Subjects -> HEALTH AND SAFETY (Total: 1527 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (88 journals)
    - HEALTH AND SAFETY (721 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (381 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (113 journals)
    - PHYSICAL FITNESS AND HYGIENE (120 journals)
    - WOMEN'S HEALTH (82 journals)

CIVIL DEFENSE (22 journals)

Showing 1 - 19 of 19 Journals sorted alphabetically
Aggression and Violent Behavior     Hybrid Journal   (Followers: 360)
Canadian Journal of Remote Sensing     Full-text available via subscription   (Followers: 51)
Disaster Recovery Journal     Full-text available via subscription   (Followers: 3)
Disasters     Hybrid Journal   (Followers: 19)
Evolution, Medicine, and Public Health     Open Access   (Followers: 8)
Global & Regional Health Technology Assessment     Open Access   (Followers: 1)
International Journal of Critical Infrastructure Protection     Hybrid Journal   (Followers: 4)
International Journal of Emergency Management     Hybrid Journal   (Followers: 10)
International Journal of Emergency Services     Hybrid Journal   (Followers: 20)
International Journal of Forensic Engineering     Hybrid Journal   (Followers: 2)
International Journal of Intelligent Defence Support Systems     Hybrid Journal   (Followers: 3)
Journal of Applied Security Research     Hybrid Journal   (Followers: 3)
Journal of Health Care Law and Policy     Open Access   (Followers: 4)
Journal of Positive Psychology and Wellbeing     Open Access   (Followers: 8)
Korean Journal of Defense Analysis     Hybrid Journal  
Prehospital and Disaster Medicine     Full-text available via subscription   (Followers: 7)
Risk, Hazards & Crisis in Public Policy     Hybrid Journal   (Followers: 5)
Strategic Analysis     Hybrid Journal   (Followers: 6)
Studies in Conflict & Terrorism     Hybrid Journal   (Followers: 389)
Similar Journals
Journal Cover
Prehospital and Disaster Medicine
Journal Prestige (SJR): 0.462
Citation Impact (citeScore): 1
Number of Followers: 7  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1049-023X - ISSN (Online) 1945-1938
Published by Cambridge University Press Homepage  [354 journals]
  • PDM volume 36 issue 6 Cover and Front matter

    • Free pre-print version: Loading...

      Pages: 1 - 6
      PubDate: 2021-11-19
      DOI: 10.1017/S1049023X21001242
       
  • PDM volume 36 issue 6 Cover and Back matter

    • Free pre-print version: Loading...

      Pages: 1 - 5
      PubDate: 2021-11-19
      DOI: 10.1017/S1049023X21001254
       
  • Opioid Attack and the Implications for Counter-Terrorism Medicine

    • Free pre-print version: Loading...

      Authors: Tin; Derrick, Kallenborn, Zachary, Hart, Alexander, Hertelendy, Attila J., Ciottone, Gregory R.
      Pages: 661 - 663
      Abstract: While the opioid epidemic engulfing the United States and the globe is well-documented, the potential use of powerful fentanyl derivatives as a weapon of terror is increasingly a concern. Carfentanyl, a powerful and deadly fentanyl derivative, is seeing a surge in popularity as an illegal street drug, and there is increasing congressional interest surrounding the classification of opioid derivatives under the Chemical Weapons Convention (CWC) given their potential to cause harm. The combination of the potency of opioid derivatives along with the ease of accessibility poses a potential risk of the use of these deadly agents as chemical weapons, particularly by terrorist organizations. Disaster Medicine specialists in recent years have established a sub-specialty in Counter-Terrorism Medicine (CTM) to address and research the unique terrorism-related issues relating to mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks.
      PubDate: 2021-10-11
      DOI: 10.1017/S1049023X21001059
       
  • Suicide Bombing Terrorism

    • Free pre-print version: Loading...

