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Hoth P, Roth J, Bieler D, Friemert B, Franke A, Paffrath T, Blätzinger M, Achatz G. Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents. Eur J Trauma Emerg Surg 2023; 49:595-605. [PMID: 36810695 PMCID: PMC10175327 DOI: 10.1007/s00068-023-02232-w] [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: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE The increase in terrorist attacks with sometimes devastating numbers of victims has become a reality in Europe and has led to a fundamental change in thinking and a reorientation in many fields including health policy. The purpose of this original work was to improve the preparedness of hospitals and to provide recommendations for training. MATERIAL AND METHODS We conducted a retrospective literature search based on the Global Terrorism Database (GTD) for the period 2000 to 2017. Using defined search strategies, we were able to identify 203 articles. We grouped relevant findings into main categories with 47 statements and recommendations on education and training. In addition, we included data from a prospective questionnaire-based survey on this topic that we conducted at the 3rd Emergency Conference of the German Trauma Society (DGU) in 2019. RESULTS Our systematic review identified recurrent statements and recommendations. A key recommendation was that regular training should take place on scenarios that should be as realistic as possible and should include all hospital staff. Military expertise and competence in the management of gunshot and blast injuries should be integrated. In addition, medical leaders from German hospitals considered current surgical education and training to be insufficient for preparing junior surgeons to manage patients who have sustained severe injuries by terrorist events. CONCLUSION A number of recommendations and lessons learned on education and training were repeatedly identified. They should be included in hospital preparations for mass-casualty terrorist incidents. There appear to be deficits in current surgical training which may be offset by establishing courses and exercises.
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Affiliation(s)
- Patrick Hoth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Johanna Roth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.,Department of Radiotherapy and Radiooncology, Hospital of the State Capital Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany.,Department of Orthopedics and Trauma Surgery, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Benedikt Friemert
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Axel Franke
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Thomas Paffrath
- General-, Visceral-, Thoracic and Trauma Surgery, Severinsklösterchen-Hospital Köln, Jacobstr. 27-31, 50678, Cologne, Germany
| | - Markus Blätzinger
- AUC (Academy for Trauma Surgery) of the German Trauma Society, Wilhelm-Hale-Str. 46B, 80639, Munich, Germany
| | - Gerhard Achatz
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
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Lu J, Wang X, Chen L, Sun X, Li R, Zhong W, Fu Y, Yang L, Liu W, Han W. Unmanned aerial vehicle based intelligent triage system in mass-casualty incidents using 5G and artificial intelligence. World J Emerg Med 2023; 14:273-279. [PMID: 37425090 PMCID: PMC10323497 DOI: 10.5847/wjem.j.1920-8642.2023.066] [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: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Rapid on-site triage is critical after mass-casualty incidents (MCIs) and other mass injury events. Unmanned aerial vehicles (UAVs) have been used in MCIs to search and rescue wounded individuals, but they mainly depend on the UAV operator's experience. We used UAVs and artificial intelligence (AI) to provide a new technique for the triage of MCIs and more efficient solutions for emergency rescue. METHODS This was a preliminary experimental study. We developed an intelligent triage system based on two AI algorithms, namely OpenPose and YOLO. Volunteers were recruited to simulate the MCI scene and triage, combined with UAV and Fifth Generation (5G) Mobile Communication Technology real-time transmission technique, to achieve triage in the simulated MCI scene. RESULTS Seven postures were designed and recognized to achieve brief but meaningful triage in MCIs. Eight volunteers participated in the MCI simulation scenario. The results of simulation scenarios showed that the proposed method was feasible in tasks of triage for MCIs. CONCLUSION The proposed technique may provide an alternative technique for the triage of MCIs and is an innovative method in emergency rescue.
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Affiliation(s)
- Jiafa Lu
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Xin Wang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Linghao Chen
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Xuedong Sun
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Rui Li
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Wanjing Zhong
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Yajing Fu
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Le Yang
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
| | - Weixiang Liu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Wei Han
- Emergency Department of Shenzhen University General Hospital, Shenzhen 518055, China
- Tianjin University, Tianjin 300072, China
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Lessons learned from terror attacks: thematic priorities and development since 2001-results from a systematic review. Eur J Trauma Emerg Surg 2022; 48:2613-2638. [PMID: 35024874 PMCID: PMC8757406 DOI: 10.1007/s00068-021-01858-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Purpose The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. Methods PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. Results Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. Conclusions The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation.
