Acute abdominal eviscerations.
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Abdominal Injuries↗
Biomedical subjects
Edward T Dickinson
Publications and source records attributed to Edward T Dickinson.
Effect of night vision goggles on performance of advanced life support skills by emergency personnel.
Night vision goggles (NVGs) are used by military personnel operating in low-light environments. It is not known whether NVGs can be used by medical personnel to provide emergency care under such conditions. This was a randomized controlled study to determine the effect of NVGs on the performance of intravenous line insertion (IVI) and endotracheal intubation (El) on training manikins. Emergency physicians and paramedics were randomized to perform EI and IVI in ambient light or in total darkness using NVGs. Each skill was repeated three times, and averages were determined. The average times for EI in ambient light and with NVGs were 48.4 and 188.2 seconds, respectively (SE of 13.4 seconds for both; p < 0.0001). The average times for IVI in ambient light and with NVGs were 34.7 and 73.7 seconds, respectively (SE of 4.1 seconds for both; p < 0.0001). Emergency personnel were able to successfully perform these skills using NVGs, but their times were significantly longer than in ambient light.
Advanced Cardiac Life Support↗
Dealing with DIG. A comprehensive review of digoxin and its therapeutic and toxic effects.
Toxicity due to cardiac glycosides is a common and potentially life-threatening problem. Treatment of such toxicity presents unique challenges to the pre-hospital provider, because many of the tools commonly used to treat patients in the field may lead to disaster if inappropriately applied. But with better understanding of the mechanism of digitalis toxicity, prehospital providers can avoid pitfalls of treatment and render lifesaving care.
Anti-Arrhythmia Agents↗
Necessity of fire department response to the scene of motor vehicle crashes.
The purpose of this study was to identify how often fire department (FD) response to the scene of motor vehicle crashes (MVCs) is necessary for rescue and fire suppression. A retrospective review of MVCs between January 1, 1997 and December 13, 2000 occurring in a suburban municipality (population 79,000, 13 FDs) was conducted. Data abstracted included the total number of reported MVCs, MVCs with personal injury (PIAC), MVCs to which the FD responded, MVCs requiring any extrication, MVCs requiring extensive extrication, and MVCs requiring fire suppression. Data were analyzed using descriptive statistics. A total of 14,450 MVCs occurred during the study period. Two thousand ninety-five (14.5%) resulted in personal injury. The FD responded to 198 MVCs (9.5% of PIAC). Twenty-four (1.1% of PIAC) required simple door release. Fourteen (0.7% of PIAC) required more extensive extrication. No MVC required fire suppression. During this study period, specialized equipment and personnel were rarely needed for patient extrication from MVCs in this municipality. At no time was fire suppression required. Routine FD response to MVCs for purposes of extrication or fire suppression is not warranted in this emergency response system. A prospective study, including a cost analysis, should be undertaken to further clarify the role of FD response to MVCs.
Accidents, Traffic↗
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↗
The utility of tympanic versus oral temperature measurements of firefighters in emergency incident rehabilitation operations.
OBJECTIVES: Emergency incident rehabilitation (EIR) is the process by which firefighters receive medical screening and monitoring as well as oral rehydration while on the scene of intense or extended fire or rescue operations. A crucial parameter in EIR medical monitoring is temperature determination because heat-related illnesses are common. The objective of this study was to compare the use of oral temperature versus infrared tympanic temperature determinations of firefighters in the outdoor environment of EIR operations. METHODS: This was a prospective observational study of firefighters participating in training scenarios involving heavy smoke and fire conditions at municipal fire training facilities. Outdoor temperature and relative humidity were obtained for each training session. Subjects were outfitted fully for fire fighting duties including full protective clothing and self-contained breathing apparatus (SCBA). Immediately on exiting the fire building, firefighters removed their SCBA masks, protective hoods, and helmets, and had simultaneous oral and tympanic temperatures taken (time 0). The subjects then sat outdoors for 10 minutes and their temperatures were again obtained (time 10). Oral and tympanic temperatures for both time points were calculated as means +/- SD. An intraclass correlation coefficient was calculated to determine how closely the simultaneously obtained oral and tympanic temperatures determinations at T-0 and T-10 correlated with each other. RESULTS: Forty-two firefighters (mean age, 44.6 years; SD 9.6) were enrolled during four separate training days. There was poor correlation between oral and tympanic temperatures in firefighters both at time 0 (r = 0.10) and at time 10 (r = 0.18). CONCLUSIONS: There is poor correlation between tympanic and oral temperature determinations in the EIR setting. Oral temperature determinations may be preferable to tympanic temperature determination in the EIR setting.
Adult↗
Outcome of travelers who refuse transport after emergency medical services evaluation at an international airport.
OBJECTIVE: To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport. METHODS: This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information. Three days later, one investigator attempted to contact the patient to administer a survey of the medical course in the three days following the initial encounter. RESULTS: Of 90 patients enrolled, 64 (71%) were reached in follow-up. Their average age was 45 years (range 10 months to 80 years); 41 (63%) were female. The most common presenting complaints were trauma-related (22 patients, 34%), neurologic (12, 19%), and gastrointestinal (7, 11%). The most common reasons for refusing transport were belief that their complaint was not serious (48, 75%) and fear they would miss a flight (34 patients, 53%). In the three days following the initial encounter, no patients recontacted 9-1-1, 16 patients (25%) had a recurrence of their initial complaints, and 32 patients (50%) saw or talked to a physician. There was one hospitalization but no deaths. Among patients lost to follow-up, no deaths of U.S. citizens were detected. CONCLUSIONS: Most patients who refused transport after EMS evaluation at an international airport had good short-term outcomes. These results may assist paramedics and MCPs to manage refusals in this setting and to allow patients to make informed decisions.
Adolescent↗