      Authors: Tin; Derrick, Galehan, Jordan, Markovic, Vesna, Ciottone, Gregory R.
      Pages: 664 - 668
      Abstract: Introduction:While suicide bombings in the context of warfare have existed throughout history, there was an exponential rise in such attacks in the decade following the initiation of the War on Terror. The health care implications of such attacks are a growing concern across the emergency response sector, and this study is an epidemiological examination of all terrorism-related bombings sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI) between suicide bombing attacks (SBA) versus non-suicide bombing attacks (NSBA).Method:Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD database was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Bombing/explosion as a primary “attack type” and explosives as a primary “weapon type” were selected for the purpose of this study, and events were further sub-classified as either “suicide attack” or “non-suicide attack.” Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.Findings:There were 82,217 bombing/explosion terrorist attacks using explosives documented during the study period with 135,807 fatalities and 352,500 NFI.A total of 5,416 events (6.59% of all events) were sub-classified as SBA causing 52,317 FI (38.52% of all FI) and 107,062 NFI (30.37% of all NFI).Mean SBA FI was 9.66 per event and mean SBA NFI was 19.77 per event compared to a mean NSBA FI of 1.09 per event and mean NSBA NFI of 3.20 per event.Conclusion:Suicide bombing attacks are a unique terrorist methodology that can inflict wide-spread psychological damage as well as significantly higher death and injury tolls when compared to more traditional NSBA. They have been increasing in popularity amongst terrorist organizations and groups, and Counter-Terrorism Medicine (CTM) specialists need to be aware of the unique injury patterns and potential risk mitigation strategies associated with SBA depending on the target type, location, and gender of the perpetrator.
      PubDate: 2021-10-22
      DOI: 10.1017/S1049023X21001151
       
  • Developing Cultural Awareness Curricular Competencies for Humanitarian
           Non-Governmental Organization Staff

    • Free pre-print version: Loading...

      Authors: Hart; Alexander, Toma, Mariana, Issa, Fadi, Neault, Noelle
      Pages: 669 - 675
      Abstract: Background:Cultural awareness is an important part of organizational success when interacting with multiple cultures. Research has shown a dearth of standardized cultural awareness training programs for non-governmental humanitarian organization staff.Purpose:This study aims to develop an expert-consensus set of cultural awareness competencies as the basis for development of humanitarian staff cultural awareness trainings.Methods:A modified Delphi process was selected. The first round of surveys collected a list of cultural awareness competencies from experts in the fields of non-governmental organization (NGO) operations and cultural awareness education and research. This collated list of competencies was then used as the basis of a survey obtaining ratings by the group on a five-point Likert scale. Competencies which achieved an average rating of 4.0 or higher were considered to be “important” for inclusion in future training programs.Results:A total of 67.9% of contacted experts agreed to participate, with 84.2% of those completing all rounds of the survey. This group developed a list of ten competencies, including: Cultural Awareness/Sensitivity and Intercultural Communication; Cultural Intelligence; Unconscious Bias/Diversity Awareness; a Universal Declaration of Ethical Principles; Gender and Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual Identities (LGBTQ+) Issues and Safety; Analytical and Critical Thinking Skills; Negotiation; Program Mission; Power Dynamics; and Empathy.Conclusions:This study defined a set of ten expert-consensus cultural awareness competencies which can be a basis for future NGO staff training. Future work can both use these competencies to create educational programs and further define and expand the set of competencies based on analyses of their implementation.
      PubDate: 2021-10-01
      DOI: 10.1017/S1049023X21000996
       
  • Characteristics of Emergency Medical Service Missions in Out-of-Hospital
           Cardiac Arrest and Death Cases in the Periods of Before and After the
           COVID-19 Pandemic

    • Free pre-print version: Loading...

      Authors: Hasani-Sharamin; Parisa, Saberian, Peyman, Sadeghi, Mostafa, Mireskandari, Seyed Mohammad, Baratloo, Alireza
      Pages: 676 - 683
      Abstract: Background:Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19.Objective:The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA.Methods:This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician’s on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared.Results:In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years.Conclusion:This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years
      PubDate: 2021-10-08
      DOI: 10.1017/S1049023X21001138
       
  • Survey about Intention to Engage in Specific Disaster Activities among
           Disaster Medical Assistance Team Members

    • Free pre-print version: Loading...

