Prehospital Care Algorithm for Blast Injuries due to Bombing Incidents

2010 ◽  
Vol 25 (6) ◽  
pp. 595-600 ◽  
Author(s):  
G. Bobby Kapur ◽  
M. Tyson Pillow ◽  
Ira Nemeth
Keyword(s):  
Interpersonal Violence ◽  
Large Scale ◽  
Prehospital Care ◽  
The United States ◽  
Mass Casualty ◽  
Prehospital Setting ◽  
Blast Injuries ◽  
Care Providers ◽  
Universal Algorithm ◽  
Emergency Medical Services Personnel

AbstractTerrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries within these categories to prevent further morbidity or mortality in the prehospital setting.

scholarly journals P135: TriagED: A serious game for mass casualty triage and field disaster management

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S113
Author(s):  
C. Wallner ◽  
P. Sneath ◽  
K. Morgan ◽  
T. Chan
Keyword(s):  
Patient Flow ◽  
Prehospital Care ◽  
Mass Casualty ◽  
Leadership Role ◽  
Card Game ◽  
Care Providers ◽  
Incident Command ◽  
Scene Management ◽  
Multiple Injured ◽  
Injured Patients

Innovation Concept: Mass Casualty Incidents (MCI) are complex events that most paramedics encounter only a few times in their careers. Triaging and managing multiple patients during an incident requires different skills than typically practiced by prehospital providers. Simulation and drills can provide an opportunity to practice those skills, but are costly and resource intensive while only allowing a few providers to be in a triage or leadership role. It is important to find engaging and less expensive methods for teaching MCI triage and initial scene management. Methods: The authors have developed and are testing a card game based on the previously published GridlockED board game. The game was developed utilizing an iterative process previously described. This game was tested with paramedics as well as other emergency medicine learners to determine usability, engagement, fidelity, as well as usefulness in teaching MCI triage and patient-flow concepts. Curriculum, Tool or Material: The card game provides a focused learning experience to allow providers to practice initial triage of multiple injured patients as well as manage patient flow from the scene to area hospitals when faced with limited prehospital resources and capabilities. Players work together in various simulated scenarios to correctly triage injured patients and send them to the correct healthcare facility. Conclusion: Serious gaming has gained momentum in medical education. Developing novel curriculae around low frequency, high stakes situations using a game like TriagED may hold the key to ensure prehospital care providers are trained for these incidents. In the future, games which integrate an element of Incident Command or receiving hosptials (e.g. full integration with GridlockED game) may help to further explore the relationship between scene management and patient flow within receiving hospitals.

scholarly journals Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Teri L. Sanddal ◽  
Nels D. Sanddal ◽  
Nicolas Ward ◽  
Laura Stanley
Keyword(s):  
Prehospital Care ◽  
Significant Risk ◽  
The United States ◽  
Care Providers ◽  
Medical Database ◽  
Time Period ◽  
The Us ◽  
Dangerous Place ◽  
Safety Restraints ◽  
Crash Characteristics

Ambulance crashes are a significant risk to prehospital care providers, the patients they are carrying, persons in other vehicles, and pedestrians. No uniform national transportation or medical database captures all ambulance crashes in the United States. A website captures many significant ambulance crashes by collecting reports in the popular media (the website is mentioned in the introduction). This report summaries findings from ambulance crashes for the time period of May 1, 2007 to April 30, 2009. Of the 466 crashes examined, 358 resulted in injuries to prehospital personnel, other vehicle occupants, patients being transported in the ambulance, or pedestrians. A total of 982 persons were injured as a result of ambulance crashes during the time period. Prehospital personnel were the most likely to be injured. Provider safety can and should be improved by ambulance vehicle redesign and the development of improved occupant safety restraints. Seventy-nine (79) crashes resulted in fatalities to some member of the same groups listed above. A total of 99 persons were killed in ambulance crashes during the time period. Persons in other vehicles involved in collisions with ambulances were the most likely to die as a result of crashes. In the urban environment, intersections are a particularly dangerous place for ambulances.

