Novel Measurement Approaches Are Needed In The Pre-Hospital Setting To Prevent Accidental Hypothermia.

Accidental hypothermia can be fatal if not recognised early, and effective management relies on the accurate recording of core body temperature. The focus of this critique - a recent study by Podsiado et al. (2019) – highlighted the need for reliable measurement of core body temperature in the pre-hospital and austere setting. An esophageal temperature probe may prove to be a reliable, and best practice approach for measuring core body temperature in critically unwell, unconscious patients suffering accidental hypothermia.

The Covid19 Pandemic and the Emergent Need for Quarantine Medicine.

The scale of the Covid19 pandemic has changed the landscape of healthcare services around the world. Quarantine is one of many non- pharmaceutical interventions historically used in managing pandemics but there is currently no global medical consensus on the best format, with most countries employing a continuously reviewed system to determine needs.

Refining Operational Vertical Mobility

Environmental hazards have an unrecognized and unmet influence on operations. The mistranslation of vertical access and rescue customs and practices, to an environment with uncertain and unrecognizable hazards, can lead to catastrophic failure. Application of these customs and practices to meet the complex operational constraints and environmental hazards central to high-hazard mission sets, has persisted and confused operational vertical rescue teams. Improvised approaches, using minimal but readily available equipment, can close gaps between theory and practice and between discrete concepts in a continuously evolving environment. This paper addresses existing gaps in operational vertical response utilizing a context-specific approach similar to the authors of the original Tactical Combat Casualty Care (TCCC) project published in the 1996 supplement of Military Medicine (Butler FK, 1996). A pragmatic framework is introduced, which has been evolving for the past 10 years within USSOCOM, Federal special operations teams, and municipal special response elements termed Operational Vertical Mobility (OVM). Operational Vertical Mobility (OVM) creates an adaptable model within high-hazard vertical response in the same manner that TCCC disrupted prehospital tactical medicine (Butler FK Jr, 2007). Since normative traditional civilian vertical practices do not translate well into the context of a Volatile, Uncertain, Complex, Ambiguous, Threat containing, and Time-compressed (VUCA-T2) environment, OVM reframes vertical response key performance parameters (KPP’s) in opposition to traditional design principles. OVM promotes creating theories out of practice rather than forcing theories into practice. In order to appraise the key performance parameters of verticality within a VUCA-T2 environment, a panel of practitioners with expertise across multiple vertical disciplines and specialized units analyzed relevant guidelines, principles, industry recommendations, nonlinear sciences, and high reliability organizational characteristics for successful operational application.

Crush Injury During Winter in the Backcountry: A Case Report

Crush injuries are complicated and uncommon in prehospital medicine. They combine the complications of traumatic injuries, medical syndromes, and technical rescue. This conflagration of complex management issues can be very difficult for prehospital providers to control. Managing a crush injury in an austere environment adds a much higher degree of complication. In this article we present the case of an adult male who sustained a right leg injury when a boulder pinned his leg on a trail in Eldorado Springs Canyon, Colorado during a winter storm with subfreezing temperatures. Remote location and a harsh environment added to the complexity of this already difficult patient injury. A positive outcome was achieved by early recognition of the potential for crush syndrome by the treating medics, a coordinated lift operation with rescue crews, and a prompt field evacuation via litter.Cu

Into the Warm Zone: Essential Elements and Considerations for Developing Warm Zone Capabilities

In 2017, a scholarship funded study tour was undertaken to learn how agencies in the United States of America were addressing a capability gap in relation to accessing, treatment and rescue of victims located in the warm zone of Active Shooter Hostile Events. Since this initial trip a number of after action reports and reviews of such incidents have been released. This paper explores the key learnings from these events to establish several essential elements and important considerations for the development of multi-agency warm zone capabilities. The incidents looked at are the: 2013 LAX Airport Active Shooter 2015 San Bernardino Terrorist Attack 2016 Pulse Nightclub Terrorist Attack 2017 Las Vegas Mass Shooting

Understanding Adaptive Bioterrorism Methods: Counter Terrorism Medicine implications of Bongkrekic Acid Poisoning

Terrorist attacks fall under a unique category within the disaster medicine (DM) spectrum. Unlike accidental man-made disasters where there is an inherent pre-disaster objective to reduce risk and mitigate potential hazards, terrorist events have the aim of intentionally inflicting maximum casualties and disrupting the day to day functioning of society.

Decision-Making for UK Police on the Transportation of Casualties with Life-Threatening Injuries

This paper examines the published evidence on police first aid training, the legal context of police first aid and ambulance dispatch, police decision making, provision of pre-hospital care in various models and the transportation of casualties to hospital other than by ambulance. It aims to encourage those involved in police forces’ clinical governance to consider the matter locally and proposes a model that may assist with such consideration and the formulation of policies and procedures if they are deemed necessary.

Application of the Ultraviolet Germicidal Irradiation system can reduce microbial surface contamination in ambulance compartments.

Emergency responders play a vital role in the treatment of critically ill or injured patients, as they are often the first point of contact for the patient in the healthcare setting. Emergency medical services also play a vital role in the prevention and control of the transmission of communicable diseases and ensuring best practice infection control is enacted. Lindsley et al. (2018) recently examined the efficacy and impact of an ultraviolet germicidal irradiation (UVGI) system to disinfect the interior of an ambulance. A critique of this article is presented in the following.

Staff perceptions on the role and value of chaplains in first responder and military settings: A scoping review

Background Chaplains in first responder and military services support staff prior to, during and after critical incidents. Some studies have explored the role of chaplains in these settings predominantly in the military and from chaplains’ perspectives. However, few studies have explored the perspective of staff. This scoping review aims to map the literature on staff perceptions of the role and value of chaplains in first responder and military settings. Method A scoping review using the Arksey & O’Malley (2003) and Joanna Briggs Institute Scoping Review Methodology was conducted. English language peer-reviewed and grey literature in CINAHL, PubMed, PsychINFO, ProQuest and Google Scholar from 2004-2019 was reviewed for inclusion. Records were included if they provided staff perspectives on the role and value of chaplains in first responder and military settings. The initial search identified 491 records after removal of duplicates. All titles and abstracts were then screened for relevance to the research question and 84 were selected for full-text review. Seven records were included in final review; five dissertations and two peer-reviewed articles. Five of these were from the military and two from the police. Data were extracted and thematically analysed to identify staff perceptions of the role, skills and attributes, and value of chaplains in first responder and military settings. Results Staff understood the role of chaplain to include the provision of spiritual and pastoral care and guidance and, in the case of police, providing scene support. Staff from all of the services identified requisite skills and attributes for chaplains such as being available, approachable and engaged; counselling; maintaining confidentiality and trust; being organisationally aware; and possessing distinct personality traits and knowledge of specialty content areas. The value chaplains brought to their services emerged from chaplains being trusted as a result of being proactively available for staff, families and bystanders for formal and informal conversation; organisational belonging and awareness resulting in enhanced staff satisfaction and retention; and promoting staff physical, mental, social and spiritual wellbeing. Conclusions Although military and police staff identified spiritual, psychological and social benefits to chaplains maintaining an active and visible role in their services, the small number of papers identified make generalisation of these findings to other first responder services problematic. Further research is therefore required to understand the impact of the chaplain’s role as part of the care team in first responder services.

Applied Pathophysiology of Blast Injuries

Safe and effective response to blast injuries is enhanced by an understanding of the physics and applied pathophysiology of these events. The mechanisms of injury are presented, along with an interpretation of the clinical implications in the tactical environment.