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Westman A, Björnstig J. A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018-2022: here be snowmobiles. Scand J Trauma Resusc Emerg Med 2024; 32:36. [PMID: 38664693 PMCID: PMC11046771 DOI: 10.1186/s13049-024-01210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training. METHODS Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms. RESULTS Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness. CONCLUSIONS These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.
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Affiliation(s)
- Anton Westman
- Centre for Disaster Medicine, Department of Diagnostics and Intervention, Umeå University, Umeå, 901 87, Sweden.
- Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - Johanna Björnstig
- Centre for Disaster Medicine, Department of Diagnostics and Intervention, Umeå University, Umeå, 901 87, Sweden
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Chlouchi A, Hmadate I, Chafi K, Rafai M, Outaghyame O, Benabbouha A, Bazine A, Elhjouji A. Seizure, A Shocking Effect of a Lightning Strike on Aerodrome: A Case Report. Air Med J 2024; 43:168-170. [PMID: 38490782 DOI: 10.1016/j.amj.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 10/20/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
Lightning injuries have a high morbidity and mortality because of the electrical effects on the circulatory, respiratory, and central nervous systems. Most lightning-related deaths occur immediately after injury due to fatal arrhythmias or respiratory failure. We describe the case of a patient who experienced a seizure and respiratory distress secondary to a lightning strike and how our team was able to stabilize and transport the patient. Ultimately, in this particular case study, the patient survived with minimal residual neurologic and hemodynamic effects. Based on this clinical vignette, we review the pathophysiology of lightning injuries and the predictive factors of positive outcomes in such unusual accidents.
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Affiliation(s)
- Abdellatif Chlouchi
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo.
| | - Ilyass Hmadate
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Khalil Chafi
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Mustapha Rafai
- Air Medical Evacuation Team, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Oussama Outaghyame
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Abdellatif Benabbouha
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Aziz Bazine
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
| | - Abderrahman Elhjouji
- Moroccan Level 2 Hospital of Bunia, Mission de l'Organisation des Nations Unies pour la stabilisation en République démocratique du Congo, Bunia, Democratic Republic of Congo
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Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness Environ Med 2024; 35:20S-44S. [PMID: 37945433 DOI: 10.1016/j.wem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023]
Abstract
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
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Affiliation(s)
- Christopher Van Tilburg
- Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | | | - William Will R Smith
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
| | - Ken Zafren
- International Commission for Alpine Rescue
- Himalayan Rescue Association, Kathmandu, Nepal
- Stanford University Medical Center, Palo Alto, CA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Wang M, Zhang H, Luo Y, Xu M. Comprehensive risk management of health, safety and environment for social emergency rescue organization. Heliyon 2024; 10:e23021. [PMID: 38163236 PMCID: PMC10754858 DOI: 10.1016/j.heliyon.2023.e23021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/04/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
During the rescue and relief work of social emergency rescue organizations, the rescue team members face significant responsibilities and risks. Social rescue organizations need to improve funding, available equipment and other aspects compared with professional emergency rescue organizations. Moreover, the development of rescue levels among emergency rescue organizations is unbalanced, and rescue teams'' comprehensive quality and skills are uneven. To understand the safety risks of these organizations before the implementation of rescue and relief tasks, the task situation and its characteristics must be assessed timely, and safety must be ensured under the premise of efficient completion of the rescue missions. Based on the theory of safety system engineering and health, safety, and environment risk management, a risk management model is established to achieve a closed-loop risk management. The risk factors in rescue and relief tasks of social rescue organizations were identified, and a health, safety and environment risk assessment index system and grading standard were established. A gray cloud model was applied for the evaluation method, the problems of information randomness, risk-level boundary fuzziness and randomness of the evaluation index data were effectively solved. Subsequently, a risk hierarchical early warning and control strategies were proposed to allocate emergency resources rationally. The proposed method was verified and found to have universal applicability and strong practicability.
