Prehospital and Disaster Medicine最新文献

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: 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: 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: 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.

Background: Just as prospective differentiation between true emergencies and calls for subacute patients is critical to the delivery of prehospital care, retrospective differentiation is critical to research and quality improvement. Determining the acuity of patients based on the type of care they received could complement the vital-sign-based instruments currently popular, yet imperfect. The study aim was to create a consensus definition of time-dependent care and a list of time-dependent interventions in paramedicine.

Methods: The study was a Delphi approach consisting of four rounds of voting by a bi-provincial panel of 22 Canadian key informants representing medical first responders, paramedics, and physicians - first to agree on a definition of time-dependent care - then to categorize 29 clinical and 34 pharmacological interventions.

Results: Based on the consensus definition of "A majority of patients who should receive the intervention, according to provincial protocols, would suffer a direct prejudice to their health or safety if the intervention, provided on its own, was not performed within eight minutes of the initial call," the panel reached consensus on 52 of 63 interventions (82.5%), of which 17 (32.7%) were voted time-dependent (11 clinical [64.7%] and six pharmacological [35.3%]). Clinical interventions included airway suction or de-obstruction, cricothyrotomy, positive pressure ventilation, chest decompression, cardiopulmonary resuscitation, defibrillation, cardioversion, pacing, and hemorrhage control. Pharmacological interventions included medication classed as sympathomimetics, caloric agents, antiarrhythmic agents, anticonvulsants, or tranquilizers.

Conclusion: The panel reached a consensus on a definition of time-dependent care and used this to identify prehospital interventions that could serve as an instrument to improve care and system performance.

Introduction: The Syrian Civil War (SCW) began in 2011 and has resulted in numerous cases of war-related civilian injuries. The modified Rapid Emergency Medicine Score (mREMS) is widely used as an effective tool for assessing clinical status and mortality risk, particularly in intensive care units (ICUs) and emergency departments (EDs). However, to date, no study has evaluated the ability of mREMS to predict mortality in patients injured during the SCW.

Study objective: The primary objective of this study was to evaluate the performance of mREMS in predicting in-hospital mortality among adult trauma patients injured during the SCW. The secondary objective was to analyze the epidemiological characteristics of both adult and pediatric populations affected by the SCW.

Methods: This single-center, retrospective observational study included patients who were injured during the SCW and presented to the ED from January 2012 through January 2016. Data from 4,074 adult patients and 1,379 pediatric patients were analyzed. The diagnostic and prognostic performance of the mREMS was specifically assessed in the adult cohort. Additionally, an epidemiological evaluation of the demographic and clinical characteristics of both cohorts was conducted.

Results: Among the 4,074 adult patients included in the study, a total of 3,657 (89.8%) were male and 417 (10.2%) were female. In-hospital mortality occurred in 484 patients (11.9%). Adult patients admitted to the ICU exhibited a mortality rate 7.6-times higher than those who were not admitted (odds ratio [OR] = 7.6; 95% confidence interval [CI], 6.2-9.3). The analysis of the mREMS revealed a median score of eight for survivors and fourteen for non-survivors, demonstrating a statistically significant difference (P < .001).

Conclusion: The present study demonstrated that the majority of civilians injured during the SCW were young males. Furthermore, this study's findings indicated that the mREMS exhibits excellent performance in predicting in-hospital mortality among trauma patients injured during the SCW.

Introduction: Thermal protective clothing (TPC) protects firefighters from physical threats associated with structural firefighting. However, it also limits the release of body heat generated, which can result in hyperthermia and dehydration. Despite the prevalence of winter structure fires in the United States, there is a paucity of cold-weather firefighting research.

Study objective: This study documented physiological responses to moderate-intensity exercise in a cold environment while wearing TPC with the hypothesis that while exercising in firefighting TPC, a cold environment would maintain normal core body temperature and decrease extremity temperature compared to a thermal neutral environment.

Methods: Fourteen firefighters (two females; 30.9 [SD = 8.1] years) participated in both a thermal neutral (20°C) and cold (-8°C) condition simulation. Each subject was outfitted with a heart rate (HR) monitor, eight surface temperature sensors, and a core temperature (Tc) capsule prior to donning TPC. For each condition, subjects walked on a treadmill in an environmental chamber to simulate the common firefighting work intervals of two 20-minute sessions, with a short rest in between, followed by a 20-minute rehabilitation period. Body temperatures, HR, respiratory rate (RR), rate of perceived exertion (RPE), and thermal sensation, comfort, and preference were recorded during exercise and recovery.

Results: Core temperature, HR, RR, and RPE increased during exercise in both conditions. Mean skin temperature (MST) rose during the thermal neutral condition but not during the cold condition. Overall, Tc (0.3 [SD = 0.4]°C; P = .0142), HR (26.3 [SD = 8.36] BPM), RR (3.56 [SD = 5.6] BPM), RPE (2.0 [SD = 1.9]), and MST (3.4 [SD = 1.2]°C) were all higher at the end of the neutral condition compared to the cold condition. During recovery, most measures returned to baseline after approximately five-to-20 minutes in both conditions, but they recovered more slowly in the thermal neutral condition.

Conclusion: Moderate-intensity exercise in TPC increased physiological and perceptual measures more in a thermal neutral environment than a cold environment. Recovery was faster following the cold condition. This may allow firefighters to work for longer durations or recover faster, possibly allowing for fewer crews on scene. However, this study did not account for the risk of other cold induced conditions due to prolonged exposure, such as frostbite. Further investigations should be conducted on cold weather firefighting and its impact on firefighters to establish guidelines and standard operating procedures.

On August 22, 2019, several cloud-to-ground currents struck the top of the popular hiking mountain Giewont (Tatra Mountains, Poland). At the scene, first aid and evacuation were provided by mountain emergency rescue services. The injured patients received care and were initially stabilized at a local general hospital. Some of the victims were then relocated to other nearby hospitals, regional trauma centers, or regional burn centers. This study is a retrospective analysis of regional health system response. The official records of the disaster response from the institutions involved were examined. Surveys were conducted through interviews with mountain rescuers, coordinators, and other health care workers regarding interventions, triage, and communication during the disaster response. The analysis was conducted in accordance with the guidelines of the Medical Commission of the International Commission for Alpine Rescue (ICAR-MEDCOM). There were 134 people involved in accidents: four died at the scene, four were considered severely injured, 118 were moderately and mildly injured, and eight had no signs of injury. Mountain rescue services were able to evacuate and provide first aid to all victims within four hours after activation. Close cooperation among various institutions involved, including mountain emergency rescue services, hospitals, fire departments, dispatch centers, and Helicopter Emergency Medical Services (HEMS), is critical to the successful management of mass-casualty incidents (MCIs) in mountain areas. Effective triage algorithms and communication structures should be implemented.