Prehospital and Disaster Medicine最新文献

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.

Introduction: Through a range of coping strategies, individuals seek to manage the stressors to which they are exposed, employing cognitive and behavioral responses that shape their emotional regulation of such events. Emergency first responders are routinely subjected to high-stress situations due to the nature of their duties and the continuous care of critically ill patients. This sustained exposure significantly increases their vulnerability to the development of mental health disorders, notably posttraumatic stress disorder (PTSD).

Objective: The aim of this study was to determine the coping strategies used by first responders when facing critical incidents and their association with PTSD.

Methods: A cross-sectional analytical study was conducted in 2022. All first responders from a volunteer fire department in a major Colombian city who voluntarily agreed to participate were included in the study. The participants were 28 ambulance crew members and 187 firefighters. Descriptive statistics were used for data analysis, and logistic regression models were applied to assess associations with PTSD. Principal components analysis was used to compute total scores, while the Lasso Method identified significant predictors.

Results: The first responders most often employed avoidance and denial as coping strategies in response to the demands of their work in the prehospital field. After witnessing devastating events, many of them turned to religion for stress relief.

Conclusions: The study identified the use of maladaptive strategies associated with PTSD among staff, making it critical to develop training programs that help first responders cope with critical incidents by developing adaptive coping skills.

This editorial discusses the common practice of using normality tests as a preliminary step for choosing between parametric and non-parametric methods. The editorial argues that such pre-testing is theoretically unfounded and practically harmful, as parametric tests are robust to moderate deviations from normality, while reliance on normality tests can distort error rates and mislead researchers.

Recent changes in artificial intelligence (AI) applications have made the technology accessible for practitioners in prehospital and disaster medicine in a way that was nearly unthinkable a few years ago. Initial anecdotal use of this technology has been met with enthusiasm and excitement. However, evidence-based research in the field is often lacking. The PDM Special Collection on Evidence-Based Artificial Intelligence in Prehospital and Disaster Medicine introduces a new forum for dissemination of innovative, high-impact research.

Introduction: Targeted identification, effective triage, and rapid hemorrhage control are essential for optimal outcomes of mass-casualty incidents (MCIs). An important aspect of Emergency Medical Service (EMS) care is field triage, but this skill is difficult to teach, assess, and research.

Study objective: This study assessed triage efficacy and hemorrhage control of emergency responders from different professions who used the Sort, Assess, Life-Saving Treatment (SALT) triage algorithm in a virtual reality (VR) simulation of a terrorist subway bombing.

Methods: After a brief just-in-time training session on the SALT triage algorithm, participants applied this learning in First VResponder, a high-fidelity VR simulator (Tactical Triage Technologies, LLC; Powell, Ohio USA). Participants encountered eleven virtual patients in a virtual scene of a subway station that had experienced an explosion. Patients represented individuals with injuries of varying severity. Metrics assessed included triage accuracy and treatment efficiency, including time to control life-threatening hemorrhage. Independent Mann-Whitney analyses were used to compare two professional groups on key performance variables.

Results: The study assessed 282 participants from the ranks of EMS clinicians and medical trainees. Most (94%) participants correctly executed both global SALT sort commands. Participants triaged and treated the entire scene in a mean time of 7.8 decimal minutes, (95%CI, 7.6-8.1; SD = 1.9 decimal minutes) with a patient triage accuracy rate of 75.8% (95%CI, 74.0-77.6; SD = 15.0%). Approximately three-quarters (77%) of participants successfully controlled all life-threatening hemorrhage, within a mean time of 5.3 decimal minutes (95%CI, 5.1-5.5; SD = 1.7 decimal minutes). Mean time to hemorrhage control per patient was 0.349 decimal minutes (SD = 0.349 decimal minutes). Overall, EMS clinicians were more accurate with triage (P ≤ .001) and were faster at triage, total hemorrhage control (P < .01), and hemorrhage control per patient (P < .004) than medical trainees.

Conclusions: Through assessments using VR simulation, it was observed that more experienced individuals from the paramedic (PM) workforce out-performed less experienced medical trainees. The study also observed that the medical trainees performed acceptably, even though their only formal training in SALT triage was a 30-minute, just-in-time lecture. Both of these findings are important for establishing evidence that VR can serve as a valid platform for assessing the complex skills of triage and treatment of an MCI, including the assessment of rapid hemorrhage control.