EMS Units Research Articles

Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade

BackgroundPrehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED).MethodsThis was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI.ResultOf 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS.ConclusionPrehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges.

Matched Cohort Study of Open Thoracostomies Performed by Ground Medics

Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment. Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field.&#x0D; Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma center with chest trauma were analyzed from 2017-2020. Outcomes were compared to a patient cohort who did not undergo POT matched by severity of injury and prehospital CPR.&#x0D; Results: A total of 14 POT patients were identified. Majority of POT were bilateral (n=11/14, 78.6%) and all of these patients (n=14/14) had prehospital cardiac arrest. Return of spontaneous circulation was obtained in 2 patients with penetrating injuries (14.3%). There was no difference in total and scene EMS time compared to the matched cohort without POT (p&gt;0.05).&#x0D; Conclusions: This study demonstrated that open thoracostomies could be performed by ground EMS units without increasing prehospital time for severely injured trauma patients and greater achievement of ROSC. Larger, prospective, multi-institutional analyses are needed to further evaluate outcomes.

281 Out-of-Hospital TXA Administration Opportunities in Trauma Patients Transported by ALS Ground EMS - A Descriptive Study

As many as 30% of severely injured trauma patients demonstrate evidence of acute coagulopathy of trauma (ACOT) at the time of ED admission. Early administration of tranexamic acid (TXA) may improve patient outcomes with ACOT. Within our system, TXA is currently available only to helicopter EMS (HEMS) units. The purpose of the current study was to determine whether there was a cohort of trauma patients transported by ground EMS (GEMS) who might benefit from out-of-hospital TXA administration.

Artificial intelligence–based design optimization of nonuniform microstrip line band pass filter

AbstractDesign optimization of many electromagnetic and multiphysics problems have multiscale issues that require a fast, efficient, and accurate surrogate‐based model to be used. Recently, in microwave engineering field, artificial intelligence–based models are being used for modeling of complex microwave stages. In all the studies, the main aim is to form models inner structure parameters, by using the given data to predict the linear/nonlinear relationships between given inputs and outputs. Herein, a surrogate‐based model of a nonuniform microstrip transmission line (NTL) with a typical application of design optimization of a band‐pass filter for ISM band application using deep learning (DL) and meta‐heuristic optimization has been presented. In order to have a computationally efficient and accurate optimization process, firstly a 3D EM unit element model of NTL has been designed. The training and test data sets are created based on different sampling methods. A DL regression model modified multilayer perceptron M2LP have been used for prediction of scattering parameters (S) of the NTL, with respect to the variation of geometrical design parameters. The proposed S‐parameters will then be used to calculate the equivalent S‐parameters of the cascading NTL to be used to calculate the NTL‐based microstrip band‐pass filter S‐parameter response. The optimal design parameters of each line used in the filter design have been determined using a fast and powerful optimization algorithm differential evolutionary algorithm.

Prehospital Response Time of the Emergency Medical Service during Mass Casualty Incidents and the Effect of Triage: A Retrospective Study.

Prehospital time affects survival in trauma patients. Mass casualty incidents (MCIs) are overwhelming events where medical care exceeds available resources. This study aimed at evaluating the prehospital time during MCIs and investigating the effect of triage. A retrospective analysis was performed using Florida's Event Medical Services Tracking and Reporting System database. All patients involved in MCIs during 2018 were accessed, and prehospital time intervals were evaluated and compared to that of non-MCIs. The effect of MCI triage and field triage (Field Triage Criteria) on prehospital time was evaluated. In 2018, it was estimated that 2236 unique MCIs occurred in Florida, with a crude incidence of 10.1-10.9/100000 people. 2180 EMS units arrived at the hospital for patient disposition with a median alarm-to-hospital time of 43.74 minutes, significantly longer than non-MCIs (39.15 min; P < 0.001). MCI triage and field triage were both associated with shorter alarm-to-hospital time (39.37 min and 37.55 min, respectively). MCIs resulted in longer prehospital time intervals than non-MCIs. This finding suggests that additional efforts are needed to reduce the prehospital time for MCI patients. MCI triage and field triage were both associated with shorter alarm-to-hospital times. Widespread use may improve prehospital MCI care.

