Prehospital and Disaster Medicine最新文献

Introduction: Conceptualizations of surge capacity are gaining traction in disaster preparedness and response, particularly in the context of critical and acute care during the pandemic as well as other disaster contexts. In most applications, the surge capacity domains describe the four types of assets required to ensure that surges in demand are addressed. Despite increasing interest and conceptual application, these constructs are yet to be considered or explored in relation to the profound resource scarcity and complex contexts of humanitarian health responses.

Objectives: The aim of this research is to explore surge capacity domain constructs in the novel context of scarce health resource allocation in humanitarian health care response settings.

Methods: This research was conducted according to an exploratory qualitative design. Clinicians and managers with relevant experiences were purposively recruited to include broad perspectives across humanitarian responses and clinical specialties. Interview transcripts were analyzed using a latent deductive pattern approach, using a deductive code book consisting of existing surge capacity domains to explore surge capacity constructs. Analysis of coded data for cross-cutting themes drove identification of new findings regarding surge capacity in the context of humanitarian health responses.

Results: Seventeen participants completed semi-structured interviews. In addition to demonstrating the relevance of existing surge capacity domains (staff, stuff, space, and systems; 4Ss), four new themes emerged: (1) sponsorship; (2) suitability; (3) security; and (4) supply. These four themes informed the conceptualization of surge capacity dimensions which must be satisfied for an asset to render a positive impact with relevance to all four surge capacity domains (4S² - cumulative 4S domains and the new dimensions).

Conclusions: Although existing surge capacity domains have proven relevant to humanitarian health care response settings, this research produced a revised conceptualization of surge capacity constructs specific to this context. The identification of four surge capacity dimensions supported the conception and development of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) 4S² model of surge capacity, thus offering a potential new tool to support humanitarian health response planning and evaluation.

Objective: This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care.

Methods: A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to "000" that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance.

Results: Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves.

Conclusion: Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.

For many researchers, the ethical approval process can appear confusing, overwhelming, or irrelevant. Common sources of confusion include knowing which types of ethics approvals are required, how to get the approval, and understanding the language surrounding the review process. This editorial discusses the importance of ethics in creating and reporting quality research and provides a practical guide to help navigate the ethical approval process.

Background: The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.

Methods: A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.

Results: There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).

Conclusions: The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.

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.