      Authors: Iyama; Keita, Kakamu, Takeyasu, Yamashita, Kazunori, Shimada, Jiro, Tasaki, Osamu, Hasegawa, Arifumi
      Pages: 684 - 690
      Abstract: Introduction:Different disaster activities should be performed smoothly. In relation to this, human resources for disaster activities must be secured. To achieve a stable supply of human resources, it is essential to improve the intentions of individuals responding to each type of disaster. However, the current intention of Disaster Medical Assistance Team (DMAT) members has not yet been assessed.Study Objective:To facilitate a smooth disaster response, this survey aimed to assess the intention to engage in each type of disaster activity among DMAT members.Methods:An anonymous web questionnaire survey was conducted. Japanese DMAT members in the nuclear disaster-affected area (Group A; n = 79) and the non-affected area (Group N; n = 99) were included in the analysis. The outcome was the answer to the following question: “Will you actively engage in activities during natural, human-made, and chemical (C), biological (B), radiological/nuclear (R/N), and explosive (E) (CBRNE) disasters'” Then, questionnaire responses were compared according to disaster type.Results:The intention to engage in C (50), B (47), R/N (58), and E (52) disasters was significantly lower than that in natural (82) and human-made (82) disasters (P
      PubDate: 2021-10-18
      DOI: 10.1017/S1049023X21001035
       
  • Lived Experience of Emergency Health Care Utilization during the COVID-19
           Pandemic: A Qualitative Study

    • Free pre-print version: Loading...

      Authors: Smith; Erin, Hill, Michella, Anderson, Cameron, Sim, Moira, Miles, Alecka, Reid, David, Mills, Brennen
      Pages: 691 - 696
      Abstract: Introduction:As the understanding of health care worker lived experience during coronavirus disease 2019 (COVID-19) grows, the experiences of those utilizing emergency health care services (EHS) during the pandemic are yet to be fully appreciated.Study Objective:The objective of this research was to explore lived experience of EHS utilization in Victoria, Australia during the COVID-19 pandemic from March 2020 through March 2021.Methods:An explorative qualitative design underpinned by a phenomenological approach was applied. Data were collected through semi-structured, in-depth interviews, which were transcribed verbatim and analyzed using Colaizzi’s approach.Results:Qualitative data were collected from 67 participants aged from 32 to 78-years-of-age (average age of 52). Just over one-half of the research participants were male (54%) and three-quarters lived in metropolitan regions (75%). Four key themes emerged from data analysis: (1) Concerns regarding exposure and infection delayed EHS utilization among participants with chronic health conditions; (2) Participants with acute health conditions expressed concern regarding the impact of COVID-19 on their care, but continued to access services as required; (3) Participants caring for people with sensory and developmental disabilities identified unique communication needs during interactions with EHS during the COVID-19 pandemic; communicating with emergency health care workers wearing personal protective equipment (PPE) was identified as a key challenge, with face masks reported as especially problematic for people who are deaf or hard-of-hearing; and (4) Children and older people also experienced communication challenges associated with PPE, and the need for connection with emergency health care workers was important for positive lived experience during interactions with EHS throughout the pandemic.Conclusion:This research provides an important insight into the lived experience of EHS utilization during the COVID-19 pandemic, a perspective currently lacking in the published peer-reviewed literature.
      PubDate: 2021-10-08
      DOI: 10.1017/S1049023X21001126
       
  • Prehospital Ketamine Administration for Excited Delirium with Illicit
           Substance Co-Ingestion and Subsequent Intubation in the Emergency
           Department

    • Free pre-print version: Loading...

