En Route Care Provided by US Navy Nurses in Iraq and Afghanistan

BACKGROUND US Navy nurses provide en route care for critically injured combat casualties without having a formal program for training, utilization, or evaluation. Little is known about missions supported by Navy nurses. OBJECTIVES To characterize the number and types of patients transported and skill sets required by Navy nurses during 2 combat support deployments. METHODS All interfacility casualty transfers between 2 separate facilities in Iraq and Afghanistan were assessed. Number of patients treated, number transported, en route care provider type, transport priority level and duration, injury severity, indication for critical care transport, en route care interventions, and vital signs were evaluated. RESULTS Of 1550 casualties, 630 required medical evacuation to a higher level of care. Of those, 133 (21%) were transported by a Navy nurse, with 131 (98.5%) classified as “urgent,” accounting for 46% of all urgent transports. The primary indication for en route care nursing was mechanical ventilation of intubated patients (97%). Mean (SD) patient transport time was 29.8 (7.9) minutes (range, 17–61 minutes). The most common en route care interventions were administration of intravenous sedation (80%), neuromuscular blockade (79%), and opioids (48%); transfusions (18%); and ventilation changes (11%). No intubations, cricothyroidotomies, chest tube placements, or needle decompressions were performed en route. No deaths occurred during transport. CONCLUSIONS US Navy nurses successfully transported critically injured patients without observed adverse events. Establishing en route care as a program of record in the Navy will facilitate continuous process improvement to ensure that future casualties receive optimized en route care.

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(P2-6) Evaluation of Air Rescue Missions Using a Helicopter — Analysis from a German Helicopter Base

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1100450x ◽

2011 ◽

Vol 26 (S1) ◽

pp. s137-s137

Author(s):

M.D. Frank ◽

U. Aschenbrenner ◽

G. Nitschke ◽

J. Braun

Keyword(s):

Injury Severity ◽

Air Rescue ◽

Coronary Syndrome ◽

Central Computer ◽

Emergency Medical ◽

Thoracic Drainage ◽

Number Of Patients ◽

Naca Score ◽

Rescue System ◽

Surrounding Areas

IntroductionIn Germany, emergency medical care is provided by ambulances. Emergency physicians also are used in the German rescue system to ensure primary care. Additionally, rescue helicopters are insertable. The rescue helicopter in Dresden covers the city of Dresden and its surrounding areas, with 517,000 inhabitants and distances up to 70 km. The goal of this study was to evaluate emergency cases in helicopter rescue missions according to primary diagnoses and severity of the mission on the basis of NACA Score.MethodsData from all emergencies using the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central computer database (MEDAT®). Data from all emergency cases between January 2006 and July 2010 were analyzed.ResultsThere was a total of 6,310 emergencies during the study period, with a significant increase over time. The helicopter was on-scene within 10.9 minutes. In total, 54% of the patients were male. The rate of female patients > 80 years of age was 64.5%. A total of 63.4% of patients suffered life-threatening injuries or dysfunctions and a NACA score ≥ 4. A total of 7.6% of patients were classified in NACA 6 or 7. The most common cause for rescue missions was an acute coronary syndrome (20.4%). Other frequent diagnoses included brain injury (13.3%), unconsciousness (12.5%), stroke (12.9%), general cerebral convulsion (7.9%), polytrauma (6.4%), and cardiac arrest (5.0%). The rate of prehospital endotracheal intubation was 15.1%. In 1.1% of patients, a thoracic drainage was established.ConclusionsIn recent years the number of helicopter rescue missions increased, along with injury severity. The total number of patients with NACA 6 and 7 was extremely high, and demonstrates the need for an efficient emergency medical rescue system that includes helicopters.

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Factors to Consider in the Use of Vital Signs Wearables to Minimize Contact With Stable COVID-19 Patients: Experience of Its Implementation During the Pandemic

Frontiers in Digital Health ◽

10.3389/fdgth.2021.639827 ◽

2021 ◽

Vol 3 ◽

Author(s):

Esther Monica Pei Jin Fan ◽

Shin Yuh Ang ◽

Ghee Chee Phua ◽

Lee Chen Ee ◽

Kok Cheong Wong ◽

...

Keyword(s):

Personal Protective Equipment ◽

Vital Signs ◽

Healthcare Facility ◽

Wearable Device ◽

Protective Equipment ◽

Healthcare Industry ◽

Patient Contact ◽

Vital Signs Monitoring ◽

Number Of Patients ◽

Patients Experience

The COVID-19 pandemic has created a huge burden on the healthcare industry worldwide. Pressures to increase the isolation healthcare facility to cope with the growing number of patients led to an exploration of the use of wearables for vital signs monitoring among stable COVID-19 patients. Vital signs wearables were chosen for use in our facility with the purpose of reducing patient contact and preserving personal protective equipment. The process of deciding on the wearable solution as well as the implementation of the solution brought much insight to the team. This paper presents an overview of factors to consider in implementing a vital signs wearable solution. This includes considerations before deciding on whether or not to use a wearable device, followed by key criteria of the solution to assess. With the use of wearables rising in popularity, this serves as a guide for others who may want to implement it in their institutions.

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A study of patients’ quality of life more than 5 years after trauma: a prospective follow-up

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01652-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Fanny Vardon-Bounes ◽

Romain Gracia ◽

Timothée Abaziou ◽

Laure Crognier ◽

Thierry Seguin ◽

...

Keyword(s):

Quality Of Life ◽

Economic Impact ◽

Physical Functioning ◽

Major Trauma ◽

Injury Severity ◽

Number Of Patients ◽

Sf 36 ◽

Socio Economic Impact

Abstract Background The long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment. Methods A prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability. Results Two hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability. Conclusion More than five years after a moderate to severe injury, patients’ quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.

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Composite and Wearable Sensor Kit for Location Aware Healthcare Monitoring and Real-Time Trauma Scoring for Survival Prediction.

10.20944/preprints201806.0479.v1 ◽

2018 ◽

Author(s):

Amit Walinjkar

Keyword(s):

Critical Care ◽

Real Time ◽

Injury Severity ◽

Vital Signs ◽

Physiological Parameters ◽

Care Team ◽

Medical Emergency ◽

Traumatic Experience ◽

The Individual ◽

Critical Care Team

With the availability of wearable health monitoring sensor modules like 3-Lead Electrocardiogram (ECG), Pulse Oximeter (SpO2), Galvanic Skin Response (GSR), Hall effect sensor (for measuring Respiratory Rate), Blood Pressure and Temperature measuring and sensing elements, it has now become possible to device a composite health status monitoring kit that can measure vital signs and other physiological parameters pertaining to human health in real time. Traditionally, the physiological parameters along with vital signs related examination was possible only in a hospitalized or ambulatory environment, however due to advances in sensing and embedded system technology and miniaturization of data acquisition and processing elements health monitoring has become possible even when individuals remain engaged in their day to day activities at the convenience of space and location. The patients or individuals subject to monitoring may suffer from a traumatic experience due to their medical condition and may need emergent incidence response and the critical care team may have to prepare for the treatment only after the patient arrives, which often is too late, as in case of cardiac arrests or severe injuries. The research focused on real-time health status monitoring and trauma scoring using standard physiological parameters along with standard telemetry protocols to make the critical care team aware of an emergent situation and prepare for a medical emergency. Vital signs and physiological parameters (heart rate, temperature, respiratory rate, and blood pressure, SpO2) were measured in real time from human subjects non-invasively. In order to enable monitoring of the patients engaged in day to day activities, errors due to the motion were removed using stationary wavelet transform correction (correlation coefficient of 0.9 after correction) and signals from various sensors were denoised, filtered and were encoded in a format suitable for further data analysis. A composite sensor kit capable of monitoring vital signs and physiological parameters can be very useful in incident response when an individual undergoes a traumatic experience related to stroke, cardiac arrest, fits or even injury, as along with monitoring information the kit can calculate scores related to trauma like the Injury Severity Score (ISS), National Early Warning Signs (NEWS), Revised Trauma Score (RTS). Trauma Injury Severity Score (TRISS), Probability of Survival (Ps) score. An open access database of vital signs and physiological parameters from Physionet, MIMIC 2 Numerics (mimicdb/numerics) database was used to calculate NEWS and RTS and to generate correlation and regression models using the vital signs/physiological parameters for a clinical class of patients with respiratory failure and admitted to Intensive Care Unit (ICU). NEWS and RTS scores showed no significant correlation (r = 0.25, p<0.001) amongst themselves, however together NEWS and RTS showed significant correlation with Ps (blunt) (r = 0.70, p<0.001). RTS and Ps (blunt) scores showed some correlation (r = 0.63, p<0.001) and NEWS score showed significant correlation (r = 0.79, p<0.001) with Ps (blunt) scores. Furthermore, since individuals have to be monitored regardless of location, these kits have to have a built-in capability to locate the individual so that the incident response team can locate the individual based on Global Positioning System coordinates (GPS). A Quantum GIS (Geographical Information System) application using real-time GPS coordinates (OpenStreetMap coordinates) was used to calculate the shortest path using QGIS Network Analysis tool to demonstrate the calculation of shortest path and direction to locate the nearest service provider in shortest time. Along with locating the nearest healthcare service provider, it would help if the critical care team could be made aware of the physiological parameters and trauma scores using standard protocols accepted across the globe. The physiological parameters from the sensors along with the calculated trauma scores were encoded according to a standard Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) coding system and International Code of Diseases (ICD) codes and the trauma information was logged to Electronic Health Records (EHR) using Fast Health Interoperability Resources (FHIR) servers. FHIR servers provided interoperable web services to log the event information in real time. It could be concluded that analytical models trained on existing datasets can help in analyzing a traumatic experience or an injury and the information can be logged using a standard telemetry protocol as a telemedicine initiative. These scores enable the healthcare service providers to estimate the extent of trauma and prepare for medical emergency procedures and find applications in general and military healthcare.

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The incidence of occult endocrinopathies in patients with cancer undergoing immunotherapy in community practice.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e14571 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e14571-e14571

Author(s):

Ahmed Abdalla ◽

Aditi Singh ◽

Hussein Gharib ◽

Benjamin Huber ◽

Sindhu Janarthanam Malapati ◽

...

Keyword(s):

Clinical Trials ◽

Testosterone Level ◽

Single Agent ◽

Laboratory Data ◽

Endocrine Function ◽

Hormone Levels ◽

Primary Indication ◽

Number Of Patients ◽

The Mean ◽

Stimulating Hormone

e14571 Background: Immune checkpoint blockade (IO) can induce inflammation of the pituitary, thyroid or adrenal glands. This usually results in non-specific symptoms such as headache, low-energy, nausea and vomiting, which can be difficult to differentiate from symptoms associated with cancer and therapy-related symptoms. Therefore, the exact incidence of endocrinopathies is exceedingly difficult to estimate in community practices. Also, the variable methods of assessment, diagnosis, and monitoring used in different clinical trials make it challenging to precisely measure the incidence of endocrinopathies. Methods: This is a single-center retrospective chart review of patients diagnosed with cancer receiving immunotherapy for cancer treatment who had routine hormone levels checked during their treatment. Data collected includes tumor types and the types of IO agents used. Laboratory data collected included thyroid-stimulating hormone (TSH), testosterone level, follicular stimulating hormone (FSH), luteinizing hormone (LH), cortisol levels. Results: In total, 75 patients were included in the study. The primary indication for IO was lung cancer in 43 patients (57%), genitourinary tumors (12%), melanoma (12%) and head & neck cancers (5.3%). Single-agent nivolumab (39 patients) was the most common IO agent used followed by single-agent pembrolizumab (22 patients), ipilimumab (11 patients), atezolizumab (3 patients), avelumab (1 patient) (There was one patient who got nivolumab initially and then pembrolizumab). Nine patients were treated with ipilimumab/nivolumab combination. The mean number of cycles received was 9.1. The total number of patients who developed at least one abnormal hormone level was 57(76%), with 33 out of 74 (45%) patients had at least one abnormal TSH, 29 out of 44 (66%) patients had at least one abnormal testosterone level, 10 out of 49 (20.4%) patients had at least one abnormal FSH and/or LH level, 36 out of 52 (69%) patients had at least one abnormal cortisol level. The mean number of days from starting IO to develop the first abnormal laboratory result was 106 days. Conclusions: The incidence of endocrinopathy was significantly high in patients receiving IO in this study, which is higher than what is reported in previous clinical trials. This could be due to frequent testing in asymptomatic patients and strict laboratory cut-off values which is not always clinically meaningful. This finding may highlight the importance of routine monitoring of the endocrine function during IO treatment. Routine measurement of hormone levels can detect asymptomatic endocrinopathy which may warrant further work-up and treatment. These findings should be validated in a larger prospective study.

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Vasopressor Use during Emergency Trauma Surgery

The American Surgeon ◽

10.1177/000313481408000518 ◽

2014 ◽

Vol 80 (5) ◽

pp. 472-478 ◽

Cited By ~ 5

Author(s):

Robert M. Van Haren ◽

Chad M. Thorson ◽

Evan J. Valle ◽

Gerardo A. Guarch ◽

Jassin M. Jouria ◽

...

Keyword(s):

Cardiac Arrest ◽

Mortality Rate ◽

Odds Ratio ◽

Injury Severity ◽

Trauma Surgery ◽

Vital Signs ◽

Severely Injured ◽

Severely Injured Patients ◽

Vasopressor Use ◽

Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

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Devastating Consequences of Subway Accidents: Traumatic Amputations

The American Surgeon ◽

10.1177/000313480607200118 ◽

2006 ◽

Vol 72 (1) ◽

pp. 74-76 ◽

Cited By ~ 3

Author(s):

Alexandra A. Maclean ◽

Andrea M. O'Neill ◽

H. Leon Pachter ◽

Maurizio A. Miglietta

Keyword(s):

New York ◽

Glasgow Coma Scale ◽

Limb Salvage ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Injury Severity ◽

Vital Signs ◽

Wound Infection Rate ◽

Operative Procedures ◽

Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

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Validation of the Pediatric Physiological and Anatomical Triage Score in Pediatric Patients with Burn Injuries

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19001389 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s61-s61 ◽

Cited By ~ 1

Author(s):

Chiaki Toida ◽

Takashi Muguruma ◽

Ichiro Takeuchi ◽

Naoto Morimura

Keyword(s):

Pediatric Patients ◽

Injury Severity ◽

Characteristic Curve ◽

Vital Signs ◽

Burn Injuries ◽

Priority Ranking ◽

Life Saving ◽

Revised Trauma Score ◽

Trauma Score ◽

Accuracy Of Prediction

Introduction:Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.Aim:This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.Methods:A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).Results:Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).Discussion:The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.

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Perineal Injuries at a Large Urban Trauma Center: Injury Patterns and Outcomes

The American Surgeon ◽

10.1177/000313480907500410 ◽

2009 ◽

Vol 75 (4) ◽

pp. 317-320 ◽

Cited By ~ 2

Author(s):

Patrizio Petrone ◽

Kenji Inaba ◽

Nir Wasserberg ◽

Pedro G. R. Teixeira ◽

Grant Sarkisyan ◽

...

Keyword(s):

Los Angeles ◽

Injury Severity ◽

Medical Center ◽

Vital Signs ◽

University Of Southern California ◽

Associated Injuries ◽

Survival Group ◽

Revised Trauma Score ◽

Perineal Injuries ◽

Trauma Score

The purpose of this study was to describe the characteristics of this unique patient population, their clinical presentations, and outcomes. The Los Angeles County and University of Southern California Medical Center Trauma Registry was used to retrospectively identify patients who sustained perineal injuries. Information included gender, age, vital signs, trauma scores, mechanisms of injury, studies performed, surgeries performed, and outcomes. Pediatric patients and injuries related to obstetric trauma were not included. Sixty-nine patients were identified between February 1, 1992 and October 31, 2005. One patient died on arrival; 85 per cent (58 of 68) were males, mean age was 30 ± 12 years, and there was a penetrating mechanism in 56 per cent. Vital signs on admission were systolic blood pressure 119 ± 33 mmHg, heart rate 94 ± 27 beats/minute, and respiratory rate 20 ± 6 breaths/min. Glasgow Coma Scale (GCS) was 13 ± 3, Revised Trauma Score (RTS) was 7.2 ± 1.5, and Injury Severity Score (ISS) was 11 ± 12. CT scan was obtained for 23 (33%) patients. Lower extremity fractures were 35 per cent and pelvic fractures 32 per cent. The most common surgery was debridement and drainage, diversion with colostomy in five patients (7%). Overall mortality was 10 per cent. Mortality group mean scores were: GCS, 6; RTS, 5.74; and ISS, 34. The survival group mean scores were: GCS, 14; RTS, 7.7; and ISS, 8. There was a statistically significant association between mortality and GCS, RTS, and ISS scores ( P < 0.001). Most patients with perineal injuries (93%) can be managed without colostomy. Associated injuries are not uncommon, particularly bony fractures. Mortality is mostly the result of exsanguination related to associated injuries.

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Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

BMC Emergency Medicine ◽

10.1186/s12873-020-00353-8 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Erik Höglund ◽

Magnus Andersson-Hagiwara ◽

Agneta Schröder ◽

Margareta Möller ◽

Emma Ohlsson-Nevo

Keyword(s):

Emergency Medical Services ◽

Vital Signs ◽

Signs And Symptoms ◽

Emergency Department Patient ◽

Medical Services ◽

Men And Women ◽

Safety Issues ◽

Levels Of Care ◽

Emergency Medical ◽

Number Of Patients

Abstract Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

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