This article presents timelines for two emergency medical incidents in which an atypical, unsafe scene was detected and managed by paramedics. Both incidents involved patients who were correctly diagnosed with meningococcal meningitis and meningococcemia (septic shock) by the paramedics on scene. A case review is presented in moderated format to discuss meningococcal disease and to present several points about scene safety in the setting of an infectious disease emergency, management principles for occupational exposures, and the local emergency management approach to a potential public health emergency in a municipality that does not have its own health department or health officer.

Adult↗

PubMed2003

Primary injury prevention in an urban EMS system.

Injury prevention is increasingly recognized as an important part of health care delivery. Emergency Medical Services (EMS) personnel may be called upon to deliver primary injury prevention (PIP) by educating both patients and peers about how to avoid future similar injury. The purpose of this study was to determine EMS provider attitudes toward PIP and knowledge and practice of PIP during day-to-day clinical work. A brief survey was administered to a sample of paramedics assessing their attitudes toward primary injury prevention, how often they practice it, and whether or not they have received any PIP education during their training. One hundred sixty-two paramedics completed surveys. Of those surveyed, 70% believe that PIP should be a core mission of EMS systems, and 82% believe PIP should be implemented at the local or regional level. However, only 33% routinely educate their patients how to modify injury risk behaviors, and only 19% routinely provide instruction about proper use of protective devices. Approximately 63% of our paramedics received any PIP education during their training. A majority of paramedics in our survey believe that PIP should be a routine part of EMS. However, many paramedics have not received any PIP education, and few paramedics practice PIP during their clinical practice.

Clinical Competence↗

PubMed2003

Prehospital management of pediatric SVT.

Accurate prehospital diagnosis and early initiation of emergency medical treatment for pediatric patients found to have supraventricular tachycardia is a reasonable task to accomplish and one that does not have to be anxiety-provoking. The most important point to remember is that the standard approach to resuscitation and stabilization for pediatric patients with narrow complex tachycardias (and those with aberrant or wide complexes identifiable as WPW) applies to all variations of SVT; thus, it is not necessary to precisely diagnose the variant prior to initiation of treatment, except for WPW, in which adenosine administration is contraindicated. Once the dysrhythmia is identified as SVT, the patient must rapidly be categorized as stable or unstable, which will then lead the EMS provider down the correct branch of the treatment algorithm. Every attempt should be made to perform a 12-lead ECG pre- and post-resuscitation, as well at to administer sedation prior to emergent synchronized cardioversion. Dosages of medications need not be memorized, provided that a readily available guide, such as a Broselow tape or regional tertiary care center laminated resuscitation card, is at hand. Finally, while termination of pediatric SVT, whether spontaneous or by EMS intervention, will also likely terminate the EMS provider's own palpitations, it is essential that these patients be seen in an emergency department immediately in order to accurately diagnose their medical condition and provide the patient and family with an appropriate disposition based on the events surrounding the incident.

Cardiovascular Agents↗

PubMedDate not supplied

Fire safety knowledge and practices among residents of an assisted living facility.

INTRODUCTION: Assisted living facilities (ALFs) pose unique fire risks to the elderly that may be linked to specific fire safety (FS) practices. OBJECTIVE: To evaluate self-reported FS practices among ALF residents. METHODS: All residents of a small ALF were surveyed regarding actual and hypothetical FS behaviors, self-perceived fire risk, and FS preparedness. RESULTS: Fifty-eight ALF residents completed the survey. Thirty-three (58%) individuals reported one or more disabilities. Seven (12%) residents ignored the fire alarm and 21 (35%) could not hear it clearly. Sixteen (28%) residents would attempt to locate the source of a fire rather than escape from the building. Only 24 (42%) residents were familiar with the building fire plan. Twenty-three (40%) people surveyed believed that they were not at risk of fire in the study facility. CONCLUSION: Residents of an ALF may be at increased fire injury risk due to their FS practices and disabilities.

Assisted Living Facilities↗

PubMedDate not supplied

Injuries from assaults on paramedics and firefighters in an urban emergency medical services system.

OBJECTIVE: To determine the nature and frequency of injuries resulting from assaults on paramedics and firefighters in a large, fire department-based emergency medical services (EMS) system. METHODS: This was a descriptive study involving retrospective analysis of an occupational injury database. All injury reports involving assaults from 1996 to 1998 were reviewed. Variables examined included the employee's age, sex, work assignment, and activity being performed when assaulted, the time of day and day of the week of the assault, the nature of the injury, whether medical care was sought, and whether time was lost from work. Assaults were classified as "intentional," if the perpetrator intended to harm the victim, or "unintentional," if the injury resulted from a patient's inadvertently striking the victim due to an acute medical condition. RESULTS: There were 1,100 injury reports submitted during the study period, of which 44 (4.0%, 95% CI 0-10.9%) involved an assault. Paramedics were assaulted in 35 (79.5%) of these incidents and firefighters in nine (20.5%). Forty-one assaults (93.2%) occurred during patient care activities. Medical attention was sought in 36 incidents (81.8%), and in 14 (31.8%) the employee lost time from work. Twenty-six assaults (59.1%) were classified as intentional and 17 (38.6%) as unintentional. One (2.3%) could not be classified. CONCLUSIONS: In this EMS system, injuries resulting from assaults were uncommon. However, due to their potential impact on the victims and the EMS system as a whole, policies and procedures should be developed to minimize these incidents.

Adult↗