Prehospital and Disaster Medicine最新文献

Introduction: Natural disasters can increase the risk of infection by severely disrupting access to basic needs, including clean water and sanitation. Hand hygiene, one of the simplest and most effective ways to prevent infections, often becomes a challenge in such situations. The study focused on individuals living in temporary housing following the earthquakes in Turkey on February 6, 2023.

Objective: The main objective of this study was to assess the prevalence of hand hygiene practices and the factors affecting these behaviors among individuals affected by disasters.

Methods: Data were collected from more than 3,600 randomly selected participants living in container cities in four provinces: Adana, Osmaniye, Hatay, and Gaziantep. Both quantitative and qualitative research methods were used to ensure a comprehensive understanding of hand hygiene behaviors. A detailed questionnaire was used to assess factors such as frequency of hand washing, access to water, and use of hygiene products. In addition, focus group discussions were conducted to explore individual and environmental factors influencing hygiene practices.

Results: The results showed that although most individuals were aware of the importance of hand hygiene, several barriers, such as limited access to clean water, psychological stress, and a lack of hygiene supplies, hindered their ability to maintain proper hygiene. The frequency of hand washing increased slightly after the disaster, but challenges such as forgetfulness, time constraints, and skin irritation from inadequate hygiene products were common.

Conclusion: This study provides important insights into the prevalence of and factors influencing hand hygiene practices in post-earthquake container cities in Turkey. Findings suggest that although individuals have a basic awareness of the importance of hand hygiene, multiple barriers, including access to water, hygiene supplies, and psychological stress, significantly impact their ability to maintain proper hygiene practices after a disaster. This study highlights the critical need for continued education, improved access to hygiene supplies, and psychosocial support to sustain hygiene behaviors in post-disaster settings. By addressing both physical and psychological barriers, public health interventions can be more effective in reducing the risk of infectious diseases in disaster-affected populations. Furthermore, the study emphasizes the importance of preparedness for future disasters by ensuring hygiene resources are readily available and individuals are equipped with the knowledge and skills to maintain hygiene under adverse conditions.

Introduction: Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.

Study objective: The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.

Methods: A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.

Results: Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.

Conclusion: Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.

Background: Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.

Study objectives: The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).

Methods: A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.

Results: Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).

Conclusion: Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.

Objectives: During mass-casualty incidents (MCIs), prehospital triage is performed to identify which patients most urgently need medical care. Formal MCI triage tools exist, but their performance is variable. The Shock Index (SI; heart rate [HR] divided by systolic blood pressure [SBP]) has previously been shown to be an efficient screening tool for identifying critically ill patients in a variety of in-hospital contexts. The primary objective of this study was to assess the ability of the SI to identify trauma patients requiring urgent life-saving interventions in the prehospital setting.

Methods: Clinical data captured in the Alberta Trauma Registry (ATR) were used to determine the SI and the "true" triage category of each patient using previously published reference standard definitions. The ATR is a provincial trauma registry that captures clinical records of eligible patients in Alberta, Canada. The primary outcome was the sensitivity of SI to identify patients classified as "Priority 1 (Immediate)," meaning they received urgent life-saving interventions as defined by published consensus-based criteria. Specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated as secondary outcomes. These outcomes were compared to the performance of existing formal MCI triage tools referencing performance characteristics reported in a previously published study.

Results: Of the 9,448 records that were extracted from the ATR, a total of 8,650 were included in the analysis. The SI threshold maximizing Youden's index was 0.72. At this threshold, SI had a sensitivity of 0.53 for identifying "Priority 1" patients. At a threshold of 1.00, SI had a sensitivity of 0.19.

Conclusions: The SI has a relatively low sensitivity and did not out-perform existing MCI triage tools at identifying trauma patients who met the definition of "Priority 1" patients.

Background: To maintain procedural proficiency and certification according to the standards set by The Joint Commission-which accredits health care centers in the United States-thrombectomy-capable stroke centers (TSCs) must achieve a minimum annual procedural volume. The addition of thrombectomy-capable centers in a regional stroke care system has the potential to increase access but also to decrease patient presentations and procedural volume at nearby centers. This study sought to characterize the impact of certifying additional thrombectomy-capable centers on procedural volume by center in a large, urban Emergency Medical Services (EMS) system.

Methods: Data were collected from each designated thrombectomy-capable center in Los Angeles (LA) County from January 1, 2018 through June 30, 2022, during which a net total of five thrombectomy-capable centers were newly designated in the County. Per center volume for ischemic stroke presentations, intravenous (IV) thrombolysis administrations (IV tissue plasminogen activator [tPA]), and thrombectomy were tabulated by six-month interval. Median last-known-well-to-procedure times by LA County Public Health service planning area (SPA) were calculated. The effect of the number of designated centers on procedural volumes per center and median last-known-well-to-procedure times were analyzed via a linear mixed effects model with a log link function.