      Authors: Solano; Joshua J., Clayton, Lisa M., Parks, Daniel J., Polley, Shayne E., Hughes, Patrick G., Hennekens, Charles H., Shih, Richard D., Alter, Scott M.
      Pages: 697 - 701
      Abstract: Introduction:Excited delirium, which has been defined as combativeness, agitation, and altered sensorium, requires immediate treatment in prehospital or emergency department (ED) settings for the safety of both patients and caregivers. Prehospital ketamine use is prevalent, although the evidence on safety and efficacy is limited. Many patients with excited delirium are intoxicated with illicit substances. This investigation explores whether patients treated with prehospital ketamine for excited delirium with concomitant substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage.Methods:Over 28 months at two large community hospitals, all medical records were retrospectively searched for all patients age 18 years or greater with prehospital ketamine intramuscular (IM) administration for excited delirium and identified illicit and prescription substance co-ingestions. Trained abstractors collected demographic characteristics, history of present illness (HPI), urine drug screens (UDS), alcohol levels, and noted additional sedative administrations. Substance intoxication was determined by UDS and alcohol positivity or negativity, as well as physician HPI. Patients without toxicological testing or documentation of substance intoxication, or who may have tested positive due to ED sedation, were excluded from relevant analyses. Subsequent ED intubation was the primary pre-specified outcome. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare variables.Results:Among 86 patients given prehospital ketamine IM for excited delirium, baseline characteristics including age, ketamine dose, and body mass index were similar between those who did or did not undergo intubation. Men had higher intubation rates. Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates, and synthetic cathinones, both bath salts and flakka, had similar rates of intubation compared to those negative for these substances. Of 27 patients with excited delirium and concomitant cocaine intoxication, nine (33%) were intubated compared with four of 50 (8%) without cocaine intoxication, yielding a 5.75 OR (95%, CI 1.57 to 21.05; P = .009).Conclusion:Patients treated with ketamine IM for excited delirium with concomitant cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the ED. Amongst other substances, no other trends with intubation were noted, but further study is warranted.
      PubDate: 2021-09-23
      DOI: 10.1017/S1049023X21000935
       
  • Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation
           Program Developed by the Thailand National Institute of Emergency Medicine
           (NIEMS)

    • Free pre-print version: Loading...

      Authors: Angkoontassaneeyarat; Chuenruthai, Yuksen, Chaiyaporn, Jenpanitpong, Chetsadakon, Rukthai, Pemika, Seanpan, Marisa, Pongprajak, Dumrongsak, Laksanamapune, Thanakorn
      Pages: 702 - 707
      Abstract: Background:Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS).Methods:This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1.Results:There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P
      PubDate: 2021-10-14
      DOI: 10.1017/S1049023X21001084
       
  • A Change from a Spinal Immobilization to a Spinal Motion Restriction
           Protocol was Not Associated with an Increase in Disabling Spinal Cord
           Injuries

    • Free pre-print version: Loading...

      Authors: Clemency; Brian M., Natalzia, Peter, Innes, Johanna, Guarino, Sharon, Welch, Jacob V., Haghdel, Arsalan, Noyes, Ekaterina, Jordan, Jeffery, Lindstrom, Heather A., Lerner, E. Brooke
      Pages: 708 - 712
      Abstract: Background:Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.Objectives:The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.Methods:This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury.Results:A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36).Conclusion:This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard.
      PubDate: 2021-11-03
      DOI: 10.1017/S1049023X21001187
       
  • High Success Rate of Prehospital and En Route Cricothyroidotomy Performed
           in the Israel Defense Forces: 20 Years of Experience

    • Free pre-print version: Loading...

      Authors: Beit Ner; Eran, Tsur, Avishai M., Nadler, Roy, Glassberg, Elon, Benov, Avi, Chen, Jacob
      Pages: 713 - 718
      Abstract: Introduction:Securing the airway is a crucial stage of trauma care. Cricothyroidotomy (CRIC) is often addressed as a salvage procedure in complicated cases or following a failed endotracheal intubation (ETI). Nevertheless, it is a very important skill in prehospital settings, such as on the battlefield.Hypothesis/Problem:This study aimed to review the Israel Defense Forces (IDF) experience with CRIC over the past two decades.Methods:The IDF Trauma Registry (IDF-TR) holds data on all trauma casualties (civilian and military) cared for by military medical teams since 1997. Data of all casualties treated by IDF from 1998 through 2018 were extracted and analyzed to identify all patients who underwent CRIC procedures.Variables describing the incident scenario, patient’s characteristics, injury pattern, treatment, and outcome were extracted. The success rate of the procedure was described, and selected variables were further analyzed and compared using the Fisher’s-exact test to identify their effect on the success and failure rates. Odds Ratio (OR) was further calculated for the effect of different body part involvement on success and for the mortality after failed ETI.Results:One hundred fifty-three casualties on which a CRIC attempt was made were identified from the IDF-TR records. The overall success rate of CRIC was reported at 88%. In patients who underwent one or two attempts, the success rate was 86%. No difference was found across providers (physician versus paramedic). The CRIC success rates for casualties with and without head trauma were 80% and 92%, respectively (P = .06). Overall mortality was 33%.Conclusions:This study shows that CRIC is of merit in airway management as it has shown to have consistently high success rates throughout different levels of training, injuries, and previous attempts with ETI. Care providers should be encouraged to retain and develop this skill as part of their tool box.
      PubDate: 2021-11-08
      DOI: 10.1017/S1049023X21001199
       
  • Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the
           Pediatric Population

    • Free pre-print version: Loading...