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Neeki MM, Cheung C, Dong F, Pham N, Shafer D, Neeki A, Hajjafar K, Borger R, Woodward B, Tran L. Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans. Trauma Surg Acute Care Open 2021; 6:e000752. [PMID: 34527813 PMCID: PMC8404440 DOI: 10.1136/tsaco-2021-000752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Traumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients. Methods A retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately. Results Proper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated. Discussion Long-term strategies may be needed to improve the capabilities and performance of prehospital providers' capabilities in this delicate life-saving procedure. Level of evidence IV.
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Affiliation(s)
- Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA.,Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Christina Cheung
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Fanglong Dong
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Nam Pham
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Dylan Shafer
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Arianna Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Keeyon Hajjafar
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Rodney Borger
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA
| | - Brandon Woodward
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA.,Department of General Surgery, California University of Science and Medicine, San Bernardino, California, USA
| | - Louis Tran
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA
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DeVita T, Brett-Major D, Katz R. How are healthcare provider systems preparing for health emergency situations? WORLD MEDICAL & HEALTH POLICY 2021; 14:102-120. [PMID: 34226853 PMCID: PMC8242524 DOI: 10.1002/wmh3.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/19/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022]
Abstract
Natural disasters, disease outbreaks, famine, and human conflict have strained communities everywhere over the course of human existence. However, modern changes in climate, human mobility, and other factors have increased the global community's vulnerability to widespread emergencies. We are in the midst of a disruptive health event, with the COVID-19 pandemic testing our health provider systems globally. This study presents a qualitative analysis of published literature, obtained systematically, to examine approaches health providers are taking to prepare for and respond to mass casualty incidents around the globe. The research reveals emerging trends in the weaknesses of systems' disaster responses while highlighting proposed solutions, so that others may better prepare for future disasters. Additionally, the research examines gaps in the literature, to foster more targeted and actionable contributions to the literature.
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Affiliation(s)
- Timothy DeVita
- Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA
| | - David Brett-Major
- Department of Epidemiology, College of Public Health University of Nebraska Medical Center Omaha Nebraska USA
| | - Rebecca Katz
- Center for Global Health Science and Security Georgetown University School of Medicine Washington District of Columbia USA
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Skryabina E, Betts N, Reedy G, Riley P, Amlôt R. UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study. Emerg Med J 2020; 38:756-764. [PMID: 33177061 PMCID: PMC8461407 DOI: 10.1136/emermed-2019-208966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 11/05/2022]
Abstract
Introduction System learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and prevents duplicating mistakes. Methods This convergent parallel mixed methods study comprises data from responses to an online survey and individual interviews with healthcare staff who took part in the responses to three terrorist incidents in the UK in 2017 (Westminster Bridge attack, Manchester Arena Bombing and London Bridge attack) to understand limitations in the response and share good practices. Results The dedication of NHS staff, staff availability and effective team work were the most frequently mentioned enabling factors in the response. Effective coordination between teams and a functional major incident plan facilitated an effective response. Rapid access to blood products, by positioning the blood bank in the ED, treating children and parents together and sharing resources between trauma centres were recognised as very effective innovative practices. Recent health emergency preparedness exercises (HEPEs) were valued for preparing both Trusts and individual staff for the response. Challenges included communication between ambulance services and hospitals, difficulties with patient identification and tracking and managing the return to ‘normal’ work patterns post event. Lack of immediately available clinical protocols to deal with blast injuries was the most commonly mentioned clinical issue. The need for psychosocial support for responding and supporting staff was identified. Discussion Between-agencies communication and information sharing appear as the most common recurring problems in mass casualty incidents (MCIs). Recent HEPEs, which allowed teams, interdisciplinary groups, and different agencies to practice responding to similar simulated incidents, were important and informed actions during the real response. Immediate and delayed psychosocial support should be in place for healthcare staff responding to MCIs.
