Prehospital and Disaster Medicine最新文献

Background: The dynamic nature of the prehospital environment poses a challenge for maintaining optimal storage conditions for medicines and other products. Failure to ensure adequate temperature control can impact drug efficacy, potentially compromising effective prehospital care. This study aims to monitor temperature variations in vehicles operated by a helicopter Emergency Medical Service (EMS) in the east of England to evaluate temperature variation and the potential exposure of therapeutic products to extreme temperatures.

Methods: This was a prospective observational study over a 12-month period (September 2022 through August 2023). ALTA Industrial Wireless temperature sensors were deployed across five Volvo XC90 rapid response vehicles (RRVs) and an AgustaWestland 169 (AW169) helicopter operated by Essex & Herts Air Ambulance (EHAAT). One RRV (RRV02) remained permanently outside for the period of observation. Sensors recorded at 30-minute intervals, triggering alerts if temperatures exceeded 25°C or dropped below 2°C. Ambient data were obtained from the Writtle Weather Station, via the Met Office Integrated Data Archive System (MIDAS). The study did not involve any patients and ethical board review was not required.

Results: A total of 102,524 readings were recorded; temperatures ranged from -9°C to 46.8°C. The RRV02 recorded the lowest monthly mean (7.9°C) while the AW169 recorded the highest (24.9°C). Overall, daily maximum temperatures ranged from 17.7°C to 46.8°C, with the AW169 reaching 46.8°C in May. Daily minimum values ranged from -9°C to 19.6°C, with the RRV02 recording -9°C in December.

Conclusion: Temperatures inside the vehicles and aircraft frequently exceed recommended limits for environmental temperatures. Indoor RRV storage provides some protection from extreme temperatures, particularly mitigating against low temperatures. The AW169 aircraft demonstrated the poorest overall temperature control. These results can be used to guide effective storage protocols and climate control strategies to ensure the integrity of therapeutic products.

Introduction: Echocardiography is the preferred method for the visual assessment of bubble load in divers. This study evaluates the feasibility of a microteaching program for training combat medics to perform ultrasound measurements using echocardiography for self-monitoring decompression stress on the waterside.

Materials and method: A microteaching was provided to combat medics of the Netherlands Armed Forces. Participants used a handheld ultrasound device connected to a tablet. After two minutes practice time, medics performed and recorded videos on randomly assigned partners while being assessed by an anesthesiologist. Three outcomes were measured: (1) observer-assessed performance adapted from Objective Structured Assessment of Technical Skills (OSATS); (2) self-perceived procedure experience; and (3) video recording quality on a five-point scale.

Results: All 21 combat medics completed the microteaching program. Three out of 21 video recordings were lost due to technical issues. All participants successfully obtained at least a partial cardiac view (median time: 61 seconds). Performance scores indicated near-competence across preparation, time-motion, and procedural flow. Image quality ratings by two reviewers showed near-perfect intra-rater agreement (κ = 0.904 and κ = 0.960) but substantial inter-rater variability (κ = 0.671); the assessor's median scores were 2.75 and 3.0 out of 5.0, respectively. Most recordings received average scores of 3.0 or higher.

Conclusion: This study demonstrates that combat medics, following a brief microteaching session, were able to acquire cardiac ultrasound images partially suitable for assessing vascular gas emboli (VGE). These findings support microteaching as a feasible first step in echocardiography training for combat medics in austere environments.

Introduction: Triage is an essential process used to adequately allocate resources and thus increase chances of survival in case of mass-casualty incidents (MCIs). Several triage scales are currently used, but data regarding their performance remain scarce. The objective was to compare the performance of two prehospital triage algorithms (Sieve versus SwissPre) using a validated physiological simulator.

Methods: This was a web-based, randomized open-label study. A real-time evolutive simulator based on a heart-lung-brain interaction model embedding functional blocks was used to simulate the evolution of vital parameters. Participants, who were randomly allocated to either algorithm, were asked to triage 30 patients in random order. The primary outcome was the triage score (each correct decision was awarded one point). The "Immediate patients" were defined as those who would die within the first hour according to the physiological model. The secondary outcome was the duration of patient triage.

Results: Out of 71 participants, 67 (94.4%) were included in the final analysis. The Sieve group achieved a mean score of 17.1 out of 30 (95%CI, 16.3 to 17.8). The SwissPre group scored 15.5 out of 30 (95%CI, 14.5 to 16.5). The mean difference between groups was 1.6 points (95%CI, 0.4 to 2.8; P = .011) in favor of the Sieve algorithm. Triage duration did not differ significantly between the Sieve (mean 43 minutes, SD = 10) and SwissPre (mean 46 minutes, SD = 23) groups, with a mean difference of three minutes (95%CI, -12 to 6; P = .507).

Conclusions: The simpler Sieve algorithm may slightly outperform the more complex SwissPre in accurately categorizing critically injured patients who would likely die within 60 minutes if left untreated. No significant difference was observed in triage speed. However, these exploratory findings should be interpreted cautiously, considering the mean difference was modest and the controlled simulated setting, limiting generalizability.

