonambulatory” for motor vehicle collisions in order to complete their prehospital electronic medical records. This assured accuracy and completeness in the data collection. All charts were abstracted for trauma-induced injury and imaging results.
ResultsA total of 608 (10.9%) persons were ambulatory at the scene, of which 284 had an injury pattern documented in the prehospital or emergency department record. The average age was 35.9 (SD = 16.8) years, and 158 (55.6%) were male. A total of 707 injuries were identified in the 284 patients who had sustained injuries.
ConclusionsAmbulation after motor vehicle collisions appears to be only infrequently associated with major injuries, although this population still may present with significant injuries. A larger, prospective study is warranted.
,Merlin MA ,Ciccosanti C ,Saybolt MD ,Bockoff O ,Mazzei M .Shiroff A A Prospective Observational Analysis of Ambulation After Motor Vehicle Collisions . Prehosp Disaster Med.2013 ;28 (1 ):1 -3 .