Emergency Scene Research Articles

Health technology assessment review: Remote monitoring of vital signs - current status and future challenges

Recent developments in communications technologies and associated computing and digital electronics now permit patient data, including routine vital signs, to be surveyed at a distance. Remote monitoring, or telemonitoring, can be regarded as a subdivision of telemedicine - the use of electronic and telecommunications technologies to provide and support health care when distance separates the participants. Depending on environment and purpose, the patient and the carer/system surveying, analysing or interpreting the data could be separated by as little as a few feet or be on different continents. Most telemonitoring systems will incorporate five components: data acquisition using an appropriate sensor; transmission of data from patient to clinician; integration of data with other data describing the state of the patient; synthesis of an appropriate action, or response or escalation in the care of the patient, and associated decision support; and storage of data. Telemonitoring is currently being used in community-based healthcare, at the scene of medical emergencies, by ambulance services and in hospitals. Current challenges in telemonitoring include: the lack of a full range of appropriate sensors, the bulk weight and size of the whole system or its components, battery life, available bandwidth, network coverage, and the costs of data transmission via public networks. Telemonitoring also has the ability to produce a mass of data - but this requires interpretation to be of clinical use and much necessary research work remains to be done.

Improving Rural Emergency Medical Service Response Time With Global Positioning System Navigation

Rural emergency medical services (EMS) often serves expansive areas that many EMS personnel are unfamiliar with. EMS response time is increased in rural areas, which has been suggested as a contributing factor to increased mortality rates from motor vehicle crashes (MVCs) and nontraumatic emergencies. The purpose of this study was to assess the effect of a global positioning system (GPS) on rural EMS response time. GPS units were placed in ambulances of a rural EMS provider. The GPS units were set for fastest route (not shortest distance) to the scene that depends on traffic lights and posted road speed. During a 1-year period from September 2006 to August 2007, EMS response time and mileage to the scene were recorded for MVCs and other emergencies. Response times and mileage to the scene were then compared with data from the same EMS provider during a similar 1-year period when GPS technology was not used. EMS calls less than 1-mile were removed from both data sets because GPS was infrequently used for short travel distances. During the 1-year period before utilization of GPS, 893 EMS calls greater than 1 mile were recorded and 791 calls recorded with GPS. The mean EMS response time for MVCs was 8.5 minutes without GPS and 7.6 minutes with GPS (p < 0.0001). When MVCs were matched for miles traveled, mean EMS response time without GPS was 13.7 minutes versus 9.9 minutes with GPS (p < 0.001). GPS technology can significantly improve EMS response time to the scene of MVCs and nontraumatic emergencies.

Black Saturday: the immediate impact of the February 2009 bushfires in Victoria, Australia

To examine the response of the Victorian State Trauma System to the February 2009 bushfires. A retrospective review of the strategic response required to treat patients with bushfire-related injury in the first 72 hours of the Victorian bushfires that began on 7 February 2009. Emergency department (ED) presentations and initial management of patients presenting to the state's adult burns centre (The Alfred Hospital [The Alfred]) were analysed, as well as injuries and deaths associated with the fires. There were 414 patients who presented to hospital EDs as a result of the bushfires. Patients were triaged at the emergency scene, at treatment centres and in hospital. National and statewide burns disaster plans were activated. Twenty-two patients with burns presented to the state's burns referral centres, of whom 18 were adults. Adult burns patients at The Alfred spent 48.7 hours in theatre in the first 72 hours. There were a further 390 bushfire-related ED presentations across the state in the first 72 hours. Most patients with serious burns were triaged to and managed at burns referral centres. Throughout the disaster, burns referral centres continued to have substantial surge capacity. Most bushfire victims either died, or survived with minor injuries. As a result of good prehospital triage and planning, the small number of patients with serious burns did not overload the acute health care system.

Screening for Traumatic Exposure and Posttraumatic Stress Symptoms in Adolescents in the War-Affected Eastern Democratic Republic of Congo

To explore adolescent mental health in the eastern Democratic Republic of Congo, scene of a complex emergency since 1996. Community cross-sectional data obtained using a cluster sample approach. From November 5, 2007, through February 5, 2008, we assessed 13 secondary schools in 4 selected health zones in the Ituri district. One thousand forty-six adolescents and young adults aged 13 to 21 years completed a self-report questionnaire. War-related traumatic events, posttraumatic stress symptoms, and sociodemographic variables. The Adolescent Complex Emergency Exposure Scale, specifically designed for this region, screened for exposure to potentially traumatic events, and the Impact of Event Scale-Revised measured symptoms of posttraumatic stress consistent with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among the 477 girls (45.6%) and 569 boys (54.4%) in the study, 95.0% reported at least 1 traumatic event. On average, adolescents were exposed to 4.71 traumatic events, with higher exposure rates reported in boys, older groups, rural and urban areas, and respondents whose mother or father was dead. Of 990 respondents, 52.2% met symptom criteria for posttraumatic stress disorder. Symptom scores were strongly related to cumulative trauma exposure; however, the strength of this relationship differed slightly across living area groups for girls. Adolescents in the eastern Democratic Republic of Congo are highly exposed to political violence, putting them at a considerable risk--mediated by living area and sex--to develop posttraumatic stress symptoms.