Introduction: In Jishishan County, Linxia Prefecture, Gansu Province, China, the altitude ranges from 1,787 meters to 4,308 meters. At 23:59 Beijing time on December 18, 2023, a magnitude 6.2 earthquake struck Jishishan County. The objective is to report the injury characteristics and medical treatments of those injured in the earthquake.

Methods: The injury and treatment data were retrospectively collected and analyzed for earthquake-related injuries among patients admitted to the People's Hospital of Linxia Hui Autonomous Prefecture and the Traditional Chinese Medicine Hospital of Linxia Hui Autonomous Prefecture.

Observations: A total of 166 patients were hospitalized: 142 at the People's Hospital of Linxia Hui Autonomous Prefecture and 24 at the Traditional Chinese Medicine Hospital of Linxia Hui Autonomous Prefecture. Among the injured, 40.3% presented with a single injury. The others had multiple injuries: 28.3% had two injuries, 14.5% had three injuries, 12.1% had four injuries, 4.2% presented with five injuries, while only 0.6% were diagnosed with six injuries. Additionally, 78.9% involved fractures alone, 36.8% involved lung contusions, and 34.9% involved both fractures and lung contusions. Conservative treatment was used slightly more than surgery (54.8% versus 45.2%). Among the 75 surgical cases, internal fixation and sutures were the most common (17.4% each). In total, 53.0% of the injured were treated and discharged and 47.0% were transferred to provincial hospitals. In addition, the outcome of injured patients with differing injury conditions was different.

Analysis: Fractures and multiple injuries were the primary injury types in this study. Suturing and internal fixation were the most common surgical interventions. The core findings of this study provide an important reference for regionalized prevention and treatment of rural earthquake injuries in high-altitude regions.

A chemical explosion and fire erupted in Conakry, Guinea, West Africa on December 18, 2023, destroying Guinea's main fuel depot and resulting in 25 dead and 459 injured. Fifteen of the deaths occurred directly at the explosion site. Firefighters initiated efforts to control the blaze and transported injured, non-ambulatory victims to local hospitals with assistance from the military, Red Cross, and mining companies. Thirteen clinical facilities within an eight-mile radius of the explosion received burn and non-burn victims, with only one of these, Donka National Hospital, capable of handling burn victims. Many less seriously injured victims self-selected where they sought care, although anecdotal information indicates that an unknown number of injured did not seek care or chose to leave the city. The disaster marked the first time stakeholders from various sectors in the Guinean society (from first responders to mining companies) came together in a concerted response. Ranked 179th of 193 countries on the Human Development Index (HDI), the disaster rapidly outstripped Guinea's response and health care capabilities, leaving behind economic shocks affecting livelihoods and the local economy. These experiences underscore the need for improved capabilities and coordination in disaster planning, warning and communication systems, and prehospital and hospital response in developing countries.

Objective: Bystander cardiopulmonary resuscitation (CPR) has been shown to be associated with increased rates of survival from non-traumatic out-of-hospital cardiac arrest (OHCA). GoodSAM is a platform integrated into the computer-assisted dispatch system. The software allows the telecommunicator to send a link to the caller's smart phone. Once activated, the telecommunicator can see and hear the patient, and obtain breathing and heart rates using the camera and microphone on the caller's phone. The telecommunicator can use the platform to identify cardiac arrest and provide real-time compression feedback. It was hypothesized that telecommunicator use of video telecommunication would be associated with increased rates of pre-arrival CPR.

Methods: This was a retrospective review of all cardiac arrest resuscitations performed from July 2021 through February 2022 in the San Antonio Fire Department (SAFD) Emergency Medical Services (EMS) system - the seventh largest city in the United States. Data source was the Office of the EMS Medical Director (OMD) Cardiac Arrest Registry. Inclusion criteria included cardiac arrests for which resuscitation was attempted. Exclusion criteria were cardiac arrest was witnessed by EMS personnel, or missing data. Dataset included: location of arrest, presumed etiology of the arrest, if dispatch CPR instructions were given; caller compliance; type of CPR performed; who witnessed the arrest; and who performed the CPR prior to EMS. Patients were dichotomized as to whether video telecommunication was used by the paramedic telecommunicator. A case was recorded as having received pre-arrival CPR if the initial CPR was performed by anyone other than the responding unit.

Results: A total of 779 cases were included in the study. Primary outcome, in the cases where video telecommunication was utilized, 46/74 (62%) received pre-arrival CPR, versus 324/705 (46%) without the use of video telecommunication, with an overall difference of 16.2% (95% CI, 4.6% to 27.9%; P = .008). When using video telecommunication, a larger proportion of the persons performing pre-arrival CPR were family members when compared to the cases where video telecommunication was not used (35% versus 17%).

Conclusion: Using video telecommunication to perform paramedic clinical dispatch telemedicine was associated with an increased rate of pre-arrival CPR. Further research will be required to show outcome-related results to determine if dispatch video and audio telemedicine can be used to increase survival in patients suffering OHCA.