Abstract 226: Statewide Out-of-hospital Cardiac Arrest During the Covid-19 Pandemic

Introduction: Little is known about statewide out-of-hospital cardiac arrests (OOHCA) during a global pandemic. Objective: To characterize the impact of the COVID-19 pandemic on state OOHCA rates. Methods: Data for non-traumatic, OOHCA were obtained and analyzed from a statewide EMS information system from March 1, 2000 to May 31, 2020 (pandemic) and compared to data obtained from the same 3-month period the prior year (control). Analysis occurred using a web-based application designed to analyze state EMS data. OOHCA were identified using a validated data filter applied to 911 calls and limited to transporting EMS units. Shockable OOHCA and arrests occurring in 5 counties with the highest number of COVID-19 deaths during the pandemic were also analyzed. Results: There were 4,665 OOHCAs identified during the pandemic compared to 3,261 OOHCA during the control period, a 43.1% increase (p&lt;0.00001). Bystander AED use (10% vs 10%), bystander CPR (38% vs. 38%), and bystander witnessed arrests (34% and 33%) were similar. Rates of EMS termination of resuscitation (TOR) were higher (59% vs. 47%), while endotracheal intubation (ETI) (12% vs. 31%), and ROSC (5% vs. 8%) were lower during the COVID-19 period. Blacks had a higher rate of OOHCA during the pandemic period (26.6% vs 18.6%, p&lt;0.00001). Overall shockable OOHCA increased by 14.8% (403 vs. 351, p=0.002) during the pandemic. Bystander AED use (10% vs 11%), bystander CPR (55% vs. 51%), and bystander witnessed (71% and 71%) were similar. Rates of field TOR were 33% vs. 24%, ETI were 14% vs. 31%, and ROSC were 16% vs. 17%. Within the 5 highest impact counties total OOHCA increased by 61.4% (2,702 vs. 1,674, p&lt;0.00001) and shockable OOHCAs increased by 21.4% (207 vs 170, p=0.004). Conclusions: OOHCA and shockable OOHCA increased during the COVID-19 pandemic statewide and to a higher degree in the 5 high impact counties. Little change was noted in rates of bystander AED use, CPR, and witnessed arrests. EMS TOR rates increased while ETI rates decreased. ROSC rates decreased in the overall OOHCA group but were not significantly changed in shockable OOHCA. OOHCA involving the black race occurred more frequently. Further research is warranted to understand the causes of these observations.

New Constraints on the Young Lava Flow Profile in the Northern Mare Imbrium

AbstractPrevious studies showed that the Eratosthenian mare (Em) unit in the northern Mare Imbrium, which is the location of the Chang'e‐3 (CE3) landing site, was simply formed by one period of thick lava flow. However, the CE3 Yutu rover equipped with lunar penetrating radar (LPR) recognized multilayered Em basalts based on the Channel 1 data reprocessed in this paper, indicating that three subdivided thin Eratosthenian lava flows should exist. The spatial variation and thickness distribution of each layer are further estimated based on the location of interfaces recognized from the shallow radar profile. Finally, we build a three‐dimensional stratigraphic model of young mare basalts with filling directions beneath the Chang'e‐3 landing site. The result infers that these young lava flows in the northern Mare Imbrium probably erupted intermittently from the same source.

New Mathematics for Nucleons

In this century it is clear that the nano range can use mathematics differently from 100 years ago where quantum mechanics QM formulated its axioms. A first news is that the postulate on ψ-waves is revised: indinite dimensions are replaced by 8 dimensions of the strong interactions geometry. It is not linear but a toriodal product of two 3-and 5-dimensional spheres. S³ is already used in the QM spin calculus for the weak WI and electromagentic EM unit sphere in the 4-dimensional space used in physics to describe its systems through 4-vectors. Vectors can be exdended by an additional list of numbers to 8 digits. This is needed in this centrury to accomodate the findings in particle physics, not only for the 8 SI gluons. It provides in addition a unification of gravity with the standard models forces.