      Authors: Donofrio; J. Joelle, Shaban, Alaa, Kaji, Amy H., Santillanes, Genevieve, Cicero, Mark X., Chang, Todd P., Gausche-Hill, Marianne, Claudius, Ilene A.
      Pages: 719 - 723
      Abstract: Introduction:Mass-casualty incident (MCI) algorithms are used to sort large numbers of patients rapidly into four basic categories based on severity. To date, there is no consensus on the best method to test the accuracy of an MCI algorithm in the pediatric population, nor on the agreement between different tools designed for this purpose.Study Objective:This study is to compare agreement between the Criteria Outcomes Tool (COT) to previously published outcomes tools in assessing the triage category applied to a simulated set of pediatric MCI patients.Methods:An MCI triage category (black, red, yellow, and green) was applied to patients from a pre-collected retrospective cohort of pediatric patients under 14 years of age brought in as a trauma activation to a Level I trauma center from July 2010 through November 2013 using each of the following outcome measures: COT, modified Baxt score, modified Baxt combined with mortality and/or length-of-stay (LOS), ambulatory status, mortality alone, and Injury Severity Score (ISS). Descriptive statistics were applied to determine agreement between tools.Results:A total of 247 patients were included, ranging from 25 days to 13 years of age. The outcome of mortality had 100% agreement with the COT black. The “modified Baxt positive and alive” outcome had the highest agreement with COT red (65%). All yellow outcomes had 47%-53% agreement with COT yellow. “Modified Baxt negative and
      PubDate: 2021-10-06
      DOI: 10.1017/S1049023X2100100X
       
  • Validation of a Belgian Prediction Model for Patient Encounters at
           Football Mass Gatherings

    • Free pre-print version: Loading...

      Authors: Spaepen; Kris, Lauwaert, Door, Kaufman, Leonard, Haenen, Winne AP, Hubloue, Ives
      Pages: 724 - 729
      Abstract: Background:To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium’s largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model.Methods:Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test.Results:A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = −5.566, P
      PubDate: 2021-09-20
      DOI: 10.1017/S1049023X21000923
       
  • Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment
           of Out-of-Hospital Hypoglycemia: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Hurtubise; Marissa, Stirling, Jeffery, Greene, Jennifer, Carter, Alix JE, Swain, Janel, Brown, Ryan, Fidgen, Dana, Goldstein, Judah P.
      Pages: 730 - 738
      Abstract: Introduction:Paramedics commonly administer intravenous (IV) dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may cause harm and lead to difficulties regulating blood glucose levels (BGLs) post-treatment. It is hypothesized that a lower concentration, such as 10% dextrose (D10), may improve symptoms while minimizing harm.Methods:PubMed, Embase, CINAHL, and Cochrane Central were systematically searched on September 15, 2020. The PRISMA guidelines were followed. GRADE and risk of bias were applied to determine the certainty of the evidence. Primary literature investigating the use of IV dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department was included. Outcomes of interest included safety, efficacy (symptom resolution), and BGL.Results:Of 680 abstracts screened, 51 full-text articles were reviewed, with eleven studies included. Data from three randomized controlled trials (RCTs) and eight observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies, there was greater symptom resolution in the D10 group (95.9%) compared to the D50 group (88.8%). However, the mean time to resolution was approximately four minutes longer in the D10 group (4.1 minutes [D50] versus 8.0 minutes [D10]). There was a greater need for subsequent doses with the use of D10 (19.5%) compared to D50 (8.1%). The post-treatment glycemic profile was lower in the D10 group at 6.2mmol/L versus 8.5mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia: 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/1057) compared to 13/310 adverse events in the D50 group.Conclusion:Studies show D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer, there appear to be fewer adverse events. The post-D10-treatment BGL may result in fewer untoward hyperglycemic episodes.
      PubDate: 2021-10-04
      DOI: 10.1017/S1049023X21001047
       
  • Children’s Health Care in Mass-Casualty Incidents: A Systematic
           Literature Review

    • Free pre-print version: Loading...

