Evidence-based emergency medicine/systematic review abstract. Is routine spinal immobilization an effective intervention for trauma patients?
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Journal Article↗
Biomedical subjects
Amado Alejandro Báez
Publications and source records attributed to Amado Alejandro Báez.
Unstable ethical plateaus and disaster triage.
Disasters are defined medically as mass casualty incidents in which the number of patients presenting during a given time period exceeds the capacity of the responders to render effective care in a timely manner. During such circumstances, triage is instituted to allocate scarce medical resources. Current disaster triage attempts to do the most for the most, with the least amount of resources. This article reviews the nature of disasters from the standpoint of immediate medical need, and places into an ethics framework currently proposed utilitarian triage schema for prioritizing medical care of surviving disaster victims. Specific questions include whether resources truly are limited, whether specific numbers should dictate disaster response, and whether triage decisions should be based on age or social worth. The primary question the authors pose is whether disaster triage, as currently advocated and practiced in the western world, is actually ethical.
Disaster Planning↗
Prehospital cardiac care Cuban style.
The Cuban national Integrated Medical Emergeny System or "Sistema Integrado de Urgencias Medicas" (SIUM) was formed in 1997. In 1998, the SIUM began an active out-of-hospital thrombolysis program using Heberkinasa, the only streptokinase obtained through recombinant DNA techniques, produced by the Cuban Center for Genetic Engineering and Biotechnology. An active community training program has also been implemented, standardizing training for the almost 20,000 members of the national emergency medical services.
Cardiovascular Diseases↗
System compliance with out-of-hospital trauma triage criteria.
BACKGROUND: Emergency Medical Services (EMS) providers are the initial link to a trauma care system. Previous studies have demonstrated poor compliance with trauma triage by EMS personnel. We sought to determine the proportion of adult EMS cases within a large state meeting Trauma Triage Criteria (TTC) who are ultimately cared for in trauma centers. METHODS: Merged EMS and hospital discharge records for 1996 were examined. All adult acute trauma cases were included. Single-system burns and late effects of injury were excluded. RESULTS: Nine thousand one hundred seventy-four adult cases had at least one TTC, and 60.1% of these patients were transported to a non-trauma center (NTC) and 74.6% of cases with an Injury Severity Score > 15 and one TTC were taken to trauma centers. Analyzing two large urban counties, 58.2% and 27.0% of all TTC cases were still taken to NTC hospitals. CONCLUSION: A significant proportion of seriously injured patients meeting TTC were transported by EMS personnel to NTCs.
Abbreviated Injury Scale↗
Basic principles of protective medical support.
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Disease Outbreaks↗
Effectiveness of a Glasgow Coma Scale instructional video for EMS providers.
INTRODUCTION: The Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness of patients who have sustained head injuries. Rapid and accurate GCS scoring is essential. OBJECTIVE: To evaluate the effectiveness of a GCS teaching video shown to prehospital emergency medical services (EMS) providers. METHODS: Participants and setting--United States, Mid-Atlantic region EMS providers. Intervention--Each participant scored all of the three components of the GCS for each of four scenarios provided before and after viewing a video-tape recording containing four scenarios. Design--Before-and-after single (Phase I) and parallel Cohort (Phase II). Analysis--Proportions of correct scores were compared using chi-square, and relative risk was calculated to measure the strength of the association. RESULTS: 75 participants were included in Phase I. In Phase II, 46 participants participated in a parallel cohort design: 20 used GCS reference cards and 26 did not use the cards. Before observing the instructional video, only 14.7% score all of the scenarios correctly, where as after viewing the video, 64.0% scored the scenarios results were observed after viewing the video for those who used the GCS cards (p = 0.001; RR = 2.0; 95% CI = 1.29 to 3.10) than for those not using the cards (p < 0.0001; RR = 10.0; 95% CI = 2.60 to 38.50). CONCLUSIONS: Post-video viewing scores were better than those observed before the video presentation. Ongoing evaluations include analysis of long-term skill retention and scoring accuracy in the clinical environment.
Audiovisual Aids↗
Weapons of mass destruction preparedness and response for the XIV Pan-American Games, Santo Domingo, 2003.
The Pan-American Games are considered to be the fourth most important international athletic event in the world. Hosted by the city of Santo Domingo, Dominican Republic, the XIV Pan-American Games lasted from 11-17 August 2003. In preparation for the Games, the Security Directorate developed and deployed a Weapons of Mass Destruction (WMD) Unit. For operational support, two strike teams (Alpha and Bravo) were active at any given time. Each team consisted of five members including a team leader, field physician, explosive ordinance disposal (EOD) officer, and two tactical officers. Three hospitals-two military and one civilian--were designated as primary medical centers for the event. With the assistance of the WMD Unit, emergency department staff were trained in the medical management of a WMD event, response protocols for WMD were created, and special decontamination areas were designated. Syndromic surveillance was performed by means of direct communications between the hospitals and units, as well as use of an electronic, Web-based surveillance tool.
