Cadaveric comparison of the optimal site for needle decompression of tension pneumothorax by prehospital care providers

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

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Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

Emergency Medicine International ◽

10.1155/2016/5437490 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Christine M. Van Dillen ◽

Matthew R. Tice ◽

Archita D. Patel ◽

David A. Meurer ◽

Joseph A. Tyndall ◽

...

Keyword(s):

Confidence Level ◽

Simulation Training ◽

Prehospital Care ◽

Tension Pneumothorax ◽

Trauma Patients ◽

Care Providers ◽

Confidence Levels ◽

Life Saving ◽

Before And After ◽

Needle Decompression

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training.Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel.Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42;P<0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77).Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

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Prehospital identification of Covid-19: an observational study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00826-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Douglas Spangler ◽

Hans Blomberg ◽

David Smekal

Keyword(s):

Predictive Value ◽

Prehospital Care ◽

The Novel ◽

Test Results ◽

Care Providers ◽

Care Systems ◽

Primary Hospital ◽

Novel Coronavirus ◽

Rule Out ◽

Descriptive Statistical Analysis

Abstract Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses. Methods Data for all patients with dispatch, ambulance, and hospital records between January 1–August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records. Results A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71–80) and 82% (78–86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85–87) and 78% (77–79). Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.

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Pulmonary Artery Injury and Cardiac Tamponade after Needle Decompression of a Suspected Tension Pneumothorax

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000046380.92001.81 ◽

2003 ◽

Vol 54 (3) ◽

pp. 610-611 ◽

Cited By ~ 64

Author(s):

Karyn L. Butler ◽

Irwin M. Best ◽

Wm. Lynn Weaver ◽

Harvey L. Bumpers

Keyword(s):

Pulmonary Artery ◽

Cardiac Tamponade ◽

Tension Pneumothorax ◽

Artery Injury ◽

Needle Decompression

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Variation in Out-of-Hospital Cardiac Arrest Management

Advances in Emergency Medicine ◽

10.1155/2016/6813718 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jason M. Jones ◽

Joseph A. Tyndall ◽

Christine M. Van Dillen

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Prehospital Care ◽

Management Strategies ◽

Retrospective Chart Review ◽

Airway Device ◽

Care Providers ◽

One Airway ◽

Time And Energy ◽

Hospital Cardiac Arrest

Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA). Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%]). One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]). Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

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Wellbeing series: Empathy and paramedic wellbeing

Irish Journal of Paramedicine ◽

10.32378/ijp.v4i2.210 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Alan M Batt

Keyword(s):

Prehospital Care ◽

Care Providers ◽

Shift Workers ◽

Practical Advice ◽

Irish College ◽

University College

<p>In this wellbeing series we present practical advice for prehospital care providers, responders, and other shift workers. These articles are produced by experts in their field. Many of these topics were presented at the Irish College of Paramedics Wellbeing Symposium in University College Cork in May 2019.</p><p> </p>

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Wellbeing Series: Compassion Fatigue.

Irish Journal of Paramedicine ◽

10.32378/ijp.v4i2.206 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Jennifer Reidy

Keyword(s):

Compassion Fatigue ◽

Prehospital Care ◽

Care Providers ◽

Shift Workers ◽

Practical Advice ◽

Irish College ◽

University College

In this wellbeing series we present practical advice for prehospital care providers, responders, and other shift workers. These articles are produced by experts in their field. Many of these topics were presented at the Irish College of Paramedics Wellbeing Symposium in University College Cork in May 2019.

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Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽

10.1542/peds.88.4.681 ◽

1991 ◽

Vol 88 (4) ◽

pp. 681-690 ◽

Cited By ~ 1

Author(s):

James S. Seidel ◽

Deborah Parkman Henderson ◽

Patrick Ward ◽

Barbara Wray Wayland ◽

Beverly Ness

Keyword(s):

Emergency Medical Services ◽

Rural Areas ◽

Urban Areas ◽

Pediatric Patients ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

Medical Services ◽

Care Providers ◽

Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

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

CJEM ◽

10.1017/cem.2019.326 ◽

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.

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Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-034094 ◽

2019 ◽

Vol 9 (12) ◽

pp. e034094

Author(s):

Dennis Walker ◽

Clint Moloney ◽

Brendan SueSee ◽

Renee Sharples

Keyword(s):

Systematic Review ◽

Medication Errors ◽

Medication Safety ◽

Data Extraction ◽

Prehospital Care ◽

Integrated Approach ◽

Care Providers ◽

Contributing Factors ◽

Multiple Sources ◽

Qualitative Synthesis

IntroductionThere is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment.Methods and analysisThe review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and ‘qualitised’ quantitative data.Ethics and disseminationNo ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations.

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