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Recently, emphasis has been placed on improving and expanding research in disaster response and the treatment of disaster-stricken populations. However, research in these settings presents unique ethical challenges with which the scientific and biomedical ethics communities continue to struggle. At the core of the controversy is the question of how best to balance the critical need for research with the equally important obligation to respect and protect the interests of research participants within the unique stress of a disaster. This concern stems from the potential of increased vulnerability of individuals stricken by disaster over and above their usual vulnerability to risk and exploitation as research subjects. Ethical principles that must be considered in these situations are the same as those that are important when conducting any human research: respect for persons, non-maleficence, beneficence, and justice. This paper explores the ethical challenges that accompany inadequate resources and personnel, the potential vulnerability of research participants, the dual role of physician-researcher, and the importance of the public's perception and trust are explored. It then proposes a number of potential avenues through which to conduct ethically justifiable research that could answer many of the pressing questions in disaster medicine and response.
Vital signs (VS) data collected in prehospital care and recorded in trauma registries are often missing or unreliable as it is difficult to record dynamic changes while performing resuscitation and stabilization. The purpose of this study was to test the hypothesis that analysis of continuous vital signs improves data quality, and predicts life-saving interventions (LSI) better than use of retrospectively compiled Trauma Registry (TR) data.
Methods:
After Institutional Review Board approval, six emergency medical services helicopters were equipped with a Vital Signs Data Recorder (VSDR) to capture continuous VS from the patient onto a handheld personal digital assistant (PDA). Prehospital LSIs (fluid bolus, cardiopul-monary resuscitation, drugs, intubation, etc.) and those performed within two hours after arrival in the trauma resuscitation unit were considered outcome variables. The VSDR and TR data were compared using Bland-Altman method. A multivariate analysis was performed to determine which VS variable best predicted LSIs using the values in the TR and the VSDR.
Results:
Prehospital VSDR data were collected from 177 patients. There was a significant difference between the highest and lowest heart rate, systolic blood pressure (SBP), and oxygen saturation between the VSDR and the TR data (p <0.001).The VSDR highest heart rate and lowest oxygen saturation recorded predicted LSIs while none of the TR vital signs did so in a multivariate model. The SBP was not an independent predictor of LSI.
Conclusions:
The VSDR data increased the odds of predicting LSIs compared to the TR data. Using continuous vital signs in prehospital care may lead to the development of better trauma prognostic models.
The objective of this study was to assess the effect of 20 minutes of heavy treadmill exertion in military-style, Level-C chemical and biological personal protective equipment (PPE), including a filtering face piece respirator, on physiological variables including venous pH, venous PCO2, SpO2 and tympanic temperature.
Methods:
Baseline physiological variables were measured in 19 healthy subjects who undertook heavy physical exertion on a treadmill at a constant room temperature of 20°C: (1) once while wearing a short-sleeved t-shirt, shorts, and running shoes; and (2) once while wearing chemical and biological PPE. Repeat measurements of physiological variables were made after 10 and 20 minutes of exertion in both groups.
Results:
Twenty minutes of physical exertion was undertaken by healthy subjects wearing chemical and biological PPE resulted in moderate hypoxemia, significantly decreased pH (p = 0.003), elevated PCO2 (p = 0.018) and elevated tympanic membrane temperature (p < 0.001), compared to baseline values. Despite these significant differences, none of the mean venous blood gas values deviated from the normal range during physical exertion.
Conclusions:
The degree and duration of physical exertion undertaken in chemical and biological PPE induced some significant changes in physiological variables compared to control but, with the exception of SpO2, did not result in changes considered to represent abnormal physiology. However, it is likely that core body temperature was underestimated by tympanic measurement. Blood gas data indicating that CO2 was retained during exertion in this type of PPE were unanticipated and require further investigation.