      Authors: Costa; Victor S.L.P., Stéfani, Giovanna M., Ferenhof, Helio A., Lima, Fabiana S., Cola, Maíra
      Pages: 739 - 746
      Abstract: Objectives:Considering the pediatric peculiarities and the difficulty of assisting this population in mass-casualty situations, this study aims to identify the main topics regarding children’s health care in mass-casualty incidents (MCIs) that are discussed in the Emergency Medicine area.Methods:This systematic review was performed according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021229552. The last update of the search in the databases was on May 27, 2021 and resulted in 45 documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages; the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health - VLH), and Web of Science, which execute the query on the topic, keywords, or abstracts. Also, to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria.Results:From the resulting papers, 21 articles served as the basis for this analysis. Revealed were the year of publication, the first author’s institution nationality, topic, and disaster management phase for each study, which allow other researchers to understand the main topics regarding children’s health care in MCIs.Conclusions:The topics regarding child’s health care in MCIs found in the primary studies of this review, in order of frequency, were: Disaster Response (including the following sub-topics: simulation, education, quality of care, use of technological tools, and damage analysis); Triage; and Disaster Planning. The Emergency Medicine operation was focused on harm reduction after the occurrence of an MCI. Further studies focusing on the pre-disaster and post-disaster phases are needed.
      PubDate: 2021-10-18
      DOI: 10.1017/S1049023X21001060
       
  • Teaching and Evaluation Methods of the Use of the Tourniquet in Severe
           Limb Bleeding among Health Care Professionals: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Sobrido-Prieto; María, Martínez-Isasi, Santiago, Pérez-López, Marta, Fernández-Méndez, Felipe, Barcala-Furelos, Roberto, Fernández-García, Daniel
      Pages: 747 - 755
      Abstract: Introduction and Objectives:Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals.Methods:The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers.Results:Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies.Conclusions:The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.
      PubDate: 2021-10-19
      DOI: 10.1017/S1049023X21001114
       
  • Comparison of Unmanned Aerial Vehicle Technology versus Standard Practice
           of Scene Assessment by Paramedic Students of a Mass-Gathering Event

    • Free pre-print version: Loading...

      Authors: Jain; Trevor, Sibley, Aaron, Stryhn, Henrik, Lund, Adam, Hubloue, Ives
      Pages: 756 - 761
      Abstract: Introduction:The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the situational awareness of medical incident commanders’ (ICs’) scene assessment of mass gatherings. Mass gatherings occur frequently and the potential for injury at these events is considered higher than the general population. These events have generated mass-casualty incidents (MCIs) in the past. The aim of this study was to compare UAV technology to standard practice (SP) in scene assessment using paramedic students during a mass-gathering event (MGE).Methods:This study was conducted in two phases. Phase One consisted of validation of the videos and accompanying data collection tool. Phase One was completed by 11 experienced paramedics from a provincial Emergency Medical Services (EMS) service. Phase Two was a randomized comparison with 47 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada) of the two scene assessment systems. For Phase Two, the paramedic students were randomized into a UAV or a SP group. The data collection tool consisted of two board categories: primary importance with 20 variables and secondary importance with 25 variables. After a brief narrative, participants were either shown UAV footage or the ground footage depending on their study group. After completion of the videos, study participants completed the data collection tool.Results:The Phase One validation showed good consensus in answers to most questions (average 79%; range 55%-100%). For Phase Two, a Fisher’s exact test was used to compare each variable from the UAV and SP groups using a P value of .05. Phase Two demonstrated a significant difference between the SP and UAV groups in four of 20 primary variables. Additionally, significant differences were found for seven out of 25 secondary variables.Conclusion:This study demonstrated the accurate, safe, and feasible use of a UAV as a tool for scene assessment by paramedic students at an MGE. No observed statistical difference was noted in a majority of both primary and secondary variables using a UAV for scene assessment versus SP.
      PubDate: 2021-10-27
      DOI: 10.1017/S1049023X2100114X
       
  • Clinical Policies and Procedures for Critical Care Transport during a
           Respiratory Pandemic

    • Free pre-print version: Loading...

