Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Determining care disposition for pediatric patients during interfacility transport is often challenging. Severity of illness scoring can assist with this process. The purpose of this retrospective study was to compare currently utilized scoring systems and their ability to reliably match pediatric transport patients' severity of illness with the level of care necessary. ⋯ Elevated PedCTAS, TPEWS, and TRAP scores are strongly associated with PICU admission within the interfacility transport setting.
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Observational Study
Can Altering Grip Technique and Bag Size Optimize Volume Delivered with Bag-Valve-Mask by Emergency Medical Service Providers?
Emergency Medical Services (EMS) professionals rely on the bag-valve-mask (BVM) to provide life-saving positive-pressure ventilation in the prehospital setting. Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. A recent study has shown that the volumes typically delivered by EMS professionals with the adult BVM are often higher than recommended by lung-protective ventilation protocols. Our primary objective was to determine if a group of EMS professionals could reduce the volume delivered by adjusting the way the BVM was held. Secondary objectives included 1) if the adjusted grip allowed for volumes more consistent with lung-protection ventilation strategies and 2) comparing volumes to similar grip strategies used with a smaller BVM. ⋯ The study suggests that it is possible to alter the volume provided by the BVM by altering the grip on the BVM. The tidal volumes recorded with the pediatric BVM were above recommended range in 2 of the 3 grips. The volumes of the pediatric BVM were overall more consistent with lung-protective ventilation volumes when compared to all 3 finger-grips of the adult BVM.
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The aim of this study was to assess the staff perception of a global positioning system (GPS) as a patient tracking tool at an emergency department (ED) receiving patients from a simulated mass casualty event. ⋯ ED staff reported that the use of GPS trackers in a disaster improved real-time tracking and could potentially improve patient management during a mass casualty event.
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Crush injuries have the potential to cause life-threatening systemic effects such as hyperkalemia, dysrhythmias, acute kidney injury, and renal failure. Systemic involvement is known as crush syndrome (CS) and results from tissue ischemia and muscle necrosis. ⋯ Hyperkalemia should be presumed in any crush injury and be treated empirically and aggressively. Although tourniquet application prior to extrication is not widely recommended to prevent CS, it should be considered in prolonged extremity entrapment.
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Botulism is a potentially lethal disease caused by a toxin released by Clostridium botulinum. Outbreaks of botulism from food sources can lead to a Mass Casualty Incident (MCI) involving sometimes hundreds of individuals. We report on a recent outbreak of botulism treated at a regional community hospital with a focus on emergency medical services (EMS) response and transport considerations. ⋯ There was one fatality in the first days of the outbreak and a second death that occurred in a patient who died after long-term acute care (LTAC) placement several months after hospital discharge. Conclusion: Local EMS providers and public safety officers have a critical role in identifying and following up on potentially exposed botulism cases. The organization of transporting agencies and the logistics of transfer turned out to be 2 opportunities for improvement in response to this mass casualty incident.