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Affiliation(s)
- Elena Skryabina
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
| | - Naomi Betts
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul Riley
- Emergency Response Department, Public Health England, Porton Down, London, UK
| | - Richard Amlôt
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
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Smith D, Walters EL, Reibling E, Brockie D, Lee C, Neeki M, Ochoa H, Henson T, Fisgus J, Thomas T. UNIFIED: Understanding New Information from Emergency Departments Involved in the San Bernardino Terrorist Attack. West J Emerg Med 2020; 21:382-390. [PMID: 32191197 PMCID: PMC7081877 DOI: 10.5811/westjem.2019.11.43437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/18/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Emergency departments (ED) are on the front line for treating victims of multi-casualty incidents. The primary objective of this study was to gather and detail the common experiences from those hospital-based health professionals directly involved in the response to the San Bernardino terrorism attack on December 2, 2015. Secondary objectives included gathering information on experiences participants found were best practices. METHODS We undertook a qualitative study using Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines by performing semi-structured interviews with physicians, nurses, and incident management staff from multiple institutions responding to the San Bernardino terrorist attack. We coded transcripts using qualitative analysis techniques and we delineated and agreed upon a refined list with code definitions using a negotiated group process. Final themes were developed and analyzed. RESULTS A total of 26 interviews were completed; 1172 excerpts were coded and categorized into 66 initial themes. Six final categories of communication, training, unexpected help, process bypassed, personal impact/emotions, and practical advice resulted. CONCLUSION Our study provides context regarding the response of healthcare personnel from multiple institutions to a singular terrorist attack in the United States. It elucidates several themes to help other institutions prepare for similar events. Understanding these common experiences provides opportunity to prepare for future incidents and develop questions to study in future events.
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Affiliation(s)
- Dustin Smith
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Elizabeth L Walters
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Ellen Reibling
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Darren Brockie
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
| | - Carol Lee
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Michael Neeki
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Humberto Ochoa
- Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California
| | - Travis Henson
- St. Bernardine's Medical Center, Department of Emergency Medicine, San Bernardino, California
| | - James Fisgus
- San Antonio Regional Hospital, Department of Emergency Medicine, Upland, California
| | - Tammi Thomas
- Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California
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Wray A, Khan F, Ray J, Rowe R, Boysen-Osborn M, Wiechmann W, Toohey S. Comparison of the Bleeding Cricothyrotomy Model to SimMan for Training Students and Residents Emergency Cricothyrotomy. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2019; 7:144-148. [PMID: 31528649 PMCID: PMC6664283 DOI: 10.30476/jamp.2019.74895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION A cricothyroidotomy is an emergency procedure that few emergency medicine residents see or perform during their training. Therefore, there is a need for low cost, high fidelity models for training. In this study, we explore a new training model for cricothyroidotomies (the bleeding CRIC [cost-effective realistic interactive cricothyroidotomy]) to determine if this new task-trainer is non-inferior compared to the current standard of training. METHODS Authors conducted a randomized control non-inferiority study. There were seventeen residents and medical students enrolled by convenience sample to partake in the study. The participants were randomized by block randomization to be taught how to perform a cricothyroidotomy on either the new task trainer or the current standard task trainer and then were asked to perform the procedure on a pig trachea model. Primary outcome measures were scores on a previously validated objective assessment tool and secondary outcomes were comfort levels and realism scores based on pre and post survey results which were analyzed with ANOVA. RESULTS There was found to be no statistically significant difference between the groups in assessment scores, time to completion, or comfort levels pre- and post-intervention. There was a statistically significant difference in that the participants gave higher realism scores in post-test analysis to the Bleeding CRIC compared to the SimMan. Both groups demonstrated that they had significantly improved comfort levels from baseline post-intervention. CONCLUSION Overall, the new task trainer was rated by learners to feel more realistic than the current standard. This study demonstrates non-inferiority of the new task trainer and further studies with larger sample sizes should be conducted to determine its true efficacy.
