Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The primary objective of this observational study was to document the heart rate (HR) responses of firefighters during incident rehabilitation following firefighting activity in a high-rise building with a simulated fire on the 10th floor. Additionally, the study investigated potential factors, including firefighting workload, ambient temperature, firefighter movement, and individual characteristics, that may have affected HR during recovery. Firefighters (n = 198) were assigned to perform a simulation of fire suppression, search and rescue, or material support during one of six firefighting trials that involved different crew sizes and ascent modes, and were performed in different environmental conditions. After completing the simulated firefighting activity, firefighters reported to a rehabilitation area on the 8th floor. The rehabilitation area was staffed by firefighter/paramedics. HR was monitored continuously during simulated firefighting activity and a 15-minute rehabilitation period. Average HR during rehabilitation (HRmean) was calculated and compared across trials. Simulated firefighting activity was performed in the summer in Virginia, USA, and ambient conditions varied among trials (mean ± SD: 31 ± 4°C; 46 ± 15% relative humidity; 32 ± 4°C heat index). Duration of simulated firefighting activity ranged from 12.0 to 20.3 minutes among trials (mean: 15.4 ± 5.2 minutes). Over all trials, mean peak HR during simulations was 173 ± 18 beats·min(-1). Mean HR over all trials at entry into rehabilitation was 149 ± 24 beats·min(-1). Following 15 minutes of recovery, mean HR over all trials was 126 ± 23 beats·min(-1). Exploratory analyses revealed that higher workload during firefighting (stair trials), higher ambient temperature (≥30°C), greater movement during rehabilitation (≥0.1 g-force), higher age (≥45 years), and higher BMI (≥30.0 kg·m(-2)) were associated with higher HR responses during rehabilitation. During complex emergency operations, emergency medical service personnel will likely encounter considerable variability in HR responses upon initial evaluation and throughout rehabilitation. Following one bout of firefighting activity during a simulated fire scenario, HR decreased but remained elevated well above resting values following 15 minutes of rehabilitation. Based on current fire service recommendations, the majority of firefighters (88%) would not have been released from rehabilitation and eligible for reassignment after a 15-minute rehabilitation period following a brief bout of simulated firefighting activity. ⋯ medical monitoring, cardiac strain, firefighting.
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Randomized Controlled Trial
Pilot Study Examining the Effects of Atropine on Performance during Uncompensable Heat Stress.
In many operational scenarios, hypohydration can be corrected with oral rehydration following the work interval. Although rare, there are potential situations that require extended intervals of uncompensable heat stress exposure while working in personal protective equipment (PPE). Under these conditions, retention of body water may be valuable to preserve work capacity and reduce cardiovascular strain. We conducted a pilot study comparing intramuscular atropine sulfate versus saline placebo to establish the safety profile of the protocol and to provide pilot data for future investigations. Five, healthy, heat-acclimated subjects completed this crossover design laboratory study. Each subject performed up to one hour of exertion in a hot environment while wearing a chemical resistant coverall. Atropine sulfate (0.02 mg/kg) or an equivalent volume of sterile saline was administered by intramuscular injection. Core temperature, heart rate, perceptual measures, and changes in body mass were measured. All five subjects completed the acclimation period and both protocols. No adverse events occurred, and no pharmacologically induced delirium was identified. Change in body mass was less following exercise influenced by atropine sulfate (p = 0.002). Exertion time tended to be longer in the atropine sulfate arm (p = 0.08). Other measures appeared similar between groups. Intramuscular atropine sulfate reduced sweating and tended to increase the work interval under uncompensable heat stress when compared to saline placebo. Heart rate and temperature changes during exertion were similar in both conditions suggesting that the influence of an anticholinergic agent on thermoregulation may be minimal during uncompensable heat stress. ⋯ thermoregulation; cholinolytic; anticholinergic; reaction time.
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Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. ⋯ Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.
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Observational Study
Accuracy of Prehospital Intravenous Fluid Volume Measurement by Emergency Medical Services.
Prehospital treatment protocols call for intravenous (IV) fluid for patients with shock, yet the measurement accuracy of administered fluid volume is unknown. The purpose of the current study was to assess the accuracy of documented and self-reported fluid volumes administered to medical patients by paramedics during prehospital care. We conducted a pilot, observational study nested within a parent cohort study of prehospital biomarkers in a single EMS agency transporting patients to a tertiary care hospital in Pittsburgh, Pennsylvania over 8 months. Among eligible nontrauma, noncardiac arrest patients, we studied the self-reported IV fluid volume on ED arrival by paramedics, documented fluid volume in the EMS record, and compared those to the mass-derived fluid volume. We quantified the absolute error between methods, and determined EMS transport times or initial prehospital systolic blood pressure had any effect on error. We enrolled 50 patients who received prehospital IV fluid and had mass-derived fluid volume measured at ED arrival. Of these, 21 (42%) patients had IV fluid volume subsequently documented in EMS records. The median mass-derived fluid volume was 393 mL [IQR: 264-618 mL]. Mass-derived volume was similar for subjects who did (386 mL, IQR: 271-642 mL) or did not (399 mL, IQR: 253-602) have documented fluid administration (p > 0.05). The median self-reported fluid volume was 250 mL [IQR: 150-500 mL] and did not differ by documentation (p > 0.05). The median absolute error comparing self-reported to mass-derived fluid volume was 109 mL [IQR: 41-205 mL], and less than 250 mL in more than 80% of subjects. The median absolute error comparing documented fluid to mass-derived fluid volume was 142 mL [IQR: 64-265 mL], and was less than 250 mL in 71% of subjects. No difference in absolute error for either self-reported or document fluid volumes were modified by transport time or prehospital systolic blood pressure. Prehospital IV fluid administration is variably documented by EMS, and when recorded is typically within 250 mL of mass-derived fluid volume. ⋯ emergency medical services; prehospital resuscitation; intravenous fluids; fluids.
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The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18-24 y and sustained an injury within the previous 24 h. ⋯ Controlling for sex, acute alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p < 0.001). Acute alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients.