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Berry CL, Golden D, Tubby B, Berry S, Hall D, Christiansen G. Prehospital Massive Transfusion for Resuscitation of an Entrapped Patient in a Rural Setting: A Case Report. PREHOSP EMERG CARE 2024:1-5. [PMID: 38809662 DOI: 10.1080/10903127.2024.2362307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
Resuscitation of injured patients suffering from hemorrhagic shock with blood products in the prehospital environment is becoming more commonplace. However, blood product utilization is typically restricted and can be exhausted in the event of a prolonged entrapment. Delivery of large amounts of blood products to a scene is rare, particularly in rural settings. We present the case of a 26-year-old male who was entrapped in a motor vehicle for 144 min. First responders assessed the entrapped patient to be in hemorrhagic shock from lower extremities injuries. The Helicopter Emergency Medical Services team exhausted their supply of blood products shortly after arrival on scene. The local trauma center's Surgical Emergency Response Team (SERT) was requested to the scene. The preplanned response included seven units of blood components to provide massive transfusion at the point of injury and released directly to field responders by the blood bank. During extrication, the patient was given two units of packed red blood cells by initial responders with three more units of blood components from the SERT supply. During transfer to the hospital, the patient received an additional three units, and four units were transfused on initial trauma resuscitation in the hospital. He was found to have severe lower extremities injuries as the cause of his hemorrhage. The patient survived to hospital discharge. Delivery of large volumes of blood products to an entrapped patient with prolonged extrication time may be a lifesaving intervention. We advocate for integration of blood bank services and on scene physician guided resuscitation for prolonged extrications.
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Affiliation(s)
- Christopher L Berry
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Daniel Golden
- Department of Trauma Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Barbara Tubby
- Blood Bank, Guthrie Medical Group Laboratories, Sayre, Pennsylvania
| | - Sarah Berry
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Derrick Hall
- Greater Valley Emergency Medical Services, Sayre, Pennsylvania
| | - Gregory Christiansen
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
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Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E58-E64. [PMID: 36214653 DOI: 10.1097/phh.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. PROGRAM A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. IMPLEMENTATION Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. EVALUATION This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. DISCUSSION Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.
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Bredmose PP, Hooper J, Viggers S, Linde J, Reid C, Grier G, Mazur S. Prehospital Care: An International Comparison of Independently Developed Training Courses. Air Med J 2022; 41:73-77. [PMID: 35248348 DOI: 10.1016/j.amj.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/18/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prehospital and retrieval medicine (PHRM) occurs in a complex work environment. Appropriate training is essential to ensure high standards of clinical care and logistic decision making. Before commencing the role, PHRM doctors have varying levels of experience. This narrative review article aims to describe and compare 6 internationally accepted PHRM courses. METHODS Six PHRM course directors were asked to describe their course in terms of education methods used, course content, and assessment processes. Each of the directors contributed to the discussion process. RESULTS Although developed independently, all 6 courses use a comparable combination of lectures, simulations, and discussion groups. The amount of each pedagogical modality varies between the courses. CONCLUSION We have identified significant similarities and some important differences among some well-accepted independently developed PHRM courses worldwide. Differences in content and the methods of delivery appear linked to the background of participants and service case mix. The authors believe that even in the small niche of PHRM, courses need to be tailored to the participants and the "destination of the participants" (ie, where they are going to use their skills).
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Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway; LifeFlight Retrieval Medicine, Queensland, Australia.
| | - Jeff Hooper
- LifeFlight Retrieval Medicine, Queensland, Australia
| | - Sandra Viggers
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Joacim Linde
- Swedish Air Ambulance, Gothenburg, SLA, Sweden, Gothenburg
| | - Cliff Reid
- NSW Ambulance Aeromedical Operations, Sydney, Australia
| | | | - Stefan Mazur
- SAAS MedSTAR, Emergency Medical Retrieval, Adelaide, Australia
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Qasim Z, Butler FK, Holcomb JB, Kotora JG, Eastridge BJ, Brohi K, Scalea TM, Schwab CW, Drew B, Gurney J, Jansen JO, Kaplan LJ, Martin MJ, Rasmussen TE, Shackelford SA, Bank EA, Braude D, Brenner M, Guyette FX, Joseph B, Hinckley WR, Sperry JL, Duchesne J. Selective Prehospital Advanced Resuscitative Care - Developing a Strategy to Prevent Prehospital Deaths From Noncompressible Torso Hemorrhage. Shock 2022; 57:7-14. [PMID: 34033617 DOI: 10.1097/shk.0000000000001816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hemorrhage, and particularly noncompressible torso hemorrhage remains a leading cause of potentially preventable prehospital death from trauma in the United States and globally. A subset of severely injured patients either die in the field or develop irreversible hemorrhagic shock before they can receive hospital definitive care, resulting in poor outcomes. The focus of this opinion paper is to delineate (a) the need for existing trauma systems to adapt so that potentially life-saving advanced resuscitation and truncal hemorrhage control interventions can be delivered closer to the point-of-injury in select patients, and (b) a possible mechanism through which some trauma systems can train and incorporate select prehospital advanced resuscitative care teams to deliver those interventions.
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Affiliation(s)
- Zaffer Qasim
- Departments of Emergency Medicine and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frank K Butler
- Uniformed Services University, Consultant in Tactical Combat Casualty Care, Joint Trauma System, San Antonio, Texas
| | - John B Holcomb
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph G Kotora
- Navy Medicine Readiness and Training Command, Naval Medical Forces Atlantic, Portsmouth, Virginia
| | - Brian J Eastridge
- Division of Trauma and Emergency General Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Karim Brohi
- Center for Trauma Sciences, Queen Mary, University of London, London, UK
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - C William Schwab
- Division of Traumatology and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendon Drew
- Joint Trauma System Committee on Tactical Combat Casualty Care, Camp Pendleton, California
| | - Jennifer Gurney
- US Army Institute of Surgical Research, Defense Committee on Trauma, Joint Trauma System, San Antonio, Texas
| | - Jan O Jansen
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lewis J Kaplan
- Division of Traumatology and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J Martin
- Department of Surgery, Scripps Mercy Hospital, San Diego, California
| | - Todd E Rasmussen
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stacy A Shackelford
- US Army Institute of Surgical Research, Defense Committee on Trauma, Joint Trauma System, San Antonio, Texas
| | - Eric A Bank
- Harris County Emergency Services District, Houston, Texas
| | - Darren Braude
- Division of Prehospital, Austere, and Disaster Medicine, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Megan Brenner
- Department of Surgery, University of California, Riverside, Riverside, California
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, The University of Arizona, Tucson, Arizona
| | - William R Hinckley
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jason L Sperry
- Section of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan Duchesne
- Division of Trauma, Acute Care, and Critical Care Surgery, Tulane University, New Orleans, Louisiana
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