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Affiliation(s)
- Mengyao Wang
- College of Engineering and Technology, China University of Geoscience (Beijing), Beijing, 100083, China
| | - Haoying Zhang
- College of Engineering and Technology, China University of Geoscience (Beijing), Beijing, 100083, China
| | - Yun Luo
- College of Engineering and Technology, China University of Geoscience (Beijing), Beijing, 100083, China
| | - Ming Xu
- College of Engineering and Technology, China University of Geoscience (Beijing), Beijing, 100083, China
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Rauch S, Lechner R, Strapazzon G, Mortimer RB, Ellerton J, Skaiaa SC, Huber T, Brugger H, Pasquier M, Paal P. Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Scand J Trauma Resusc Emerg Med 2023; 31:95. [PMID: 38071341 PMCID: PMC10710713 DOI: 10.1186/s13049-023-01164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially. AIMS The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome. METHODS A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened. RESULTS The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work. CONCLUSIONS Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.
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Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Department of Anaesthesia and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
- Medical University Innsbruck, Innsbruck, Austria.
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehr Hospital Ulm, Ulm, Germany
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Corpo Nazionale del Soccorso Alpino E Speleologico (CNSAS), Milan, Italy
| | - Roger B Mortimer
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Fresno Medical Education Program, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - Sven Christjar Skaiaa
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Tobias Huber
- Department of Anaesthesiology and Intensive Care Medicine, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Medical University Innsbruck, Innsbruck, Austria
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Private Medical University, Salzburg, Austria
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Nedelea PL, Manolescu E, Ciumanghel AI, Constantin M, Hauta A, Sirbu O, Ionescu L, Blaj M, Corlade-Andrei M, Sorodoc V, Cimpoesu D. The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania-Case-Based Review. J Clin Med 2023; 12:4922. [PMID: 37568324 PMCID: PMC10419366 DOI: 10.3390/jcm12154922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1).
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Affiliation(s)
- Paul Lucian Nedelea
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Emilian Manolescu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Adi-Ionut Ciumanghel
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Anesthesia Intensive Care Unit, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Mihai Constantin
- 2nd Internal Medicine Clinic, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandra Hauta
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Oana Sirbu
- 2nd Internal Medicine Clinic, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lidia Ionescu
- 3rd Surgery Clinic, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Mihaela Blaj
- Anesthesia Intensive Care Unit, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | | | - Victorita Sorodoc
- 2nd Internal Medicine Clinic, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Cimpoesu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
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Martin-Gill C, Brown KM, Cash RE, Haupt RM, Potts BT, Richards CT, Patterson PD. 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care. PREHOSP EMERG CARE 2023; 27:131-143. [PMID: 36369826 DOI: 10.1080/10903127.2022.2143603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel. OBJECTIVES We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel. METHODS We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing. CONCLUSIONS This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel M Haupt
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Benjamin T Potts
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Park-Ross JF, Howard I, Hodkinson P. Rescue Activity of a Civilian Helicopter Emergency Medical Service in the Western Cape, South Africa: A 5-Year Retrospective Review. Wilderness Environ Med 2022; 33:437-445. [PMID: 36229384 DOI: 10.1016/j.wem.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Helicopter search and rescue (SAR) in Africa is conducted primarily by military organizations. Since 2002, the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial, and aquatic rescue. To our knowledge, this is the first description of the operations of an African helicopter rescue service. METHODS A 5-y retrospective review of the terrestrial and aquatic helicopter rescue activity of a civilian-operated HEMS in the Western Cape, South Africa, from January 1, 2012 through December 31, 2016, was conducted. Data were extracted from the organization's operational database, aviation documents, rescue reports, and patient care records. Patient demographics and activity at the time of rescue, temporal and geographical distribution, crewing compositions, patient injury, triage, clinical interventions, and rescue techniques were analyzed. RESULTS A total of 581 SAR missions were conducted, of which 451 were terrestrial and 130 were aquatic rescues. The highest volume of rescues was conducted within the urban Cape Peninsula. Hoisting using a rescue harness was the most common rescue technique used. A total of 644 patients were rescued, with no or minor injuries representing 79% of the sample. Trauma (33%, 196/644) was the most common medical reason for rescue, with lower limb trauma predominant (15%, 90/644). The most common clinical interventions performed were intravenous access (n=108, 24%), spinal immobilization (n=92, 21%), splinting (n=76, 17%), and analgesia administration (n=58, 13%). CONCLUSIONS The rescue techniques utilized are similar to those described in high-income settings. Uninjured patients comprised the majority of the patients rescued.
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Affiliation(s)
- Jocelyn Frances Park-Ross
- Department of Emergency Medicine, University of Cape Town, Cape Town; Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ian Howard
- Department of Emergency Medicine, University of Cape Town, Cape Town
| | - Peter Hodkinson
- Department of Emergency Medicine, University of Cape Town, Cape Town
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Emergency Service Assistance for Injuries on Alpine Ski Slopes: A Cross-Sectional Study. Prehosp Disaster Med 2022; 37:778-782. [PMID: 36199228 DOI: 10.1017/s1049023x22001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Injuries on alpine ski slopes have been described in cohorts of a reasonable sample size, but constant improvements in safety gear, increased use of airborne rescue, and safety measures during the coronavirus disease 2019 (COVID-19) pandemic mandate re-evaluation. Therefore, the purpose of this study was to evaluate skiing and snowboarding injuries, effectiveness of airborne rescue, and impact of the COVID-19 pandemic on a large sample size. METHODS Data on alpine injuries were prospectively collected from the state emergency services dispatch center in the state of Tyrol (Austria). A total of 10,143 patients were identified, with an average age of 33.5 years (SD = 20.36). The ski patrol was involved in 8,606 cases (84.9%) and some patients (n = 1,536; 15.1%) required helicopter rescue. RESULTS A total of 10,143 patients were identified from the dataset of the emergency dispatch center. The most frequently injured region was the knee (30.2%), and it was followed by the shoulder (12.9%), the lower leg (9.5%), and the head/skull (9.5%). CONCLUSION The present findings indicate that the most frequent site of injuries on alpine slopes is the knee, and life-threatening injuries are rare. Airborne rescue is very time-effective, however clinical studies with patient follow-up should be emphasized to determine the impact of airborne rescue on patient outcome. The present findings indicate that the duration of all rescue operations has been prolonged as a result of the introduction of safety measures during the COVID-19 pandemic.
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10
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A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol. Injury 2022; 53:3070-3077. [PMID: 36038387 DOI: 10.1016/j.injury.2022.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lightning strikes have high morbidity and mortality rates. Thousands of fatalities are estimated to be caused by lightning worldwide, with the number of injuries being 10 times greater. However, evidence of lightning injuries is restricted to case reports and series and nonsystematic reviews. In this clinical review, we systematically select, score, and present evidence regarding lightning injuries. MATERIAL AND METHODS We performed a systematic search for reviews and guidelines in the PubMed, Embase (OvidSP), MEDLINE (OvidSP), and Web of Science databases. All publications were scored according to the Levels of Evidence 2 Table of the Oxford center for Evidence-Based Medicine. The reviews were also scored using the scale for the quality assessment of narrative review articles (SANRA) and guidelines from the Appraisal of Guidelines for Research & Evaluation (AGREE II). RESULTS The search yielded 536 articles. Eventually, 56 articles were included, which consisted of 50 reviews, five guidelines and one overview. The available reviews and guidelines were graded as low to moderate evidence. Most damage from lightning injuries is cardiovascular and neurological, although an individual can experience complications with any of their vital functions. At the scene, initial treatment and resuscitation should focus on those who appear to be dead, which is called the reverse triage system. We proposed an evidence-based treatment protocol for lightning strike patients. CONCLUSION It is vital that every lightning strike patient is treated according to standard trauma guidelines, with a specific focus on the possible sequelae of lighting injuries. All emergency healthcare professionals should acknowledge the risks and particularities of treating lighting strike injuries to optimize the care and outcomes of these patients. Our evidence-based treatment protocol should help prehospital and in-hospital emergency healthcare practitioners to prevent therapeutic mismanagement among these patients.
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Perry O, Jaffe E, Bitan Y. Dynamic Communication Quantification Model for Measuring Information Management During Mass-Casualty Incident Simulations. HUMAN FACTORS 2022; 64:228-249. [PMID: 34275344 PMCID: PMC8873974 DOI: 10.1177/00187208211018880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/25/2021] [Accepted: 04/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To develop a new model to quantify information management dynamically and to identify factors that lead to information gaps. BACKGROUND Information management is a core task for emergency medical service (EMS) team leaders during the prehospital phase of a mass-casualty incident (MCI). Lessons learned from past MCIs indicate that poor information management can lead to increased mortality. Various instruments are used to evaluate information management during MCI training simulations, but the challenge of measuring and improving team leaders' abilities to manage information remains. METHOD The Dynamic Communication Quantification (DCQ) model was developed based on the knowledge representation typology. Using multi point-of-view synchronized video, the model quantifies and visualizes information management. It was applied to six MCI simulations between 2014 and 2019, to identify factors that led to information gaps, and compared with other evaluation methods. RESULTS Out of the three methods applied, only the DCQ model revealed two factors that led to information gaps: first, consolidation of numerous casualties from different areas, and second, tracking of casualty arrivals to the medical treatment area and departures from the MCI site. CONCLUSION The DCQ model allows information management to be objectively quantified. Thus, it reveals a new layer of knowledge, presenting information gaps during an MCI. Because the model is applicable to all MCI team leaders, it can make MCI simulations more effective. APPLICATION This DCQ model quantifies information management dynamically during MCI training simulations.
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Affiliation(s)
- Omer Perry
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Jaffe
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Magen David Adom (MDA), Israel
| | - Yuval Bitan
- 26732 Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Prevention of Hypothermia in the Aftermath of Natural Disasters in Areas at Risk of Avalanches, Earthquakes, Tsunamis and Floods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031098. [PMID: 35162119 PMCID: PMC8834683 DOI: 10.3390/ijerph19031098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Throughout history, accidental hypothermia has accompanied natural disasters in cold, temperate, and even subtropical regions. We conducted a non-systematic review of the causes and means of preventing accidental hypothermia after natural disasters caused by avalanches, earthquakes, tsunamis, and floods. Before a disaster occurs, preventive measures are required, such as accurate disaster risk analysis for given areas, hazard mapping and warning, protecting existing structures within hazard zones to the greatest extent possible, building structures outside hazard zones, and organising rapid and effective rescue. After the event, post hoc analyses of failures, and implementation of corrective actions will reduce the risk of accidental hypothermia in future disasters.
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Paal P, Zafren K, Pasquier M. Higher pre-hospital anaesthesia case volumes result in lower mortality rates: implications for mass casualty care. Br J Anaesth 2021; 128:e89-e92. [PMID: 34794765 DOI: 10.1016/j.bja.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/30/2023] Open
Abstract
Senior physicians with a higher pre-hospital anaesthesia case volume have higher first-pass tracheal intubation success rates, shorter on-site times, and lower patient mortality rates than physicians with lower case volumes. A senior physician's skill set includes the basics of management of airway and breathing (ventilating and oxygenating the patient), circulation, disability (anaesthesia), and environment (especially maintaining core temperature). Technical rescue skills may be required to care for patients requiring pre-hospital airway management especially in hazardous environments, such as road traffic accidents, chemical incidents, terror attacks or warfare, and natural disasters. Additional important tactical skills in mass casualty situations include patient triage, prioritising, allocating resources, and making transport decisions.
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Affiliation(s)
- Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
| | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, USA; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Walpoth BH, Maeder MB, Courvoisier DS, Meyer M, Cools E, Darocha T, Blancher M, Champly F, Mantovani L, Lovis C, Mair P. Hypothermic Cardiac Arrest - Retrospective cohort study from the International Hypothermia Registry. Resuscitation 2021; 167:58-65. [PMID: 34416307 DOI: 10.1016/j.resuscitation.2021.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
AIM The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidence-based guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR. METHODS Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020. RESULTS Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0 °C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors. CONCLUSIONS This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.
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Affiliation(s)
- Beat H Walpoth
- Dept. of Cardiovascular Surgery, University Hospitals, Geneva, Switzerland (Emeritus).
