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van Veelen MJ, Brugger H, Falla M, Strapazzon G. Chest compressions at altitude are of decreased quality, require more effort and cannot reliably be self-evaluated. Scand J Trauma Resusc Emerg Med 2023; 31:92. [PMID: 38049828 PMCID: PMC10696710 DOI: 10.1186/s13049-023-01149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
- Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy.
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Department of Neurology/Stroke Unit, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland
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van Veelen MJ, Strapazzon G. Green HEMS in mountain and remote areas: reduction of carbon footprint through drones? Scand J Trauma Resusc Emerg Med 2023; 31:36. [PMID: 37464430 PMCID: PMC10355073 DOI: 10.1186/s13049-023-01099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Michiel J. van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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van Veelen MJ, Roveri G, Regli IB, Dal Cappello T, Vögele A, Masè M, Falla M, Strapazzon G. Personal Protective Equipment Protocols Lead to a Delayed Initiation of Patient Assessment in Mountain Rescue Operations. High Alt Med Biol 2023; 24:127-131. [PMID: 37262193 DOI: 10.1089/ham.2022.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
van Veelen, Michiel J., Giulia Roveri, Ivo B. Regli, Tomas Dal Cappello, Anna Vögele, Michela Masè, Marika Falla, and Giacomo Strapazzon. Personal protective equipment protocols lead to a delayed initiation of patient assessment in mountain rescue operations. High Alt Med Biol. 24:127-131, 2023. Introduction: Mountain rescue operations can be challenging in austere environmental conditions and remote settings. Airborne infection prevention measures include donning of personal protective equipment (PPE), potentially delaying the approach to a patient. We aimed to investigate the time delay caused by these prevention measures. Methods: This randomized crossover trial consisted of 24 rescue simulation trials intended to be as realistic as possible, performed by mountain rescue teams in difficult terrain. We analyzed the time needed to perform an airborne infection prevention protocol during the approach to a patient. Time delays in scenarios involving patients already wearing versus not wearing face masks and gloves were compared using a linear mixed model Results: The airborne infection prevention measures (i.e., screening questionnaire, hand antisepsis, and donning of PPE) resulted in a time delay of 98 ± 48 (26-214) seconds on initiation of patient assessment. There was a trend to a shorter time to perform infection prevention measures if the simulated patient was already wearing PPE consisting of face mask and gloves (p = 0.052). Conclusion: Airborne infection prevention measures may delay initiation of patient assessment in mountain rescue operations and could impair clinical outcomes in time-sensitive conditions. Trial registration number 0105095-BZ Ethics Committee review board of Bolzano.
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Affiliation(s)
- Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Giulia Roveri
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ivo B Regli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Anna Vögele
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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van Veelen MJ, Voegele A, Rauch S, Kaufmann M, Brugger H, Strapazzon G. COVID-19 Pandemic in Mountainous Areas: Impact, Mitigation Strategies, and New Technologies in Search and Rescue Operations. High Alt Med Biol 2021; 22:335-341. [PMID: 34319777 PMCID: PMC8558066 DOI: 10.1089/ham.2020.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/29/2021] [Indexed: 12/03/2022] Open
Abstract
van Veelen, Michiel J., Anna Voegele, Simon Rauch, Marc Kaufmann, Hermann Brugger, and Giacomo Strapazzon. COVID-19 pandemic in mountainous areas: impact, mitigation strategies, and new technologies in search and rescue operations. High Alt Med Biol. 22:335-341, 2021.-Mitigating the spread of COVID-19, an airborne infection, can lead to delays in the prehospital response and impair the performance of search and rescue (SAR) services in mountainous and remote areas. We provide an overview of the developing epidemiological situation related to the COVID-19 pandemic in mountainous areas and review current protocols to determine their suitability for mountain rescue teams. We also discuss using novel technologies to reduce the adverse effects caused by COVID-19 mitigation strategies such as delays caused by donning personal protective equipment (PPE) and reduced rescuer performance due to impaired movement and ventilation. COVID-19 has spread even in mountainous and remote locations. Dedicated protocols for the use of PPE appropriate for SAR rescuers exerting physical effort in remote areas and using technologies such as drones, telemedicine, and localization and contact tracing applications could contribute to an effective and timely emergency response in mountainous and remote settings.
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Affiliation(s)
- Michiel J. van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
| | - Anna Voegele
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesia and Intensive Care, “F. Tappeiner” Hospital, Merano, Italy
| | - Marc Kaufmann
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
- Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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Abstract
Hypothermia in trauma patients is a common condition. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. Additionally, hypothermia in trauma patients can deepen through environmental exposure on the scene or during transport and medical procedures such as infusions and airway management. This vicious circle has a detrimental effect on the outcome of major trauma patients. This narrative review describes the main factors to consider in the co-existing condition of trauma and hypothermia from a prehospital and emergency medical perspective. Early prehospital recognition and staging of hypothermia are crucial to triage to proper care to improve survival. Treatment of hypothermia should start in an early stage, especially the prevention of further cooling in the prehospital setting and during the primary assessment. On the one hand, active rewarming is the treatment of choice of hypothermia-induced coagulation disorder in trauma patients; on the other hand, accidental or clinically induced hypothermia might improve outcomes by protecting against the effects of hypoperfusion and hypoxic injury in selected cases such as patients suffering from traumatic brain injury (TBI) or traumatic cardiac arrest.
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Affiliation(s)
| | - Monika Brodmann Maeder
- Eurac Research, Institute of Mountain Emergency Medicine, 39100 Bolzano, Italy;
- Department of Emergency Medicine, University Hospital Bern and Bern University, 3010 Bern, Switzerland
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van Veelen MJ, Kaufmann M, Brugger H, Strapazzon G. Drone delivery of AED's and personal protective equipment in the era of SARS-CoV-2. Resuscitation 2020; 152:1-2. [PMID: 32380028 PMCID: PMC7198402 DOI: 10.1016/j.resuscitation.2020.04.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022]
Affiliation(s)
| | - Marc Kaufmann
- Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
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van Veelen MJ, van den Brand CL, Reijnen R, van der Linden MC. Effects of a general practitioner cooperative co-located with an emergency department on patient throughput. World J Emerg Med 2016; 7:270-273. [PMID: 27942343 DOI: 10.5847/wjem.j.1920-8642.2016.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2013 a General Practitioner Cooperative (GPC) was introduced at the Emergency Department (ED) of our hospital. One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED. To determine the change in patient flow, we assessed the number of self-referrals, redirection of self-referrals to the GPC and back to the ED, as well as ward and ICU admission rates and length of stay of the remaining ED population. METHODS We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands. RESULTS More than half of our ED patients were self-referrals. At triage, 54.5% of these self-referrals were redirected to the GPC. After assessment at the GPC, 8.5% of them were referred back to the ED. The number of patients treated at the ED declined with 20.3% after the introduction of the GPC. In the remaining ED population, there was a significant increase of highly urgent patients (P<0.001), regular admissions (P<0.001), and ICU admissions (P<0.001). Despite the decline of the number of patients at the ED, the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period, a total increase of 270 hours in two months (P<0.001). CONCLUSION Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.
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Affiliation(s)
- Michiel J van Veelen
- Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, Botswana
| | | | - Resi Reijnen
- Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands
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