Analgesia in the Field

1989 ◽  
Vol 4 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Ronald D. Stewart
Keyword(s):  
United States ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
The United States ◽  
Mass Casualty ◽  
Transport Systems ◽  
Medical Problems ◽  
Interhospital Transport ◽  
Injured Patients

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).

scholarly journals Agreement between Prehospital and Final Diagnosis in Patients with Acute Allergic Reactions: A Cross-Sectional Study

2021 ◽  
pp. 142-149
Author(s):  
Saeed Golfiroozi ◽  
Nader Tavakoli ◽  
Peyman Namdar ◽  
Mohammad Amin Zare
Keyword(s):  
Allergic Reaction ◽  
Prehospital Care ◽  
Demographic Data ◽  
Vital Signs ◽  
Final Diagnosis ◽  
Prehospital Setting ◽  
Allergic Reactions ◽  
Care Providers ◽  
Cross Sectional ◽  
Mortality And Morbidity

Introduction: Acute allergic reactions are usually first encountered in the prehospital setting and account for about 0.3% to 0.8% of prehospital runs in different countries. Right, and rapid recognition and treatment are necessary to decrease mortality and morbidity, especially in severe critical cases. This study evaluates the accuracy of prehospital care providers’ diagnosis in patients with acute allergic reactions in comparison with final (discharge) diagnosis as the gold standard. Methods: Patients who were transported to 2 urban referral hospitals between 2008 and 2014 under the dispatch code of “acute allergic reaction” were included in the study, retrospectively. Demographic data, etiology of an allergic reaction, clinical presentations, vital signs stability, and need for epinephrine injection were evaluated. The prehospital care providers’ diagnosis (documented on-call report) was compared with the final diagnosis (documented on discharge summary form). Results: A total of 300 patients were included in the study. In 55 (18.3%) cases the prehospital care providers’ and final diagnoses were different. Diagnoses were similar in 245 (81.6%) patients. Kappa coefficient was calculated as 0.621which shows a moderate-to-substantial agreement between prehospital and final diagnoses. Fifteen patients (5%) were discharged from the hospital with a diagnosis of anaphylaxis and only 4 cases (26.6%) were diagnosed in the prehospital setting. Conclusion: Although the overall agreement between prehospital and final diagnosis of acute allergic reactions calculated in this study was good, the accuracy of diagnosing the anaphylaxis (as the most critical allergic reaction with a potential fatality) was less than optimal.

Withholding CPR in the Prehospital Setting

1990 ◽  
Vol 5 (1) ◽  
pp. 45-46 ◽  
Author(s):  
Samuel J. Stratton
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Care Community ◽  
Social And Emotional ◽  
Number Of Factors ◽  
Prehospital Emergency ◽  
Law And Science

The expansion of hospices and recognition of living wills have made it necessary for emergency care providers to re-evaluate the appropriateness of universal application of cardiopulmonary resuscitation (CPR) in the field. The prehospital care community is coming to realize that CPR is beneficial only in certain specific situations. Some believe that when CPR is not likely to be beneficial, it should be withheld. Withholding CPR seems to be a simple matter of law and science, but a number of factors complicate the issue, especially in the prehospital setting: What are the definitive signs of irreversible, sudden death? When is the application of CPR futile? What are the responsibilities of the prehospital emergency care provider who announce someone dead? What is the lay public's perception of stopping or withholding CPR? Withholding CPR in this environment is a complicated social and emotional issue as well as a scientific and legal one.

Trends in cancer care with the Affordable Care Act.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 46-46
Author(s):  
Tasneem Kaleem ◽  
Robert Clell Miller
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Large Scale ◽  
Primary Care Providers ◽  
The United States ◽  
Outcome Data ◽  
Fee For Service ◽  
Care Providers ◽  
The Affordable Care Act ◽  
Set Up

46 Background: Accountable Care Organizations (ACO), as proposed by the Affordable Care Act, will change the delivery of health care in the United States. ACO serve as a network of providers with primary care providers (PCP) set up as gate-keepers for referrals to specialists. Within the next several years, many trends will emerge and drive progress of change, requiring oncologist to take a lead role to adapt to the evolving landscape of health care. Methods: Literature search of internet-based and academic sources for oncology and the Affordable Care, with a focus on ACO formation. Results: Four main expected trends and strategies to adapt to changes were formulated. Trend 1: Changes in referral patterns towards oncologists. Referral will be based on outcome data and ACO membership. Strategy: Increase communication and education to PCP and other providers. Endorse multidisciplinary clinics, which have shown to improve guideline compliance, coordination, and communication. Trend 2: Formation of large scale oncology provider groups collaborating with PCP/ACO. Physicians will be able to provide around the clock care to patients with the goal of reducing hospital visits. Strategy: Establish oncology homes with goal of reducing inpatient and ED visits by providing telephone symptom management, daily questionnaires and opportunities for end of life discussions. Trend 3: Reimbursement reform to oncologists based on quality measures. ACO can bill fee for service basis and eligibility for bonus payments based on outcomes. Strategy:Adherence to evidence based guidelines chosen by evaluating efficacy, toxicity and cost have been proven to increase quality of patient care. Trend 4: Development to pathway driven medicine.ACO structure lends to a centralized governance committee responsible in choosing guidelines for treatment within an ACO. Strategy: Oncologists should provide a voice for the field and patients when different guidelines are chosen. Conclusions: In the context of the Affordable Care Act, oncology specialists are encouraged to participate in the new organization model to ensure best outcomes for both physicians and patients. Awareness of future trends and ways to contribute will be the first step in adapting to implementation of the Affordable Care Act.

