Prehospital and disaster medicine
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Prehosp Disaster Med · Feb 2014
Reconsidering policy of casualty evacuation in a remote mass-casualty incident.
Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation. ⋯ In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
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Prehosp Disaster Med · Feb 2014
Comparative StudyUse of a hooked cutting device compared with scissors for the emergency exposure of critically ill and injured patients.
The initial assessment of critical patients includes prompt identification of life-threatening conditions. Any device or technique that can aid in this process may ultimately save lives. This study examined whether clothing could be removed faster with the use of a hooked cutting device as compared with the commonly-used heavy-duty, blunt-tipped, serrated scissors. ⋯ The hooked device was 69% faster at removing clothing than traditionally-used scissors. Though simple in concept, these implications can be life saving, particularly in conditions of uncontrolled, life-threatening external hemorrhage.
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Prehosp Disaster Med · Feb 2014
Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.
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. ⋯ In 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.
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Prehosp Disaster Med · Feb 2014
Cervical spine fractures in elderly patients with hip fracture after low-level fall: an opportunity to refine prehospital spinal immobilization guidelines?
Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined. ⋯ C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.
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Prehosp Disaster Med · Feb 2014
Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis.
Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant. ⋯ In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.