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Affiliation(s)
- Alisa Wray
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
| | - Faraz Khan
- University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - John Ray
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
| | - Robert Rowe
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
| | - Megan Boysen-Osborn
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
| | - Warren Wiechmann
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
| | - Shannon Toohey
- University of California, Irvine, Department of Emergency Medicine, Orange, CA, USA
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Neeki MM, Dong F, Liang L, Toy J, Carrico B, Jabourian N, Sin A, Hussain F, Brown S, Safdari K, Borger R, Wong D. Evaluation of the effect of methamphetamine on traumatic injury complications and outcomes. Addict Sci Clin Pract 2018; 13:11. [PMID: 29592800 PMCID: PMC5874991 DOI: 10.1186/s13722-018-0112-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the impact of methamphetamine use on trauma patient outcomes. Methods This retrospective study analyzed patients between 18 and 55 years old presenting to a single trauma center in San Bernardino County, CA who sustained traumatic injury during the 10-year study period (January 1st, 2005 to December 31st, 2015). Routine serum ethanol levels and urine drug screens (UDS) were completed on all trauma patients. Exclusion criteria included patients with an elevated serum ethanol level (> 0 mg/dL). Those who screened positive on UDS for only methamphetamine and negative for cocaine and cannabis (MA(+)) were compared to those with a triple negative UDS for methamphetamine, cocaine, and cannabis (MA(−)). The primary outcome studied was the impact of a methamphetamine positive drug screen on hospital mortality. Secondary outcomes included length of stay (LOS), heart rate, systolic and diastolic blood pressure (SBP and DBP, respectively), and total amount of blood products utilized during hospitalization. To analyze the effect of methamphetamine, age, gender, injury severity score, and mechanism of injury (blunt vs. penetrating) were matched between MA(−) and MA(+) through a propensity matching algorithm. Results After exclusion, 2538 patients were included in the final analysis; 449 were patients in the MA(+) group and 2089 patients in the MA(−) group. A selection of 449 MA(−) patients were matched with the MA(+) group based on age, gender, injury severity score, and mechanism of injury. This led to a final sample size of 898 patients with 449 patients in each group. No statistically significant change was observed in hospital mortality. Notably, a methamphetamine positive drug screen was associated with a longer LOS (median of 4 vs. 3 days in MA(+) and MA(−), respectively, p < 0.0001), an increased heart rate at the scene (103 vs. 94 bpm for MA(+) and MA(−), respectively, p = 0.0016), and an increased heart rate upon arrival to the trauma center (100 vs. 94 bpm for MA(+) and MA(−), respectively, p < 0.0001). Moreover, the MA(+) group had decreased SBP at the scene compared to the MA(−) group (127 vs. 132 bpm for MA(+) and MA(−), respectively, p = 0.0149), but SBP was no longer statistically different when patients arrived at the trauma center (p = 0.3823). There was no significant difference in DBP or in blood products used. Conclusion Methamphetamine positive drug screens in trauma patients were not associated with an increase in hospital mortality; however, a methamphetamine positive drug screen was associated with a longer LOS and an increased heart rate.
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Affiliation(s)
- Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA. .,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA.
| | - Fanglong Dong
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Lidia Liang
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Jake Toy
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Braeden Carrico
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Nina Jabourian
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Arnold Sin
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Farabi Hussain
- Department of General Surgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Sharon Brown
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Keyvan Safdari
- Department of Anesthesiology, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Rodney Borger
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - David Wong
- Department of General Surgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
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Bobko JP, Sinha M, Chen D, Patterson S, Baldridge T, Eby M, Harris W, Starling R, Lichtman O. A Tactical Medicine After-action Report of the San Bernardino Terrorist Incident. West J Emerg Med 2018; 19:287-293. [PMID: 29560056 PMCID: PMC5851501 DOI: 10.5811/westjem.2017.10.31374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Joshua P Bobko
- Loma Linda University, Department of Emergency Medicine, Loma Linda, California.,West County Special Weapons and Tactical Team, Orange County, California
| | - Mrinal Sinha
- First Care Provider Foundation, Research Associate
| | - David Chen
- Huntington Beach Special Weapons and Tactical Team, Huntington Beach, California
| | - Stephen Patterson
- San Bernardino Sheriff Aviation Department, Division of Aviation, San Bernardino, California
| | | | - Michael Eby
- San Bernardino Police Department, San Bernardino, California
| | | | - Ryan Starling
- San Bernardino Police Department, San Bernardino, California
| | - Ofer Lichtman
- Rancho Cucamonga Fire District, Rancho Cucamonga, California
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12
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Neeki MM, Dong F, Avera L, Than T, Borger R, Powell J, Vaezazizi R, Pitts R. Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department. West J Emerg Med 2016; 17:690-697. [PMID: 27833674 PMCID: PMC5102593 DOI: 10.5811/westjem.2016.9.31384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient’s acuity level to determine the need to transport to an ED. Methods We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients’ acuity level in a large Level II trauma center between April 2015 and November 2015. Under-triage was defined as lower acuity assessed by paramedics but higher acuity by EPs. Over-triage was defined as higher acuity assessed by paramedics but lower acuity by EPs. The degree of agreement between the paramedics and EPs’ evaluations of patient’s acuity level was compared using Chi-square test. Results We included a total of 503 patients in the final analysis. For paramedics, 2 51 (49.9%) patients were assessed to be emergent, 178 (35.4%) assessed as urgent, and 74 (14.7%) assessed as non-emergent/non-urgent. In comparison, the EPs assessed 296 (58.9%) patients as emergent, 148 (29.4%) assessed as urgent, and 59 (11.7%) assessed as non-emergent/non-urgent. Paramedics agreed with EPs regarding the acuity level assessment on 71.8% of the cases. The overall under- and over-triage were 19.3% and 8.9%, respectively. A moderate Kappa=0.5174 indicated moderate inter-rater agreement between paramedics’ and EPs’ assessment on the same cohort of patients. Conclusion There is a significant difference in paramedic and physician assessment of patients into emergent, urgent, or non-emergent/non-urgent categories. The field triage of a patient to an alternative destination by paramedics under their current scope of practice and training cannot be supported.