Results: Procedural volume, ischemic stroke presentation volume, and last-known-well-to-procedure times had high variability over the time period studied. Nonetheless, the median values for each metric in this EMS system remained largely stable over the study period. There was no statistically significant association between the number of thrombectomy-capable centers and per center procedural volumes or times-to-procedure.

Conclusion: The designation of additional thrombectomy-capable centers in a regional stroke care system was not significantly associated with the volume of procedures by center or times-to-procedure, suggesting that additional centers may increase patient access to time-sensitive interventions without diluting patient presentations at existing centers.

Introduction: Non-traumatic back pain commonly leads people to seek health care from paramedics via triple-zero (emergency phone number in Australia), yet the management approaches by providers of ambulance services remain unclear.

Study objectives: This study aims to investigate paramedic management of non-traumatic back pain in New South Wales (NSW), Australia, including the call characteristics, provisional diagnoses, and the clinical care being delivered by paramedics.

Methods: This study is a retrospective analysis of NSW Ambulance computer-aided dispatch and electronic medical records from January 1, 2017 through December 31, 2022. Adults who sought ambulance service with a chief complaint of back pain, were triaged as non-traumatic back pain, and subsequently received treatment by paramedics were included. Multivariable logistic regression models were used to explore factors associated with primary outcomes; ambulance transport, opioid use, and use of medication combinations were reported as odds ratios (ORs).

Results: There were 73,128 calls to NSW Ambulance with a chief complaint of back pain that were triaged as non-traumatic back pain. Of these, 54,444 (74.4%) were diagnosed with spinal pain, of which 52,825 (97.1%) were categorized by the paramedic as back or neck pain, 1,573 (2.9%) as lumbar radicular pain, and 46 (0.1%) as serious spinal pathology. Eight out of ten patients with spinal pain were transported to emergency departments. The medicine most administered by a paramedic was an opioid (37.4% of patients with spinal pain). Older patients (OR = 1.36; 95% CI, 1.30 to 1.44) were more likely to be transported to an emergency department. Patients with moderate (OR = 4.39; 95% CI, 4.00 to 4.84) and severe pain (OR = 18.90; 95% CI, 17.18 to 20.79) were more likely to be administered an opioid.

Conclusions: Paramedic management of non-traumatic back pain in NSW typically results in the administration of an opioid and transport to an emergency department.

Introduction: Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers' first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

Objective: This study's aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

Methods: This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Results: Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Conclusions: Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency's decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers' proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

Objectives: This study aimed to design and validate a measurement tool in Turkish to assess the challenges perceived by individuals involved in the disaster response process, such as volunteers, health care personnel, firefighters, and members of nongovernmental organizations (NGOs).

Methods: This methodological study was conducted from November 2023 through March 2024. The scale development process comprised item development, expert reviews, and language control, followed by the creation of a draft survey, pilot testing, application of the final scale, and statistical analyses. All stages, including validity and reliability analyses, were conducted in Turkish. While reliability analysis used Cronbach's alpha, item-total correlations, intraclass correlation coefficients, test-retest reliability, Tukey's additivity, and Hotelling's T-squared tests, validity analysis included Exploratory and Confirmatory Factor Analyses (EFA/CFA). Software such as AMOS 22.0 and SPSS 22.0 were used to perform statistical analysis.

Results: Findings indicated six dimensions with 23 items, with factor loadings ranging from 0.478 to 0.881. The CFA demonstrated acceptable fit indices. Test-retest analysis showed a robust positive correlation (r = 0.962) between the measurements. The scale's total Cronbach's alpha coefficient was 0.913. Sub-dimension reliability scores were calculated as follows: 0.865 for environmental and health, 0.802 for communication and information, 0.738 for organizational, 0.728 for logistical, 0.725 for individual, and 0.809 for other factors.

Conclusions: This study showed that the Perceived Challenges in Disaster Response Scale (PCDRS), developed and validated in Turkish, is a reliable and valid measurement tool. It offers a foundation for understanding the challenges faced by disaster response teams and for formulating improvement strategies.

Objective: The aim of this study was to systematically review evidence that supports best practice post-crash response emergency care.

Study design: The research questions to achieve the study objective were developed using the Patient, Intervention, Control, Outcome standard following which a systematic literature review (SLR) of research related to prehospital post-road-crash was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: A total of 89 papers were included in the analysis, presented according to the PRISMA guidelines.

Conclusions: This research explored and identified key insights related to emergency care post-road-crash response. The findings showed that interservice coordination and shared understanding of roles was recommended. Application of traditional practice of the "Golden Hour" has been explored and contested as a standard for all care. Notwithstanding this, timeliness of provision of care remains important to certain patient groups suffering certain injury types and is supported as part of a trauma system approach for patient care.

A common and unfortunate error in statistical analysis is the failure to account for dependencies in the data. In many studies, there is a set of individual participants or experimental objects where two observations are made on each individual or object. This leads to a natural pairing of data. This editorial discusses common situations where paired data arises and gives guidance on selecting the correct analysis plan to avoid statistical errors.