A National Model for Tactical Emergency Medical Support in Finland

Introduction:Tactical Emergency Medical Response (TEMS) originated in the 1990s in Finland. It is a nationally standardized joint-effort with EMS and police special units, such as SWAT.Aim:To describe a national system of TEMS in Finland.Methods:In Finland, TEMS is a national response system of specially trained paramedics and pre-hospital doctors, working normally in HEMS or a local physician staffed rapid response car. There is a two-tier selection to get accepted in the basic course. The police run background checks for all participants before they are accepted to the course. The course itself is four days and it covers the basics of police tactics, protective gear, penetrating wounds, evacuation, etc. After graduating from the basic course, the paramedic/doctor is qualified to participate in missions. Although healthcare professionals are involved, a TEMS mission is under the police command and is used as one of the police’s special teams to operate in areas where normal EMS cannot be allowed for safety reasons. TEMS does not carry any weapons. The Police provide the teams with the same protective equipment that the SWAT/CTU has. After some years, there is a three-day refresher course for active TEMS service. In this course, the main training points are working in austere environments, such as helicopters, boats, and in urban environments wearing civilian clothing. Police pay for the usage of TEMS in missions, but they do not pay for training days.Results:TEMS has good national coverage. In 2017, there were 131 TEMS activations. The normal response to a mission is a team of one or two TEMS operators.Discussion:TEMS has achieved good national coverage and is deployed often. TEMS has also channeled information and training, such as TECC, to normal EMS personnel and raised their preparedness as well.

Inter-Authority and Cross-Border Cooperation Using the Tetra Digital Radio Network

Introduction:The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.Methods:The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.Results:Pending configuration of necessary talk groups, the system will be functional and in use in 2019.Discussion:Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.

Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach.

Introduction Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

330 Reducing Door-to-CT Times in Patients Presenting With Acute Stroke

The purpose of this study was to determine the best process to reduce the “door-to-CT,” (DtC) time and “door to read” (DtR) time for patients presenting to the emergency department (ED) with an initial triage assessment of acute stroke. This was a ten-month retrospective chart review of the DtC and DtR times for all patients presenting to the ED with an initial triage assessment of acute stroke between February 2016 and November 2016. The study site is located in a diverse suburban setting with a volume of 44,000 patients per year. It is a 911-receiving Stroke Center with a single CT scanner located 565 feet from the ED. The baseline process was activation of a “code stroke,” at triage, after which the patient was moved to an empty treatment bay to be evaluated by an emergency physician (EP) and then sent to CT. Two interventions were sequentially compared from baseline: direct transport to CT from triage on the Emergency Medical Services gurney (EMS to CT) versus immediate transfer to a dedicated “Stroke Stretcher” (SS) at triage with subsequent transport to CT (SS to CT). For both interventions, the EP was called to evaluate the patient at triage. Descriptive statistics were computed for study variables to ensure that all data values were within expected ranges. A one-way analysis of variance (ANOVA) was conducted to explore the impact of EMS to CT and SS to CT on the time it would take for patients presenting with acute stroke to undergo a CT and obtain the results. Three groups were created based on the procedure used to get the patient to CT (Baseline : n = 131; EMS to CT : n = 30; SS to CT : n = 42). In order to determine efficiency of each procedure, time in minutes was obtained from the time patients: (1) entered the door to the time the results were read (DtR), (2) entered the door to the time they arrived for a CT scan (DtC), and (3) time from CT scan to radiology read (CT to Read). There was a statistically significant difference (p < .001) in the DtR and DtC times. Post-hoc comparisons showed that for the DtR time, there was a significant difference between baseline (35.9 minutes) and EMS to CT (23.9 minutes, p = .001), and baseline and SS to CT (28.6 minutes, p = .029). There was no significant difference between EMS to CT and SS to CT (p = .646). Comparisons also showed that there was a significant difference in time for DtC between baseline (24.0 minutes) and EMS to CT (12.9 minutes, p < .001) and baseline and follow-up (15.8 minutes, p = .001). There was no significant difference between EMS to CT and SS to CT (p = .957). Comparisons of the CT to Read groups showed no significant difference between any group (baseline: 11.8 minutes, EMS to CT 11.0 minutes, SS to CT 12.7 minutes). Reducing the DtC and DtR times is essential in the treatment of patients presenting with acute stroke that are eligible for tissue plasminogen activator (TPA) treatment. This is especially true in EDs that do not have a contiguous CT scanner within the department. This study showed no statistical difference in EMS to CT versus SS to CT and both interventions demonstrated improvement over the baseline process. Implementing a reserved stretcher at triage for the immediate assessment and transport of patients presenting with stroke symptoms increases TPA eligibility amongst patients as fewer will fall out due to time delays. It also improves the turn around time for EMS units to return to active status. Future research will look to streamline the process further in order to deliver the most efficient care to patients presenting with strokes.