The conspicuity of first-responder safety garments

Introduction This study compared the conspicuity of three types of first-responder safety garments (NFPA 1971-2007 turnout gear coats, and ANSI/ISEA 107 and 207 safety vests). Method Participants drove instrumented vehicles on a closed track during both daytime and nighttime, indicating when they could first detect pedestrians in a simulated emergency response scene. Pedestrians wore one of the safety garments and stood on either side of the emergency scene, facing or perpendicular to oncoming traffic, and either stationary or walking in place. Results All three garment standards provided equal levels of conspicuity, in that the distances at which the pedestrians were detected were equivalent. Time of day was a significant factor, with longer mean detection distances being observed in daytime. Pedestrian orientation was significant, with mean detection distances being longest when facing traffic. Pedestrian motion did not result in significant differences in detection distance. Discussion The results suggest that all three garment types studied are equivalent in making first responders conspicuous as pedestrians when working an emergency response scene in close proximity to traffic. Impact on Industry Whether an NFPA or ANSI/ISEA compliant is worn, first responders are equally likely to be detected by passing motorists, and as such these garments should be considered to be equivalent.

Violence et urgence

We study the process of acting through the analysis of violence being only from the fact of emergency. Medical technicality and effectiveness are paradoxically binded to confusion and communication problems in emergency rooms. This place becomes thus favourable with an acting out in the reality, of phantasms, family scenes, dramas whose acts unfolding the knowledge of the patients, their family and the practitioners. The scene of emergency should not be that of a wild psychodrama. The urgentist must hold account of the opacity of the psychic fact to try to prevent violent acts, which not always emanate from its patients.

Letter To The Editor: New Digital Video Intubation Device

Digital video intubation is leading the way into a refreshing trend to change traditional endotracheal intubation and bring 21 century low cost, hand held digital technology to the medical emergency field. The RES-Q-SCOPE(R) is one of the first products to address well known issues plaguing endotracheal intubation for many years and drastically simplify the procedure. The RES-Q-SCOPE ® (http://www.res-q-tech-na.com for full details and video) may be considered essential in combat and mass casualties, for paramedics, first responders teams and in the emergency rooms. The state of the art hand held FIELD VIDEO LARYNGOSCOPE is self contained and uses a rechargeable power source. It features a pre-loaded standard 6-8.5mm Endotracheal Tube with disposability advantages enabling rapid serial intubations in the field and rapid establishment of an airway. The RES-Q-SCOPE ® is a patented and FDA registered, multifunction field video laryngoscope, which uses cutting edge digital image technology featuring a 2.75”color LCD screen to externally visualize the intubation process in the field. The RES-Q-SCOPE ® requires modest training to slide the device into position to visualize the epiglottis with little effort. There should be minimal need, if any, to reposition the C-spine in case of suspected neck injury. Furthermore, the RES-Q-SCOPE ® itself features a channel where a standard endotracheal tube can be easily pre-loaded into the device. A light source for external visualization of the intubation process, as the endotracheal tube passes into the trachea. The process can be seen through a small color LCD screen, which has the ability to adopt multiple positions, so that the practitioner can be located at the side of the patient or at multiple other positions around the patient. A vacuum source can be attached to an external adapter provided, to assist clearing fluids that may be present in the throat. The same channel can be reversibly, used to provide oxygen if needed. A disposable unit can be easily detached and discarded. Multiple clean intubations may be performed in the field by simply attaching a new disposable unit, thus allowing for serial intubation of multiple patients in a disaster theater or emergency scene. The RES-Q-SCOPE ® is powered with a rechargeable long duration battery, also allowing for serial intubations when needed. An additional and emergency dry cell pack is also available using 4 AA's to use under extreme conditions such as the battlefield. The RES-Q-SCOPE ® is a product designed to improve the chances of saving a life in a respiratory emergency where it occurs. It is considered essential in disaster preparation and emergency response of all kinds including combat emergencies. Complete information and description and video, can be obtained by visiting http://www.res-q-tech-na.com and watch a video of a conscious intubation under LCD screen visualization. This technology is readily available at an extremely low cost (whole kit for around $400-$500).