Bioterrorism↗
Emergency medical services workforce in the city of Santo Domingo.
UNLABELLED: Santo Domingo is the largest city in the Dominican Republic. In recent years this city has experienced a significant increase in ambulance services. OBJECTIVE: To describe the current emergency medical services (EMS) workforce trends in Santo Domingo. METHODS: This was a cross-sectional descriptive study. Emergency medical services providers working within the city of Santo Domingo filled out a nine-item self-administered questionnaire. RESULTS: A total of 101 providers, 48 volunteer and 53 paid, returned the survey (response rates of 75% and 91.4%, respectively). The volunteers showed a mean of 7.48 +/- 2.02 years of involvement in EMS, whereas the paid providers had a mean of 3.58 +/- 2.91 years. When asked about planned long-term involvement in EMS, 93.8% of the volunteers responded positively, compared with 58.5% of the paid group. Nine (16.98%) of the paid providers were not satisfied with their jobs, whereas all the volunteers (100%) stated that they were satisfied; 46 (86.8%) and 27 (50.9%) of the paid providers agreed that better salary and better work hours, respectively, would influence their satisfaction. Among the volunteers, 40 (83.3%) stated that occupational health insurance would improve job satisfaction; and 39 (81.3%) stated that life insurance would bring satisfaction to their job. Logistic regression analysis showed no predictive association between job satisfaction and years of service (p = 0.342). CONCLUSION: Volunteers appeared to be less educated but with a higher long-term interest in EMS. Salary and better work hours seem to be important factors affecting satisfaction of paid providers, whereas occupational health and life insurance appear to affect the satisfaction of volunteers.
Adult↗
Receiving care facility and outcome differences for victims of severe violent injuries.
OBJECTIVE: Each year millions of people die resulting from violence. Our objective was to evaluate and describe the demographic characteristics, access to trauma center care, mortality and morbidity outcomes of victims of severe violence in Pennsylvania. METHODS: This was a cross-sectional population-based observational study. ICD-9-CM diagnostic codes were utilized to define acute injuries; severe injury was defined by an Injury Severity Score (ISS) greater than 15. Descriptive statistics and confidence intervals were used to present group characteristics. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations, and the Odds Ratio was used as the measure of strength of association. For all tests statistical significance was set at the 0.05 level. RESULTS: A total of 8,977 patients with ISS > 15 were included; out of which 663 cases resulted from violence. Three hundred and forty seven (52.3%) were admitted to non-trauma center hospitals (NTC); Three hundred-and-sixteen (47.7%) to trauma center hospitals (TC). Mean length of stay and the rate of complications were significantly greater in the NTC facilities (p = 0.001 and 0.003, respectively) and a higher but statistically nonsignificant mortality increase was found in non-trauma centers (10.4% vs. 15.2%). CONCLUSION: Despite statewide EMS and trauma care systems, half of severely injured victims of violence were cared for in NTC facilities. TC hospitals showed a small but significant outcomes benefit in terms of complications and lengths of stay.
Adult↗
Effectiveness of a simple Internet-based disaster triage educational tool directed toward Latin-American EMS providers.
BACKGROUND: A previous survey demonstrated a lack of standardization related to disaster triage among Latin-American providers. OBJECTIVE: To assess the effectiveness of a short Internet-based educational intervention in disaster and mass-casualty triage. Using three Spanish Internet emergency medical services (EMS) forums, Latin-American providers were invited to participate in the study. The tool consisted of two educational modules: an introduction to disaster triage module and a START (simple triage and rapid treatment) module. Pre- and post-intervention tests were administered, each consisting of five standardized scenarios. Factorial analysis was used to measure the weight of each scenario. The first and fifth scenarios were identical for intraclass correlation. Skill retention was assessed through a one-month follow-up survey. Statistical analysis was performed using chi-square and Fisher's exact test. A total of 55 EMS providers participated in the study. Five of 55 (9.1%) participants correctly answered four or more scenarios on the pretest intervention, compared with 53 of 55 (96.4%) on the posttest [p < 0.001, relative risk 10.60 (95% CI 4.59-24.49)]. Similar findings were obtained for those accurately triaging all five scenarios, with zero of 55 (0%) in the pretest compared with 49 of 55 in the posttest (p < 0.001). Follow-up at one month was 69%. Four or more scenarios were correctly answered at follow-up by 34 of 38 (89.5%) respondents. No significant difference was noted compared with the immediate post-course survey (p = 0.18). Although initial ability of the cohort to accurately triage patients was suboptimal, a short Internet-based educational tool significantly impacted the cohort's ability to perform triage in a simulated patient environment. This improvement was maintained after one month.
Disaster Planning↗