Smartglasses for the Triage of Casualties and the Identification of Hazardous Materials

Abstract Emergency Medical Services (EMS) can be confronted with complex and challenging situations with many casualties that require special procedures and organizational structures. In order to keep control and records, incident commanders use paper-based notes, lists and forms. The increasing availability of smartglasses leads to the research question, whether they can support members of EMS and improve processes and efficiency. In this contribution, we describe use cases for smartglasses in emergency medicine, such as the triage in incidents with many casualties and the recognition of hazardous materials in accident contexts. We describe results from interviews with 10 members of EMS and civil protection units in Germany and from prototypical applications that have been developed and evaluated together with domain experts. The prototypical applications described in this contribution have shown promising results with respect to usability and acceptance.

Situational awareness and information flow in prehospital emergency medical care from the perspective of paramedic field supervisors: a scenario-based study.

BackgroundIn prehospital emergency medical services, one of the key factors in the successful delivery of appropriate care is the efficient management and supervision of the area’s emergency medical services units. Paramedic field supervisors have an important role in this task. One of the key factors in the daily work of paramedic field supervisors is ensuring that they have enough of the right type of information when co-operating with other authorities and making decisions. However, a gap in information sharing still exists especially due to information overload. The aim of this study was to find out what type of critical information paramedic field supervisors need during multi-authority missions in order to manage their emergency medical services area successfully. The study also investigated both the flow of information, and interactions with the paramedic field supervisors and the differences that occur depending on the incident type.MethodsTen paramedic field supervisors from four Finnish rescue departments participated in the study in January–March 2012. The data were collected using semi-structured interviews based on three progressive real-life scenarios and a questionnaire. Data were analysed using deductive content analysis. Data management and analysis were performed using Atlas.ti 7 software.ResultsFive critical information categories were formulated: Incident data, Mission status, Area status, Safety at work, and Tactics. Each category’s importance varied depending on the incident and on whether it was about information needed or information delivered by the paramedic field supervisors. The main communication equipment used to receive information was the authority radio network (TETRA). However, when delivering information, mobile phones and TETRA were of equal importance. Paramedic field supervisors needed more information relating to area status.ConclusionsParamedic field supervisors communicate actively with EMS units and other authorities such as Emergency Medical Dispatch, police, and rescue services during the multi-authority incidents. This study provides knowledge about the critical information categories when receiving and sharing the information to obtain and maintain situational awareness. However, further research is needed to examine more the information flow in prehospital emergency care to enable a better understanding of required communication in situational awareness formation.

Degradation of Benzodiazepines after 120 Days of EMS Deployment

Introduction. EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. Objective. To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units. Methods. Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May–August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT). Results. 192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7–98.2%) and of midazolam was 99.0% (97.7–100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6–99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7–92.3%]). Mean MKT was 31.6°C (95%CI 27.1–36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam. Conclusions. Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.