Structural and process quality in the management of diabetic emergencies in Germany.

Although acute complications of diabetes account for approximately 3% of all emergency calls, clinically relevant indicators of structural and process quality in the management of diabetic emergencies have not yet been studied. The purpose of this investigation was, therefore, to collect representative data on these indicators for the whole of Germany. Standardized questionnaires comprising 20 items were sent to all 312 emergency medical services in Germany. Apart from demographic data, information was obtained about the diagnostic materials and drugs carried by the ambulances, methods of blood glucose measurement, the level of qualification of the emergency teams, the frequency of diabetic emergencies, and the need for further training. The return rate of the questionnaires was 55%, corresponding to 172 emergency medical service districts serving a total population of 45.3 million. The data revealed deficits with regard to structural and process quality. Thus, only 6% of ambulances carried glucagon and only 11% ketone test strips. In 57% capillary blood was used for glucose determination, in 17% visually read test strips were still used. While in some districts hospital admission after hypoglycaemic episodes was mandatory even for patients well educated about their diabetes, in other districts multimorbid patients on oral antidiabetics were sometimes only treated at the emergency scene. Emergency medical technicians increasingly carried out both the diagnosis and treatment of diabetic emergencies. The structural and process quality of the management of diabetic emergencies in Germany is in need of improvement. The most important factor is continuing education of the entire emergency team.

Emergent management of pelvic ring fractures with use of circumferential compression.

Bottlang, Michael PhD; Krieg, James C. MD; Mohr, Marcus; Simpson, Tamara S. MD; Madey, Steven M. MD Author Information

The importance of access-to-patient-period in the emergency service

The "period-to-help" (Hilfsfrist) is defined by the federal states as a measure for further planning and structure the emergency services. This period is composed of distinct time intervals and ends with the arrival of the rescue team at the emergency. From a physician's point of view it is merely the time to the first contact with the patient that is of vital interest. Data on the discrepancy between arrival at the emergency scene and the first contact with the patient are lacking. We analysed prospectively 680 emergencies outside the hospital and calculated the so-called "access-to-patient" period (Zugangszeit). 552 emergencies supplied with an ambulance and 128 emergencies supplied with a helicopter ambulance service were analysed. The mean total time period for the ambulance arriving at the patient was 8.17 minutes +/- 30.3 seconds while being 10.52 minutes +/- 73.3 seconds for the helicopter ambulance service. The "access-to-patient" period was 50.9 minutes +/- 8.2 seconds for the ambulance and 75.7 minutes +/- 21.7 seconds for the helicopter ambulance service. For road accidents the "access-to-patient" period was significantly shorter for both the ambulance (12.4 +/- 4.1 seconds) and the helicopter (19,6 +/- 10,8 seconds), while in emergencies taking place inside closed buildings these time intervals were 5 and 6.5 times longer (ambulance 64.2 +/- 10,9 seconds). As outer circumstances counted most to prolonged access-to-patient periods the latter did not correlate with the severity of the injury or the emergency. Appropriate guidance and briefing of the crew of an emergency service at the scene is able to minimize the access-to-patient period (74.5 versus 60.4 seconds for the ambulance and the helicopter, respectively). Delays were caused in 22.6 % of all emergencies, mostly due to imprecise orders, impassable terrain and the inability to identify the building. If we consider that road accidents count for merely 10 % of all emergencies it seems appropriate to re-define the so-called "period-to-help" (Hilfsfrist) that takes into account the "access-to-patient" period (Zugangszeit) that is on average 50 seconds. The primary goal of any further planning must be to keep the interval without sufficient therapy as short as possible.

Finnish National Training Centre for Emergency Services.

This is a review of the facilities and programmes of the Finnish National Centre for Emergency Services in Kuopio, Finland. It includes the Emergency Services College that provides all of the training for emergency service workers in Finland and provides some services for the international community. There are needs for training by the medical community in Finland that relate both to skills and knowledge. Education and training focus on the demonstration of evidence-based competence. The facility includes a training ground for the provision of immediate emergency medical care, scene safety, extrication, industrial accidents, and water rescue. It is used for the training of paramedic students, nurses, medical students, firefighters, dispatch center staff, and officers. Computer-aided simulations are used to enhance the learning process. Plans are underway for adding tele-education and/or virtual-reality facilities. Close liaison is maintained with the University of Kuopio, Kuopio University Hospital, and with the Pohjois-Savo Polytechnic Institute.

