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Gangadharan M, Hayanga HK, Greenberg R, Schwengel D. A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents. Anesth Analg 2024; 138:893-903. [PMID: 38109852 DOI: 10.1213/ane.0000000000006719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.
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Affiliation(s)
- Meera Gangadharan
- From the Department of Anesthesiology, Critical Care and Pain Medicine, UT Houston, McGovern Medical School, Houston, Texas
| | - Heather K Hayanga
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
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Grissom TE, Samet RE. The Anesthesiologist's Role in Teaching Airway Management to Nonanesthesiologists: Who, Where, and How. Adv Anesth 2021; 38:131-156. [PMID: 34106831 PMCID: PMC7534755 DOI: 10.1016/j.aan.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Thomas E Grissom
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, T1R77, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Ron E Samet
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, T1R77, 22 South Greene Street, Baltimore, MD 21201, USA
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van Schuppen H, Boomars R, Kooij FO, den Tex P, Koster RW, Hollmann MW. Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:67-82. [PMID: 33742579 DOI: 10.1016/j.bpa.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Affiliation(s)
- Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - René Boomars
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Helicopter Mobile Medical Team (MMT), De Boelelaan 1117, Amsterdam, the Netherlands
| | - Paul den Tex
- University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Amsterdam Resuscitation Studies (ARREST), Meibergdreef 9, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands
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Demaret P, Lebrun F, Devos P, Champagne C, Lemaire R, Loeckx I, Messens M, Mulder A. Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study. Eur J Pediatr 2016; 175:921-30. [PMID: 27075015 DOI: 10.1007/s00431-016-2723-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/17/2016] [Accepted: 03/30/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED This study aims to describe the pediatric physician-staffed EMS missions at a national level and to compare the pediatric and the adult EMS missions. Using a national database, we analyzed 254,812 interventions including 15,294 (6 %) pediatric emergencies. Less children than adults received an intravenous infusion (52.7 versus 77.1 %, p < 0.001), but the intra-osseous access was used more frequently in children (1.3 versus 0.8 %, p < 0.001). More children than adults benefited from a therapeutic immobilization (16.3 versus 13.2 %, p < 0.001). Endotracheal intubation was rare in children (2.1 %) as well as cardiopulmonary resuscitation (1.2 %). Children were more likely than adults to suffer from a neurological problem (32.4 versus 21.3 %, p < 0.001) or from a trauma (27.1 versus 16.8 %, p < 0.001). The prevalence of the pediatric diagnoses showed an age dependency: the respiratory problems were more prevalent in infants (40.3 % of the 0-12-months old), 52.1 % of the 1-4-year-old children suffered from a neurological problem, and the prevalence of trauma raised from 14.8 % of the infants to 47.1 % of the 11-15 year olds. CONCLUSION Pre-hospital pediatric EMS missions are not frequent and differ from the adult interventions. The pediatric characteristics highlighted in this study should help EMS teams to be better prepared to deal with sick children in the pre-hospital setting. WHAT IS KNOWN • Pediatric and adult emergencies differ. • Pediatric life-threatening emergencies are not frequent. What is New: • This study is the first to describe a European national cohort of pediatric physician-staffed EMS missions and to compare the pediatric and the adult missions at a national level. • This large cohort study confirms scarce regional data indicating that pediatric pre-hospital emergencies are not frequent and mostly non-life-threatening.
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Affiliation(s)
- Pierre Demaret
- Division of pediatric critical care medicine, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium.
- Intensive care unit, CHC, Clinique Saint-Joseph, Rue de Hesbaye 75, 4000, Liège, Belgium.
| | - Frédéric Lebrun
- Division of pediatric critical care medicine, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
- Division of pediatric emergencies, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
| | - Philippe Devos
- Intensive care unit, CHC, Clinique Saint-Joseph, Rue de Hesbaye 75, 4000, Liège, Belgium
| | - Caroline Champagne
- Division of pediatric emergencies, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
| | - Roland Lemaire
- Division of pediatric emergencies, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
| | - Isabelle Loeckx
- Division of pediatric critical care medicine, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
| | - Marie Messens
- Division of pediatric emergencies, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
| | - André Mulder
- Division of pediatric critical care medicine, Department of Pediatrics, CHC, Clinique de l'Espérance, Rue Saint-Nicolas 447, 4420, Liège, Belgium
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Duggan LV, Griesdale DEG. Secondary cervical spine injury during airway management: beyond a 'one-size-fits-all' approach. Anaesthesia 2016; 70:769-73. [PMID: 26580247 DOI: 10.1111/anae.13163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- L V Duggan
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
| | - D E G Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Razavizadeh MR. Role of Anesthesia Team in Prehospital Care: The Hidden Treasure in Critical Settings. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e29422. [PMID: 26101766 PMCID: PMC4475337 DOI: 10.5812/atr.29422v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/16/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Mohammad Reza Razavizadeh
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Razavizadeh, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9133611014, E-mail:
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Handy JM, Morris C. The evolving roles of the anaesthetist during emergency medical care. Anaesthesia 2012; 68 Suppl 1:1-2. [DOI: 10.1111/anae.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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