| | - Monika Brodmann Maeder
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | | | - Marie Meyer
- Dept. of Anesthesia, University Hospital, Lausanne, Switzerland
| | - Evelien Cools
- Division of Anesthesia, University Hospitals, Geneva, Switzerland
| | - Tomasz Darocha
- Dept. Anesthesiology & Intensive Care, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Christian Lovis
- Division of Medical Information Sciences, University Hospitals, Geneva, Switzerland
| | - Peter Mair
- Dept. of Anesthesia, University Hospitals, Innsbruck, Austria
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15
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Drones to the rescue? Exploring rescue workers' behavioral intention to adopt drones in mountain rescue missions. INTERNATIONAL JOURNAL OF PHYSICAL DISTRIBUTION & LOGISTICS MANAGEMENT 2021. [DOI: 10.1108/ijpdlm-01-2020-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeMountaineering and related activities are increasingly becoming popular and are accompanied by an increase in medical incidents. Emergency operations in mountainous terrain are time-critical and often pose major logistical challenges for rescuers. Drones are expected to improve the operational performance of mountain rescuers. However, they are not yet widely used in mountain rescue missions. This paper examines the determinants that drive the behavioral intention of mountain rescuers to adopt drones in rescue missions.Design/methodology/approachThis is a behavioral study that builds upon an extended model of the unified theory of acceptance and use of technology (UTAUT) and investigates the relationship between individual attitudes, perceptions, and intentions for drone adoption. Original survey data of 146 mountain rescuers were analyzed using moderated ordinary least squares (OLS) regression analysis.FindingsResults indicate that the behavioral intention to use drones in mountain rescue missions is driven by the expected performance gains and facilitating conditions. Favorable supporting conditions and experience with drones further moderate the relationship between performance expectancy and behavioral intention. The effects for effort expectancy, social influence, and demonstrations were not significant.Practical implicationsRescue organizations and stakeholders are recommended to consider the identified determinants in the implementation of drones in emergency logistics. Drone manufacturers targeting mountain rescue organizations are advised to focus on operational performance, provide sufficient support and training, and promote the gathering of practical experience.Originality/valueA tailored-model that provides first empirical results on the relevance of personal and environmental factors for the acceptance of drones in emergency logistics is presented.
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Schön CA, Gordon L, Hölzl N, Milani M, Paal P, Zafren K. Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Wilderness Environ Med 2020; 31:506-520. [PMID: 33077333 DOI: 10.1016/j.wem.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.
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Affiliation(s)
- Corinna A Schön
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
| | - Les Gordon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; University Hospitals, Morecambe Bay Trust, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Natalie Hölzl
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care, Klinikum Immenstadt, Germany
| | - Mario Milani
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK
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Lunde A, Braut GS. The Concept of Overcommitment in Rescue Operations: Some Theoretical Aspects Based on Empirical Data. Air Med J 2019; 38:343-349. [PMID: 31578972 DOI: 10.1016/j.amj.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Studies on Norwegian avalanche rescue operations have indicated high-stake searching of avalanches during elevated risk conditions. We perceive these characteristics as a sign of overcommitment. The purpose of this study is to explore the concept of overcommitment in Norwegian medical evacuation and rescue operations. How can overcommitment be described and understood as a uniform concept in rescue operations based on empirical data? METHODS In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian air ambulance service. RESULTS In this first in a series of 2 articles, crewmembers' reflections on the concept of overcommitment, important factors to consider when balancing risk and benefit in every mission, and a number of causal factors are presented. A definition of overcommitment in the context of rescue activities is presented. CONCLUSION Air ambulance personnel recognize overcommitment in a variety of situations. They broaden the concept to include both regular, everyday actions and hazardous rescue attempts in extraordinary incidents. The causal factors form recognizable constellations that may offer useful starting points for systems-based counteracting measures. The definition of overcommitment could provide a background for evaluation and learning in the rescue service.