Emergency medical service agency definitions of response intervals

There is a time continuum from emergency medical services (EMS) dispatch, response, scene, transport, and arrival at the hospital. Previous research has documented favorable patient outcome with short response intervals; however, these studies revealed the documentation of EMS time intervals is not always consistent. This study evaluates how agencies estimate these times and factors that may affect the length of response intervals. The study used a mail questionnaire to assess factors related to response intervals and to determine how agencies define and record response intervals. All ground-based EMS agencies in a southwestern state were invited to participate in the survey. Univariate and stratified data analyses compared definitions of response intervals. Agencies varied as to how they defined the start and end of the response. Fifty-six percent stated that their response started when the responding unit was notified of the call. However, almost 23% defined response interval as starting when dispatch received the call, and 11% defined it as starting with the initial 911 call. A factor that affected response intervals was routing of the 911 call. Less than 6% of agencies had only 1-call routing. Agencies use different time points as the start and end of their response interval, which makes comparison of results directly related to response intervals across agencies or regions difficult. To maintain an appropriate standard of prehospital emergency medical care throughout the state, the use of consistent standard terminology defining response intervals will help reach that goal.

The effect of helicopter transport on adult patients' body temperature

Reprint no. 74/I/208 Introduction The adverse and potentially fatal effects of hypothermia have been known for a long time.‘” Hypothermia usually is defined as a core body temperature below 35” C (95” F). Hypothermia further is divided into mild core temperatures ranging fi-om 33” to 35” C (91.4” to 95” F), moderate core temperatures from 27” to 32” C (80.6” to 89.6” F), and severe core temperatures below 27” C (80.6” E).’ These numbers can vary slightly depending on the researcher. Varon et al.’ said, “Hypothermia occurs when the thermoregulatory response is impaired, overwhelmed, or both.” Although secondary hypothermia usually results from an underlying disease that interferes with normal heat conservation mechanisms, primary (accidental) hypothermia results when normal heat conservation mechanisms cannot overcome exposure to a low environmental temperature.‘~z The purpose of this study was to de termine whether or not an adult patient’s core body temperature is compromised when transported in a helicopter environment from an emergency scene or between facilities. Some studies have been conducted on neonatz@ and pediatrS hypothermia during interfacility transport, but few studies have been published on the effect of helicopter transport on adult hypothermia. No two people become hypothermic at the same rate.’ The body loses heat through conduction, convection, evaporation, and radiation.“” Age, drug intoxication, and preexisting illness are three

A method to reduce response times in prehospital care: The motorcycle experience

This study compared the response times of a motorcycle and a standard ambulance in a congested urban emergency medical services (EMS) setting. The study was performed in Taipei, Taiwan, a densely populated urban area. A basic life support (BLS) motorcycle (without defibrillation capability) and an advanced life support (ALS) ambulance were based at three study hospitals and simultaneously dispatched when there was a perceived need for ALS ambulance transport. Over a 3-month period, prehospital personnel evaluated 307 medical and trauma emergencies. Time data were insufficient for analysis in 33 cases, leaving a study population of 274. Response times of the motorcycle and the ambulance were prospectively assessed and compared. During rush hours, the response times of the motorcycle and ambulance were 4.9 ± 3.0 minutes and 6.3 ± 3.4 minutes ( P < .05), respectively, and in non-rush hours, 4.2 ± 2.1 minutes and 5.1 ± 2.5 minutes ( P < .05), respectively. Using motorcycles to transport EMTs to the emergency scene significantly reduced response time compared with a standard ambulance in a congested urban setting. Large prospective studies are required to determine the impact on patient outcome of shorter EMS response times using motorcycles. EMS motorcycles appear feasible and deserve consideration to help expedite prehospital care in other systems in densely populated cities.

Use of Automated External Defibrillators by Police Officers for Treatment of Out-of-Hospital Cardiac Arrest

Objective: To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest. Methods: This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation. Results: EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8±4.7 minutes in the control phase to 8.7±3.7 minutes in the intervention phase ( P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge. Conclusion: In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge. [Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM: Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med August 1998; 32:200-207.]

