Prehospital and disaster medicine
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Prehosp Disaster Med · Jun 2012
A human factors analysis of an EMS crew's exposure to carbon monoxide.
The safety of personnel and resources is considered to be a cornerstone of prehospital Emergency Medical Services (EMS) operations and practice. However, barriers exist that limit the comprehensive reporting of EMS safety data. ⋯ The goal of this approach is to analyze processes for the purposes of making an environment safer for patients and providers. This report describes an application of this approach to safety incident analysis following a situation during which a paramedic ambulance crew was exposed to high levels of carbon monoxide.
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Prehosp Disaster Med · Jun 2012
Predictors of ambulance transport in patients with ST-elevation myocardial infarction.
Despite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated. Hypothesis It was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization. ⋯ Of the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106). Conclusion No associations between mode of transport and patient age, sex, weekend/evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More effective ways are needed to educate the public on the importance of EMS activation when one is concerned for acute coronary syndrome.
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Prehosp Disaster Med · Jun 2012
Simulation training with structured debriefing improves residents' pediatric disaster triage performance.
Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance. ⋯ Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.
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Prehosp Disaster Med · Jun 2012
Red blood cell transfusion: experience in a rural aeromedical transport service.
The administration of blood products to critically ill patients can be life-saving, but is not without risk. During helicopter transport, confined work space, communication challenges, distractions of multi-tasking, and patient clinical challenges increase the potential for error. This paper describes the in-flight red blood cell transfusion practice of a rural aeromedical transport service (AMTS) with respect to whether (1) transfusion following an established protocol can be safely and effectively performed, and (2) patients who receive transfusions demonstrate evidence of improvement in condition. ⋯ In this rural AMTS, transfusion was an infrequent, likely life-saving, and potentially high-risk emergent therapy. Strict compliance with an established transfusion protocol resulted in appropriate and effective decisions, and transfusion proved to be a safe in-flight procedure for both patients and providers.