Prehospital and disaster medicine
-
Prehosp Disaster Med · Aug 2012
The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies: data from the DCLHb clinical trials.
The Revised Trauma Score (RTS) has been proposed as an entry criterion to identify patients with mid-range survival probability for traumatic hemorrhagic shock studies. ⋯ The use of an RTS 2-5.99 inclusion criterion range identifies a traumatic hemorrhagic shock patient subgroup with predicted and actual mortality that approach the desired 50% rate. The exclusion of GCS <5 from this RTS 2-5.99 subgroup patients yields a smaller, more uniform patient subgroup whose mortality is more likely related to hemorrhagic shock than traumatic brain injury. Future studies should examine whether the RTS or other physiologic criteria such as the GCS score are most useful as traumatic hemorrhagic shock study entry criteria.
-
Prehosp Disaster Med · Aug 2012
Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity.
The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While "severe breathing problems" is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity. ⋯ The study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.
-
Prehosp Disaster Med · Aug 2012
The impact of stress on paramedic performance during simulated critical events.
Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics' ability to care for patients during stressful events. In this study, we examined paramedics' acute stress responses and performance during simulated high-stress scenarios. ⋯ Clinical performance and documentation appear vulnerable to the impact of acute stress. This highlights the importance of developing systems and training interventions aimed at supporting and preparing emergency workers who face acute stressors as part of their every day work responsibilities.
-
Immediate resuscitation is necessary in order to achieve conscious survival for persons who have lost airways or pulses. However, current literature suggests that even in medically-trained personnel, CPR skills are forgotten shortly after certification. ⋯ The results of this study suggest that repetition may be more important than days since last trained for skill and knowledge retention, and methods of "refreshing" skills should be examined. While skills deteriorate rapidly, changing frequency of certification is not necessarily the best way to increase retention of skill and knowledge.
-
Prehosp Disaster Med · Aug 2012
Independent application of the Sacco Disaster Triage Method to pediatric trauma patients.
Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been validated for pediatric trauma victims. ⋯ The Sacco Triage Method, with or without its age adjustment term, was a highly accurate predictor of mortality in pediatric trauma patients in this registry database. This triage method appears to be a valid strategy for the prioritization of injured children.