Emergency Response to Mass Casualty Incidents in Lebanon

2013 ◽  
Vol 7 (4) ◽  
pp. 433-438 ◽  
Author(s):  
Mazen J. El Sayed
Keyword(s):  
Emergency Management ◽  
Emergency Response ◽  
Large Scale ◽  
The United States ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Incident Management ◽  
Response Process ◽  
Response Systems ◽  
Emergency Response Systems

AbstractThe emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure. (Disaster Med Public Health Preparedness. 2013;0:1–6)

Acute Cyanide Poisoning in Prehospital Care: New Challenges, New Tools for Intervention

2006 ◽  
Vol 21 (S2) ◽  
pp. s40-s48 ◽  
Author(s):  
Tee Guidotti
Keyword(s):  
Prehospital Care ◽  
The United States ◽  
Prehospital Setting ◽  
Hospital Treatment ◽  
Cyanide Poisoning ◽  
Chemical Terrorism ◽  
Cyanide Antidote ◽  
Fire Smoke ◽  
The Us

AbstractEffective management of cyanide poisoning from chemical terrorism, inhalation of fire smoke, and other causes constitutes a critical challenge for the pre-hospital care provider. The ability to meet the challenge of managing cyanide poisoning in the prehospital setting may be enhanced by the availability of the cyanide antidote hydroxocobalamin, currently under development for potential introduction in the United States. This paper discusses the causes, recognition, and management of acute cyanide poisoning in the prehospital setting with emphasis on the emerging profile of hydroxocobalamin, an antidote that may have a risk:benefit ratio suitable for empiric, out-of-hospital treatment of the range of causes of cyanide poisoning. If introduced in the US, hydroxocobalamin may enhance the role of the US prehospital responder in providing emergency care in a cyanide incident.

scholarly journals Which is more effective for ventilation in the prehospital setting during cardiopulmonary resuscitation, the laryngeal mask airway or the bag-valve-mask? - A review of the literature

2010 ◽  
Vol 8 (3) ◽  
Author(s):  
Emma Flavell ◽  
Malcolm Boyle
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Laryngeal Mask ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Airway Patency ◽  
Gastric Regurgitation ◽  
Over Time

Introduction Prehospital care providers are responsible for providing adequate ventilation during cardiopulmonary resuscitation (CPR). Endotracheal intubation (ETI) is widely accepted as the 'gold standard' for airway protection and the preferred method for ventilation. However, most Australian paramedics are not trained to perform ETI. Laryngeal Mask Airway (LMA) and Bag-Valve-Mask (BVM) are seen as adequate alternatives to ETI as recommended by the International Liaison Committee of Resuscitation (ILCOR). The objective of this study was to identify which airway device LMA or BVM (with OPA/NPA) is more effective in airway patency and ventilation during cardiopulmonary resuscitation in the prehospital environment. Methods A literature search was conducted using medical electronic databases, MEDLINE CINHAL, EMBASE, Meditext, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus. These databases were searched from January 1996 until the end of January 2010. Articles were included if the principal objective was to compare ventilation efficiency of the LMA against the BVM in the prehospital setting. References from articles retrieved were reviewed. Results There were 2937 articles located by the search. Of these, 30 articles met the inclusion criteria with twelve relevant to the prehospital environment. In the twelve prehospital studies, two involved the use of mannequins, four were retrospective, five were observational, and there was one a literature review. Conclusion The findings from this review suggest that the LMA is more effective at ventilations over time during CPR in adults, as there is less risk of gastric regurgitation and pulmonary aspiration. The BVM is quicker at performing the first ventilation but there is a loss of effectiveness over time. BVM is considered the best method for ventilating children and neonates.

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