      Authors: Leisten; David C., Wheeler, Jennifer, Boomhower, James, Frakes, Michael A., Denison, Todd, Cohen, Jason E., Wilcox, Susan R.
      Pages: 762 - 766
      Abstract: The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.
      PubDate: 2021-09-22
      DOI: 10.1017/S1049023X21001023
       
  • A Scoping Review on Category A Agents as Bioweapons

    • Free pre-print version: Loading...

      Authors: Beale; Sarah L., Zolnikov, Tara Rava, Firebaugh, Casey Mace
      Pages: 767 - 773
      Abstract: Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats must be comprehensively reviewed to create a preparedness plan to recognize outbreaks, to educate the public, and to offer vaccinations and/or treatment options, if available. A scoping review using PRISMA guidelines was performed to categorize current information on Category A biological agents as well as understand their potential for future threats. The results used 34 articles and found that while botulin neurotoxins were the most lethal, anthrax posed the most likely threat for use as a bioweapon. Most research was conducted on plague, though it is not the most likely threat. Smallpox is the most likely agent to vaccinate against as there is already a working vaccine that has proven effective and the issue at hand is the need for a larger stockpile. Ultimately, preparedness efforts should include vaccinations and continued research and development of them. Category A agents are a serious public health concern; updated and reformed bioterrorism preparedness plans could greatly minimize panic and mortality.
      PubDate: 2021-10-07
      DOI: 10.1017/S1049023X21001072
       
  • Alternate Care Sites for COVID-19 Patients: Experience from the H144
           Hospital of the Health Service of the Principality of Asturias, Spain

    • Free pre-print version: Loading...

      Authors: Castro Delgado; Rafael, Pérez Quesada, Paloma, Pintado García, Eduardo, Marañón Zabalza, Iñigo, Vallina-Victorero Vázquez, Manuel, Escribano Balín, Rodrigo
      Pages: 774 - 781
      Abstract: Coronavirus disease 2019 (COVID-19) temporary hospitals, also called “alternate care sites” (ACS), as support to the health network have had uneven use. The World Health Organization (WHO) has published different recommendations in this regard. World-wide, many health services have improved their surge capacity with the implementation of new temporary hospital structures, but there have been few experiences of use over time despite representing an important element as support to the hospital network in the management of COVID-19 patients. In this article, the experiences are explained in the design, execution, and use of the temporary COVID-19 Hospital H144 of the Health Service of the Principality of Asturias (Sespa), with 144 beds, which was in operation from April 1 through July 1, 2020 (without admitting patients) and from November 12, 2020 through March 5, 2121, admitting a total of 334 COVID-19 patients (66% women; 34% men) and generating 3,149 hospital stays. Maximum occupancy was 74 patients. Mean stay was 9.42 days (MD = 3.99; [1-34]). At discharge, 126 patients (38%) went to a nursing home, 112 (33%) to their home, 40 (12%) were transferred to another hospital, and 56 (17%) died. The mean age of the admitted patients was 82.79 years (MD = 8.68; [29-104]) and was higher in women (85.09; MD = 7.57; P = .000) than in men (78.28; MD = 9.22). Some aspects to consider for future experiences of use have been: teamwork from different fields of knowledge (ie, architecture, engineering, medicine, and nursing) is essential for success; integration in the health system must be fully developed from different perspectives (ie, information system, logistics, medical records, or clinical procedures, among others); clear procedures for patient admission from different structures (ie, home, hospitals, nursing homes, or primary health care network) must combine with flexibility of use to adapt to new and unknown circumstances; and they must not compromise specialized staff availability in other health facilities.
      PubDate: 2021-10-06
      DOI: 10.1017/S1049023X21001102
       
  • The Effect of Heat Events on Prehospital and Retrieval Service Utilization
           in Rural and Remote Areas: A Scoping Review

    • Free pre-print version: Loading...