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Affiliation(s)
| | - Geir Sverre Braut
- The University of Stavanger, Stavanger, Norway; Stavanger University Hospital, Stavanger, Norway
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18
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Métrailler-Mermoud J, Hugli O, Carron PN, Kottmann A, Frochaux V, Zen-Ruffinen G, Pasquier M. Avalanche victims in cardiac arrest are unlikely to survive despite adherence to medical guidelines. Resuscitation 2019; 141:35-43. [DOI: 10.1016/j.resuscitation.2019.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/17/2019] [Accepted: 05/31/2019] [Indexed: 12/23/2022]
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Wallner B, Moroder L, Brandt A, Mair P, Erhart S, Bachler M, Putzer G, Turner R, Strapazzon G, Falk M, Brugger H. Extrication Times During Avalanche Companion Rescue: A Randomized Single-Blinded Manikin Study. High Alt Med Biol 2019; 20:245-250. [PMID: 31264903 DOI: 10.1089/ham.2019.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims: This study aimed to determine the time needed for one or two companion rescuers to access, extricate, and deliver cardiopulmonary resuscitation (CPR) to a fully buried manikin during a simulated avalanche burial scenario. Materials and Methods: In this randomized, single-blinded study, 18 medical students were required to extricate a manikin manually from a simulated avalanche burial of 1 m in depth, either alone or in teams of two. Each participant performed three consecutive tests with the manikin in three different positions in random order. Results: Median time to first manikin contact was 2.5 minutes, median time to airway access 7.2 minutes, and median time to standard position for CPR 10.1 minutes. Overall, the number of rescuers (one compared to two rescuers, 10.5 minutes vs. 9.3 minutes; p = 0.686) and the burial position of the manikin (10.8 minutes vs. 10.6 minutes vs. 8.8 minutes; p = 0.428) had no influence on extrication times. Preexisting training (6.1 minutes vs. 11.0 minutes p = 0.006) and a learning effect obtained during the experiments (12.4 minutes the first test vs. 9.3 in the third test; p = 0.017) improved all extrication times. Conclusion: It takes an average of 7 minutes after location of a simulated avalanche victim, buried at a depth of 1 m, to free the airway, plus a further 3 minutes to initiate CPR in standard supine position. This is more than two-thirds of the 15 minutes considered necessary for successful companion avalanche rescue. Even minimal training significantly reduced extrication times. These findings emphasize the importance of regular practice in specific extrication techniques that should be part of any training in avalanche companion rescue.
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Luca Moroder
- Department of Anaesthesiology and Critical Care Medicine, General Hospital Brixen, Brixen, Italy
| | - Anna Brandt
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Erhart
- Department of Orthopaedics and Traumatology, University Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Mirjam Bachler
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Sorani M, Tourani S, Khankeh HR, Panahi S. Challenges of helicopter emergency medical service: A qualitative content analysis in Iranian context. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Ströhle M, Wallner B, Lanthaler M, Rauch S, Brugger H, Paal P. Lightning accidents in the Austrian alps - a 10-year retrospective nationwide analysis. Scand J Trauma Resusc Emerg Med 2018; 26:74. [PMID: 30201016 PMCID: PMC6131802 DOI: 10.1186/s13049-018-0543-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. Methods From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. Results The Austrian Alpine Police database, containing 109.168 patients for the years 2005–2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene; survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. Discussion Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low. Trial registration The study was approved by the Ethics Committee of the Medical University of Innsbruck (AN4757 315/4.4) and retrospectively registered with Clinical Trials NCT03405467, January 19, 2018.
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Affiliation(s)
- Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.
| | - Michael Lanthaler
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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Strapazzon G, Brugger H. On-Site Treatment of Snow Avalanche Victims: From Bench to Mountainside. High Alt Med Biol 2018; 19:307-315. [PMID: 30183350 DOI: 10.1089/ham.2018.0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The number of avalanche accidents involving winter recreationists has notably increased in recent decades due to the increasing popularity of outdoor winter activities. The International Liaison Committee on Cardiopulmonary Resuscitation, the International Commission for Mountain Emergency Medicine (ICAR Medcom), and the Wilderness Medical Society have recently published evidenced-based recommendations for the on-site treatment of snow avalanche victims. Despite these recommendations, recent studies found poor knowledge and compliance by both healthcare providers and laypersons. The aim of this nonsystematic review is to provide an updated overview of avalanche accident epidemiology, to present recent advances in snow avalanche pathophysiology, and to discuss recent advancements in on-site treatment of snow avalanche victims.
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Affiliation(s)
- Giacomo Strapazzon
- 1 Institute of Mountain Emergency Medicine , Eurac Research, Bolzano, Italy .,2 International Commission of Mountain Emergency Medicine (ICAR Medcom) , Kloten, Switzerland
| | - Hermann Brugger
- 1 Institute of Mountain Emergency Medicine , Eurac Research, Bolzano, Italy .,2 International Commission of Mountain Emergency Medicine (ICAR Medcom) , Kloten, Switzerland
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