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Affiliation(s)
- Michael M Neeki
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Fanglong Dong
- Western University of Health Sciences, Graduate College of Biomedical Sciences, Pomona, California
| | - Leigh Avera
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Tan Than
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Rodney Borger
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Joe Powell
- City of Rialto Fire Department, Rialto, California
| | - Reza Vaezazizi
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Richard Pitts
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
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Frequency of Methamphetamine Use as a Major Contributor Toward the Severity of Cardiomyopathy in Adults ≤50 Years. Am J Cardiol 2016; 118:585-9. [PMID: 27374605 DOI: 10.1016/j.amjcard.2016.05.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/07/2016] [Accepted: 05/23/2016] [Indexed: 01/11/2023]
Abstract
Methamphetamine is one of the most commonly abused illegal drugs in the United States. Health care providers are commonly faced with medical illness caused by methamphetamine. This study investigates the impact of methamphetamine use on the severity of cardiomyopathy and heart failure in young adults. This retrospective study analyzed patients seen at Arrowhead Regional Medical Center from 2008 to 2012. Patients were between 18 and 50 years old. All patients had a discharge diagnosis of cardiomyopathy or heart failure. The severity of disease was quantified by left ventricular systolic dysfunction: heart failure with preserved ejection fraction to mildly reduced if ejection fraction was >40% and moderate to severely depressed if ejection fraction was ≤40%. Methamphetamine abuse was determined by a positive urine drug screen or per documented history. Of the 590 patients, 223 (37.8%) had a history of methamphetamine use. More than half the population was men (n = 389, 62.3%); 41% was Hispanic (n = 243), 25.8% was Caucasian (n = 152), and 27.8% was African-American (n = 164); 60.9% were in the age range of 41 to 50 years (n = 359). Patients with a history of methamphetamine use had increased odds (odds ratio = 1.80, 95% confidence interval 1.27 to 2.57) of having a moderately or severely reduced ejection fraction. Additionally, men were more likely (odds ratio 3.13, 95% confidence interval 2.14 to 4.56) to have worse left ventricular systolic dysfunction. In conclusion, methamphetamine use was associated with an increased severity of cardiomyopathy in young adults.
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Neeki MM, MacNeil C, Toy J, Dong F, Vara R, Powell J, Pennington T, Kwong E. Accuracy of Perceived Estimated Travel Time by EMS to a Trauma Center in San Bernardino County, California. West J Emerg Med 2016; 17:418-26. [PMID: 27429692 PMCID: PMC4944798 DOI: 10.5811/westjem.2016.5.29809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/06/2016] [Accepted: 05/05/2016] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA) as communicated by emergency medical services (EMS) personnel and their actual time of arrival (TOA). The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California. METHODS This retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place. RESULTS A total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001). Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001). We also found month and time of day to be associated with variability in the difference between the median of the estimated and actual arrival time (p=0.0082 and p=0.0005 for month and time of the day, respectively). CONCLUSION EMS personnel underestimate their travel time by a median of nine minutes, which may cause the trauma team to abandon other important activities in order to respond to the emergency department prematurely. The discrepancy between ETA and TOA is unpredictable, varying by month and time of day. As such, a better method of estimating patient arrival time is needed.
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Affiliation(s)
- Michael M Neeki
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Colin MacNeil
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Jake Toy
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - Fanglong Dong
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - Richard Vara
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Joe Powell
- City of Rialto Fire Department, Rialto, California
| | - Troy Pennington
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Eugene Kwong
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
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