      Authors: O’Donnell; Elen, Honan, Bridget, Quilty, Simon, Schultz, Rebecca
      Pages: 782 - 787
      Abstract: Introduction:It is well-established that heatwaves increase demand for emergency transport in metropolitan areas; however, little is known about the impact of heat events on demand for prehospital retrieval services in rural and remote areas, or how heatwaves are defined in this context.Inclusion Criteria:Papers were eligible for inclusion if they reported on the impact of a heat event on the activity of a prehospital and retrieval service in a rural or remote area.Methods:A search of PubMed, Cochrane, Science Direct, CINAHL, and Google Scholar databases was undertaken on August 18, 2020 using search terms related to emergency medical transport, extreme heat, and rural or remote. Data relevant to the impact of heat on retrieval service activity were extracted, as well as definitions of extreme heat.Results:Two papers were identified, both from Australia. Both found that heat events increased the number of road ambulance call-outs. Both studies used the Excess Heat Factor (EHF) to define heatwave periods of interest.Conclusions:This review found almost no primary literature on demand for prehospital retrieval services in rural and remote areas, and no data specifically related to aeromedical transport. The research did recognize the disproportionate impact of heat-related increase in service demand on Australian rural and regional health services. With the effects of climate change already being felt, there is an urgent need for more research and action in this area.
      PubDate: 2021-11-02
      DOI: 10.1017/S1049023X21001163
       
  • EMS at 3600 Meters: Exploring Barriers to Emergency Care and Transport in
           Rural Andean Perú

    • Free pre-print version: Loading...

      Authors: Vasa; Alison H., Falkenstein, Karen A., Centrone, Wayne A.
      Pages: 788 - 792
      Abstract: Background:Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention.Methods:Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes.Results:Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as “structural problems,” such as lack of infrastructure, lack of structured care delivery, and unclear protocols.Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement.Conclusion:While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.
      PubDate: 2021-11-02
      DOI: 10.1017/S1049023X21001175
       
  • Penetrating Heart Injury Repaired with Peripheral Cannulation: Case Report

    • Free pre-print version: Loading...

      Authors: Ovali; Cengiz, Kocaoglu, Alper Selim, Demirdizen, Gürkan, Aydar, Yuksel
      Pages: 793 - 796
      Abstract: Heart injuries usually occur due to penetrating or blunt traumas. High mortality rates are seen in heart injuries, owing to firearms and cutting/piercing tools. Factors such as the degree of injury, its localization, and the length of time to reach the hospital influence mortality rates. Despite the increase in imaging facilities and improvements in hospital transportation in today’s conditions, high mortality rates are still observed, owing to causes such as sudden blood loss, cardiac arrest, or cardiac tamponade. The present study aimed to present the successful treatment of a 46-year-old male patient with injuries to the left atrium and posterior wall of the left ventricle due to a gunshot wound using the approach of median sternotomy and peripheral cannulation.
      PubDate: 2021-09-21
      DOI: 10.1017/S1049023X21000959
       
  • Major Hospital Fire in Saint Lucia

    • Free pre-print version: Loading...

      Authors: Greenidge; Charles, Cawich, Shamir O., Burt, Richard, Francis, Tashina
      Pages: 797 - 802
      Abstract: This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable lesion for developing countries in the Caribbean, especially since there have been four hospital fires reported in the Caribbean within the past decade.
      PubDate: 2021-09-24
      DOI: 10.1017/S1049023X21000947
       
  • Medical Utilization Rate at Music Festivals: The Effect of Crowd Behavior

    • Free pre-print version: Loading...

      Authors: Fidacaro; George A., Friedman, Matt S., Strayer, Reuben J.
      Pages: 803 - 804
      PubDate: 2021-10-11
      DOI: 10.1017/S1049023X21000960
       
  • Comment on “The Impact of Treatment with Continuous Positive Airway
           Pressure on Acute Carbon Monoxide Poisoning”

    • Free pre-print version: Loading...

      Authors: Loughran; David, Nelson, Lewis
      Pages: 805 - 806
      PubDate: 2021-10-04
      DOI: 10.1017/S1049023X21001011
       
  • Application of a Standard Operating Procedure in Transporting Patients
           during the COVID-19 Pandemic in the Air Emergency Medical Services

    • Free pre-print version: Loading...

      Authors: Esmaeilzadeh; Mohammad Hossein, Peyravi, Mahmoudreza, Ahmadi Marzaleh, Milad
      Pages: 807 - 808
      PubDate: 2021-10-04
      DOI: 10.1017/S1049023X21001096
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 54.224.117.125
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-