Unfortunately, P value multiplicity continues to be a pervasive threat to statistical validity in medical research. Performing many hypothesis tests, and treating them each as if they were a single hypothesis, leads to a dramatic increase in the risk of false research claims. This editorial describes a simple method for authors to avoid P value multiplicity while improving clarity of the findings for the reader.

On March 28, 2025, a 7.7-magnitude earthquake struck the Sagaing region of Myanmar, resulting in 3,816 deaths and 5,104 injured, with Mandalay Region sustaining the most severe damage. Singapore Emergency Medical Team (SGEMT), verified by the World Health Organization (WHO) in 2024 as a Type-1 fixed Emergency Medical Team (EMT), was deployed in response. This mixed-methods study reports on the patient case mix and operational challenges encountered during the deployment. Data were derived from daily situation reports, clinical health records consistent with the WHO minimum data set (MDS), post-deployment review proceedings, and unstructured interviews with administrative, clinical, and logistics leads.Deployment was delayed by diplomatic complexities and logistical challenges in freight transport. Clinical operations commenced on April 8, 2025 at Bahtoo Stadium, Mandalay, where SGEMT managed 1,803 patients over eight days. Quantitatively, 21.6% presented with direct earthquake-related injuries, 7.9% with conditions indirectly related to displacement, and 70.5% with chronic or unrelated conditions, reflecting patterns observed in other post-earthquake responses. Acute respiratory infections were the predominant infectious disease. Most patients were female, underscoring the importance of gender-sensitive approaches. The integration of a physiotherapist in a Type-1 facility, beyond WHO EMT minimum standards, enhanced clinical efficacy and rehabilitative capacity.Qualitatively, thematic analysis guided by the 4Cs of disaster partnering -coordination, cooperation, communication, and collaboration - revealed critical enablers and constraints within the Association of Southeast Asian Nations (ASEAN) humanitarian framework. Findings highlight the need to reinforce regional coordination mechanisms to strengthen future disaster response in complex geopolitical situations.

On April 28, 2025, a large-scale blackout affected mainland Spain and Portugal for over ten hours, severely impacting Emergency Medical Services (EMS). Although the cause remains uncertain and initially cyberattack was a concern, it has most probably been related to infrastructure failure. This event exposed critical vulnerabilities in EMS preparedness, as no region had a specific contingency plan for power outages.The blackout led to wide-spread disruption, including traffic signal failures that caused accidents and delayed emergency response, and the collapse of communication networks that affected 1-1-2 emergency calls. Fuel shortages also emerged as gas stations became non-operational. Patients using home medical devices faced life-threatening situations, with at least one death reported due to a ventilator failure. The reliance on technology proved to be a major weakness, as many EMS systems lacked backup communication tools like satellite phones or analog radios, and many hospitals and ambulance bases were not prepared with stable generators and adequate fuel access.Coordination between EMS, hospitals, and other emergency services was challenged by incompatible protocols and equipment. Despite these difficulties, EMS demonstrated adaptability by prioritizing urgent care and reallocating resources. The event exposed systemic fragilities and underscored the need for robust emergency planning, interagency drills, technological redundancy, and investment in resilient infrastructure. This incident serves as a global wake-up call, emphasizing that health systems must be prepared for increasing risks from climate change, cyber threats, and energy insecurity. Emergency preparedness should shift from being reactive to proactive, focusing on flexible systems, coordinated action, and workforce training to ensure continuity of health care during future blackouts.

Introduction: For suspected acute myocardial infarction (AMI) and unstable angina patients, prehospital aspirin (ASA) administration has been the standard of care by Emergency Medical Services (EMS) field providers. Recently, Emergency Medical Dispatchers (EMDs), using Medical Priority Dispatch System (MPDS), provide telephone instructions to qualifying suspected AMI patients to take ASA, prior to EMS field provider arrival. No formal studies exist that measure time saved from earlier Dispatcher-Directed Aspirin Administration (DDAA).

Objectives: The primary objectives of the study were: (1) to determine the amount of time saved, if any, using DDAA; and (2) to describe the frequency of DDAA and Field Provider-Directed Aspirin Administration (FPAA).

Methods: The retrospective study analyzed EMD and EMS data collected during a six-month period at three dispatch services and three EMS agencies in the United States. The frequency and mean (plus 95% confidence interval [CI]) time of DDAA and FPAA were calculated. Reasons why patients who qualified to take ASA per dispatch protocol but did not take it were also assessed.

Results: A total of 108,459 EMS cases were analyzed; EMD/EMS delivered ASA to 4.0% (n = 4,113) of these patients. The most frequent primary impressions were: cardiac chest pain (angina), cardiovascular (CV)-chest pain (presumed cardiac), ST-segment elevation myocardial infarction (STEMI), and CV-chest pain - acute coronary syndrome (ACS; 50.0%). Overall, DDAA saved 13 minutes mean time (95% CI, 11.4-14.6; P < .001) (median: 12.3 minutes) from the case creation time.

Conclusions: It was found that DDAA provides measurable time savings in ASA delivery to patients. Further studies will need to assess if the reduction of ASA delivery time by EMDs has the potential to improve overall care and survival for patients. The study identified beneficial new knowledge for possible future enhancements to medical dispatch protocols and for EMS providers.