An 83-year-old woman with suspected SARS: Implications for emergency nursing

An 83-year-old woman with suspected SARS: Implications for emergency nursing

Environmental SEM in a Multi-User Biological Sciences E.M. Unit

Environmental scanning electron microscopy (ESEM) has matured into a mainstream technique in many areas of microscopy. Instrumentation has evolved and our understanding of some of the imaging mechanisms has progressed. However the majority of laboratories where ESEMs are located are based around the materials sciences. Despite the fact that ESEM is the only SEM instrument that permits liquid water to be present whilst imaging, the housing of such a microscope in biological EM units has been relatively rare. This authors laboratory is a multi-user EM unit based in a School of Biological Sciences. There exists the opportunity for basic biological scientists, clinical and pre-clinical medical and dental researchers to make use of such a resource. Indeed as the ESEM is housed alongside a conventional high vacuum instrument and a cryo high vacuum instrument there exists the ideal opportunity to carry out comparative studies.This study will examine a range of biological samples using ESEM, cryo SEM and dry high vacuum SEM.

Injuries in a 1-Day Recreational Cycling Tour: Bike New York

Study objective: To describe injuries during a 1-day urban cycling tour. Methods: During the May 1996 “Bike New York” tour, we monitored EMS calls to identify injuries in a cohort of helmeted cyclists shielded from traffic. We collected demographic information from entry records, injury data from ambulance call reports, and follow-up on transported patients from telephone interviews with emergency physicians. Data were summarized using proportions, relative risks (RRs), 95% confidence intervals (CIs), and χ 2 Results: Approximately 28,000 cyclists participated, of which 23,502 (84%) were officially registered. Sixty-eight percent of registered bicyclists were male, and 92% were between 18 and 55 years old. Of the 140 EMS calls made during the tour, 136 (97%) involved participants; this yielded an injury incidence of 5 per 1,000 riders, or 12 to 13 per 100,000 person-miles. Injury was more common among younger cyclists (RR=1.4 for age ≤35 years versus age >35 years; 95% CI, 1.0 to 2.0; P <.05), and possibly women (RR=1.3; 95% CI, .9 to 1.8; P =.11). Injuries were mostly minor, but there were 7 concussions and 6 clavicle fractures; none of the 140 injuries was fatal. Thirty-eight calls resulted in ED transport, and 5 of these patients were admitted. Although EMS units were evenly distributed along the route, most EMS calls occurred in only 3 of the 7 zones ( P <.001). Conclusion: Injuries during the largest 1-day US cycling tour were uncommon. More data are needed to determine the relative importance of injury risk factors. Data collection during mass events may help guide distribution of EMS personnel. [Emond SD, Tayoun P, Bedolla JP, Camargo CA Jr: Injuries in a 1-day recreational cycling tour: Bike New York. Ann Emerg Med January 1999;33:56-61.]

84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.

57. Feasibility of the Global Positioning Satellite System for Rural Aeromedical Transport

Aeromedical navigation to the scene of an accident using navigational assistance computer mapping software (NACM) can be difficult in rural areas due to the lack of topographic landmarks. In these instances, navigation is made easier using the Global Positioning Satellite (GPS) system to determine latitude and longitude.Purpose: To determine the reliability and feasibility of portable GPS receivers compared with our current system of NACM (MAP EXPERT®) in the navigation of aeromedical transport flights.Design: A non-randomized prospective trial comparing flights using either GPS or NACM. Setting: Flight program at a Level I trauma center.Methods: GPS receivers (for transmitting location) were carried by half the helicopters and ground EMS units. The NACM system was used to transmit the location of the accident to the other flights. Data on flight time, distance, and accident location were collected. Pilots and EMS personnel using the portable GPS system completed a questionnaire regarding accuracy, reliability, and ease of use.Results: This study included 51 flights; GPS (n = 26) and NACM (n = 25). There was no difference in the miles flown per minute in the NACM group (1.69 miles/minute) compared with the GPS group (1.70 miles/minute). Pilots and EMS personnel rated the GPS reliable, accurate, and easy to use for navigation.