Law Enforcement Agencies and Out-of-Hospital Emergency Care

Study objective: We sought to assess the involvement of law enforcement agencies in out-of-hospital emergency medical care and their attitudes toward expanded roles in emergency medical services (EMS) systems. Methods: We mailed a 20-question survey to 800 police chiefs and sheriffs randomly selected from a list of all law enforcement agencies in the United States. The questions focused on the characteristics of each law enforcement agency, its current level of involvement in providing out-of-hospital emergency medical care, and the characteristics of its associated community and local EMS system. The survey concluded with four statements to assess officer attitudes toward an expanded role in EMS-related activities. We used the χ 2 or Fisher exact test to analyze differences in proportions. The α-error rate was set at .05. Results: Seventeen surveys were returned as undeliverable. Of the remaining 783 surveys, we received 602 responses (77%). Five hundred forty-nine (70.1%) of the respondents were the primary law enforcement agencies in their communities; they make up the final sample. The median number of officers per agency was 12 (range, 1 to 2,623), and the median population served was 6,936 (range, 150 to 1,500,000). Responses indicated that 442 (80.7%) agencies responded to one or more specific types of medical emergencies and 263 (50.3%) provided some level of patient care. Law enforcement officers frequently arrived at the scene of medical emergencies before EMS personnel (81.5%), with a roll-time interval of less than 8 minutes (87.2%). Only 14 agencies (2.6%) used automatic external defibrillators. Fifty-three percent agreed with the statement that EMS-related activities would interfere with their law enforcement duties. However, more than 60% of respondents agreed that law enforcement agencies should be involved in providing emergency medical services for life-threatening emergencies, that their officers would be willing to undertake extra medical training, and that EMS-related activities would improve their public images. Conclusion: Many law enforcement agencies are involved to some extent in providing out-of-hospital emergency medical care, and most of the agencies we surveyed would support additional medical training and new or expanded roles for themselves in EMS systems. Alonso-Serra HM, Delbridge TR, Auble TE, Mosesso VN, Davis EA: Law enforcement agencies and out-of-hospital emergency care. Ann Emerg Med April 1997; 29:497-503.]

Emergency scene endotracheal intubation before and after the introduction of a rapid sequence induction protocol

Introduction: A change in airway management protocol provided the opportunity to evaluate scene airway management by air medical crew before and after the introduction of a rapid sequence induction protocol. Methods: A retrospective chart review and a descriptive study of scene trauma patients whose airway was established primarily by an air medical crew during two study periods: April 1994 through March 1995 (group 1, before rapid sequence induction) and April 1995 through March 1996 (group 2, after rapid sequence induction). Data collected included demographics, type of airway, Glasgow Coma Scale score, scene time, and outcome. The setting included a four helicopter air medical transport program using nurse/paramedic crews with a service area of 25,000 square miles in central, southeastern, and northeastern Ohio. Results: Group 1 patients ( n = 148) averaged 31.6 years of age and were primarily male (79.7%) with blunt injuries (92.6%) with an average Glascow Coma Scale score of 7.7. Group 2 ( n = 95) was similar, averaging 31.1 years of age, primarily male (77.9%) with blunt injuries (94.7%) and a Glascow Coma Scale score of 8.6. Groups 1 and 2 differed in oral endotracheal intubation rate ( 19 118 versus 36 95 [p = 0.03] ) and in scene time (15.7 minutes versus 20.1 minutes [ p = 0.0012]). The groups did not differ in rate of successful intubation or the rate of subsequent cricothyrotomy. Conclusion: Rapid sequence induction added significantly to ground time without significantly increasing intubation success rate or decreasing cricothyrotomy rate. Its use at the scene of injury may not be appropriate.

Triage By Emergency Medical Dispatchers

AbstractPurpose:This study is an evaluation of the ability of medically trained and controlled emergency medical dispatchers to use telephone triage techniques to direct the appropriate prehospital unit to an emergency scene.Methods:Emergency dispatchers, educated in a formal emergency medical dispatch program, were assigned one of four triage priorities to incoming 9-1-1 calls. The actual field management delivered for each patient was compared with the dispatcher's triage to determine the appropriateness of triage.Results:A total of 1,045 consecutive calls were reviewed with 74.4% sorted as needing advanced life support (ALS) units on scene; 65.3% (95% CI, 61.9 to 68.6%) of these calls required ALS intervention. A total of 3.4% of the runs sorted to the non-ALS response groups were identified to have required ALS intervention. Comparing the need for ALS intervention, a significant difference was found between the triage groups.Conclusion:Emergency medical dispatchers, using a formal system for telephone triage, are able to direct appropriate prehospital resources to the emergency scene.

Study of electrocardiogram at the emergency scene in cases of out-of-hospital cardiopulmonary arrest

Study of electrocardiogram at the emergency scene in cases of out-of-hospital cardiopulmonary arrest

急性心肺停止例の救急現場心電図所見と心拍再開率の検討

急性心肺停止例の救急現場心電図所見と心拍再開率の検討