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Bryan E Bledsoe

Publications and source records attributed to Bryan E Bledsoe.

33 records · Page 2Linked to original sources
PubMed2003

Beyond the debriefing debate: what should we be doing?

It is clear that it is very difficult to treat trauma-related stress after the fact. EMS and fire personnel must develop personal stress management strategies and have a personal-support system in place. Most stresses in EMS are the day-to-day hassles of the job. Occasionally, some of us will be involved in a disaster operation. As with the day-to-day stressors, the best way to manage disasters is through planning and preparation. As Lauren Simon Ostrow wrote, "In the end, EMS may want to re-examine the all-American notion that we should always feel good, that stress is bad and that we have to take corrective action to resolve every negative reaction to stress, even if it is normal."

Crisis Intervention↗
PubMed2002

It's Isaac again.

Explore the source record for details and available documents.

Alcoholism↗
PubMed2002

No more coma cocktails. Using science to dispel myths & improve patient care.

It should be clear from this discussion that coma cocktails are a bad idea and should be immediately abandoned. In fact, the indiscriminate use of the coma cocktail may indeed harm patients, EMS has evolved to a point where any EMS provider should be able to reasonably determine the most likely cause of coma, or, in a worst-case scenario, narrow the cause to but a few possibilities. Certainly, patients with bona fide hypoglycemia should receive IV glucose. Because the consequences of prolonged hypoglycemia are severe, if there's a doubt about whether hypoglycemia is present, then glucose should be empirically administered. Naloxone should be used only for those cases in which a narcotic overdose appears likely. Similarly thiamine administration should be limited to patients suspected of chronic alcohol abuse and who exhibit at least one of the three symptoms of WE described above. Flumazenil has no role in the routine treatment of coma unless the patient is known to not be benzodiazepine dependent and the overdose is known to result only from benzos--two very difficult requirements to verify in the back of an ambulance at 2 a.m. Coma cocktails are bad medicine. Let's banish them from our EMS armamentarium.

Coma↗
PubMedDate not supplied

Critical incident stress management (CISM): benefit or risk for emergency services?

BACKGROUND: Critical incident stress management (CISM) has become a common practice in modern emergency services. Described in 1983 as critical incident stress debriefing (CISD), CISM was originally marketed to help emergency personnel deal with ostensibly stressful situations they would encounter as a part of their work. OBJECTIVE: To review the status of the medical and psychological literature regarding the efficacy and safety of CISM. METHODS: Several pertinent databases were accessed and searched for scientific articles pertaining to CISM. These were subsequently analyzed for methodology and pertinence to the study topic. RESULTS: Numerous scientific articles were found concerning CISM. Several high-quality studies were identified, but many other studies lacked adequate methodology sufficient for use in an evidence-based medicine approach. Others were from trade magazines, non-refereed journals, and obscure mental health journals. Several meta-analyses and randomized controlled trials (RCTs) were found. Overall, these studies show that, at best, CISM has no effect on preventing psychiatric sequelae following a traumatic event, particularly post-traumatic stress disorder (PTSD). Furthermore, several studies report possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM. CONCLUSIONS: Despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of this, CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.

Crisis Intervention↗
PubMedDate not supplied

Air medical helicopter accidents in the United States: a five-year review.

OBJECTIVE: To determine the number of air medical helicopter accidents in the United States during a five-year period beginning January 1, 1997, and ending December 31, 2001. METHODS: The National Transportation Safety Board's (NTSB's) Accident Synopses database was accessed to determine the number of accidents involving air medical helicopters during the five-year study period. The NTSB reports for each accident were downloaded. RESULTS: The NTSB records revealed 47 accident files pertaining to air medical helicopters during the five-year study period. These were analyzed for: date of accident, time of accident, air ambulance operator, location of accident, type of aircraft, number of persons, number of fatalities, number of injuries, cause of accident, and other factors the NTSB investigators deemed appropriate. Of the 47 accidents, there were 40 fatalities and 36 injuries. Overall, there were 13 helicopter types involved. The majority of accidents (70%) were attributed to pilot error. The number of accidents increased from a low of 4 in 1997 to a maximum of 12 in both 2000 and 2001. CONCLUSIONS: This study has examined 47 U.S. air medical helicopter accidents for a five-year period (1997-2001). There was an increase in the number of accidents during the study period. However, this study is limited by the fact that it presents only raw data and does not reflect the actual incidence of accidents per hours flown. Various factors related to these accidents have been described. These factors should be considered when strategies to improve air medical helicopter safety are developed.

Accidents, Aviation↗