1
|
Yilmaz S, Tatliparmak AC, Ak R. START-A (Simple Triage, Rapid Treatment and Analgesia) in Mass Casualty Incidents. Wilderness Environ Med 2024; 35:246-248. [PMID: 38379475 DOI: 10.1177/10806032231222474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Sarper Yilmaz
- Department of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Turkey
| | - Ali C Tatliparmak
- Department of Emergency Medicine, Uskudar University Faculty of Medicine Istanbul, Turkey
| | - Rohat Ak
- Department of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Turkey
| |
Collapse
|
2
|
Valence TD, Suppan L. Time to Reconsider Analgesia in Mass Casualty Incidents. Wilderness Environ Med 2023; 34:524-527. [PMID: 37923685 DOI: 10.1016/j.wem.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
The provision of analgesia in mass casualty incidents has traditionally been viewed as low-priority and reserved for later stages of care. Poor pain management is commonplace in trauma victims, and inadequate acute pain management can hinder evacuation efforts and may lead to the development of chronic pain and posttraumatic stress disorder. New, safe, and simple methods for administering quality analgesia have proven to be safe and effective in the prehospital setting and, as such, could easily be implemented into mass casualty incident protocols and allow for analgesia at earlier stages in such incidents, thereby improving patient care.
Collapse
Affiliation(s)
- Timothee de Valence
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
3
|
Pietsch U, Fischer H, Rüst CA, Hossfeld B, Grünenfelder A, Wenzel V, Albrecht R. Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study. Scand J Trauma Resusc Emerg Med 2023; 31:2. [PMID: 36609399 PMCID: PMC9824964 DOI: 10.1186/s13049-023-01066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pain is one of the major prehospital symptoms in trauma patients and requires prompt management. Recent studies have reported insufficient analgesia after prehospital treatment in up to 43% of trauma patients, leaving significant room for improvement. Good evidence exists for prehospital use of oral transmucosal fentanyl citrate (OTFC) in the military setting. We hypothesized that the use of OTFC for trauma patients in remote and challenging environment is feasible, efficient, safe, and might be an alternative to nasal and intravenous applications. METHODS This observational cohort study examined 177 patients who were treated with oral transmucosal fentanyl citrate by EMS providers in three ski and bike resorts in Switzerland. All EMS providers had previously been trained in administration of the drug and handling of potential adverse events. RESULTS OTFC caused a statistically significant and clinically relevant decrease in the level of pain by a median of 3 (IQR 2 to 4) in NRS units (P < 0.0001). Multiple linear regression analysis showed a significant absolute reduction in pain, with no differences in all age groups and between genders. No major adverse events were observed. CONCLUSIONS Prehospital administration of OTFC is safe, easy, and efficient for extrication and transport across all age groups, gender, and types of injuries in alpine environments. Side effects were few and mild. This could provide a valuable alternative in trauma patients with severe pain, without the delay of inserting an intravenous line, especially in remote areas, where fast action and easy administration are important.
Collapse
Affiliation(s)
- Urs Pietsch
- grid.413349.80000 0001 2294 4705Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland ,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henning Fischer
- grid.413349.80000 0001 2294 4705Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
| | - Christoph Alexander Rüst
- grid.413349.80000 0001 2294 4705Department of Intensive Care Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Björn Hossfeld
- Federal Armed Forces Hospital, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, and HEMS, Christoph 22” Ulm, Ulm, Germany
| | | | - Volker Wenzel
- Department of Anaesthesiology and Intensive Care Medicine, Friedrichshafen Regional Hospital, Friedrichshafen, Germany ,grid.15276.370000 0004 1936 8091Department of Anesthesiology, University of Florida, Gainesville, FL USA
| | - Roland Albrecht
- grid.413349.80000 0001 2294 4705Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland ,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
A Framework for Case-Based Learning in Prehospital Medicine: The London's Air Ambulance Experience. Air Med J 2022; 41:521-525. [PMID: 36494166 DOI: 10.1016/j.amj.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
Clinical governance is the framework around which health care organizations can maintain a higher standard of safety and care. One of the central aspects of clinical governance is continuous professional education, including case-based review and case-based learning. In this article, we present the case-based education process in use at London's Air Ambulance, a mature advanced prehospital system in London, UK. The case review process begins with an on-scene hot debrief, an informal process often involving other emergency services. This is usually followed by internal team feedback and debrief and patient follow-up. All cases are then reviewed over the next 24 to 48 hours by the duty prehospital consultant (attending) in the rapid review process. After this, certain cases are volunteered or selected for discussion in the twice weekly death and disability (D&D) meeting or the monthly dispatch meeting. A small subset of cases is highlighted through this process for full formal audit and presentation at the monthly clinical governance meetings based on their educational value. Another subset of cases involving a fatality is also discussed at the monthly clinical pathology correlation meeting with the input of local forensic pathologists. Organization of the process, structure of the meetings, and educational value are described in detail.
Collapse
|
5
|
Mass casualty medicine: time for a 21st century refresh. Br J Anaesth 2021; 128:e65-e67. [PMID: 34949438 DOI: 10.1016/j.bja.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/20/2022] Open
Abstract
Mass casualty events are on the rise globally, as we face increasing pressures from scarcity of resources, population growth, systemic inequalities, geopolitical instabilities, and polarised discourse. Although they are rare events for an individual practitioner, they are going to happen to someone, somewhere, this week, this month, this year. And whilst they are often the last consideration for healthcare systems under constant pressures from daily routine work, individuals, departments, hospitals, and systems have to step up effectively in times of crisis. Failure to do so can lead to suboptimal outcomes for casualties, and even perceived failures can have crippling consequences on staff, families, and communities for years.
Collapse
|
6
|
Park CL, Grier GR. Provision of pre-hospital medical care for terrorist attacks. Br J Anaesth 2021; 128:e85-e89. [PMID: 34903363 DOI: 10.1016/j.bja.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
The delivery of medical care to the severely injured during major incidents and mass casualty events has been a recurring challenge for decades across the world. From events in resource-poor developing countries, through richly funded military conflicts, to the most equipped of developed nations, the provision of rapid medical care to the severely injured during major incidents and mass casualty events has been a priority for healthcare providers. This is often under the most difficult of circumstances.1,2 Whilst mass casualty events are a persistent global challenge, it is clear in developed countries that patients and their families demand and expect a high standard of care from their rescuers, that this care should be delivered rapidly, and this should be of the highest quality possible.3 Whilst there is respect afforded to those who 'run towards danger' during a high-threat situation, first responders are subjected to a high degree of scrutiny for their actions, even when the circumstances they are presented with are considered to be extraordinary.4 Likewise, even for those who are catastrophically injured beyond salvage, society expects the response to be dignified, calculated, and thorough.3.
Collapse
Affiliation(s)
- Claire L Park
- Barts Health NHS Trust, London, UK; King's College Hospital NHS Trust, London, UK; Institute of Pre-Hospital Care at London's Air Ambulance, London, UK; Specialist Firearms Department of the Metropolitan Police Service, London, UK.
| | - Gareth R Grier
- Barts Health NHS Trust, London, UK; Institute of Pre-Hospital Care at London's Air Ambulance, London, UK; Queen Mary University London, London, UK
| |
Collapse
|