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Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing.
Study objective:
To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events.
Methods:
Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadiums first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a “DRUG-ROCK” Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests.
Results:
Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5±22.5 minutes (± standard deviation; range: 5–150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (±2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1–4), with 27% rated as moderate (score = 5–9), and 6% severe (score >10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p <0.005).
Conclusion:
The DRISS was useful in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.
Emergency services personnel are highly vulnerable to acute and cumulative critical incident stress (CIS) that can manifest as anger, guilt, depression, and impaired decision-making, and, in certain instances, job loss. Interventions designed to identify such distress and restore psychological functioning becomes imperative.
Methods:
A statewide debriefing team was formed in 1988 through a collaborative effort between an academic department of emergency medicine and a social work department of a teaching hospital, and a metropolitan area fire department and ambulance service. Using an existing CIS debriefing model, 84 pre-screened, mental health professionals and emergency services personnel were provided with 16 hours of training and were grouped into regional teams.
Debriefing requests are received through a central number answered by a communicator in a 24-hour communications center located within the emergency department. Debriefings are conducted 48–72 hours after the event for specific types of incidents. Follow-up telephone calls are made by the debriefing team leader two to three weeks following a debriefing. The teams rely on donations to pay for travel and meals.
Results:
One hundred sixty-eight debriefings were conducted during the first four years. Rural agencies accounted for 116 (69%) requests. During this period, 1,514 individuals were debriefed: 744 (49%) firefighters, 460 (30%) EMTs, and 310 (21%) police officers, dispatchers, and other responders. Deaths of children, extraordinary events, and incidents involving victims known to the responders (35%, 14%, and 14% respectively) were the most common reasons for requesting debriefings. Feedback was received from 48 (28%) of the agencies that requested the debriefing. All of those who responded felt that the debriefing had a beneficial effect on its personnel. Specific individuals identified by agency representatives as having the greatest difficulty were observed to be returned to their pre-incident state.
Conclusion:
CIS debriefings are judged as beneficial. A statewide response team is an effective way to provide these services at no cost to agencies.
World attention has been focused on Bosnia/Hercegovina, where war erupted in 1992. The regional hospital of Mostar, an industrial city with a population of 100,000, operated -with chronic shortages of medical supplies including general anesthetic agents. In February 1992, just prior to the referendum for independence in that republic, a shipment of medical supplies with anesthesics, food, and clothing was delivered safely to Ljubuski, a village near Mostar, for Mostar hospital and surrounding clinics by a small, private organization from Birmingham, Alabama. No difficulties were encountered in delivering the supplies despite warnings from the U.S. State Department, the lengthy transit from Austria through Croatia to Bosnia, an active black market, and the inexperience of the relief agency. This disaster relief effort by a small, private sponsor was representative of both the positive aspects of such a project, as well as typical negative aspects. These efforts had been discouraged in the past, but as disaster medicine matures, there may be room for such endeavors, if properly directed.
Bicycles may be useful in the delivery of out-of-hospital emergency medical services. The use of bicycles in providing emergency medical services was investigated by surveying currently existing bicycle-medic systems.
Methods:
Two questionnaires were developed to gain information on service areas, injuries, gear used, missions, and specific data from bicycle-medic response.
Results:
Of 210 surveys mailed to bicyclemedics, 21 (10%) were completed and returned by the pre-established deadline. Of 11 surveys mailed to bicycle-medic supervisors, four (36%) were returned. Preliminary results showed that 76% of respondents are career providers and the remainder serve as volunteers. Mean age for respondents was 33±7.4 years, with 96% being males. Most teams have been in existence for three to four years. Job satisfaction was greater when participating on the bicycle crews than when not performing on the bicycle crew, t = 4.15, p = 0.0002. The teams varied in size (6–100 persons) with a mean value of 31. On the average, team size represented 10% of total number of personnel for the respective organizations.
The majority of bicycle teams operate all year in all conditions. Most bicycle-medic teams were initiated for special events. Nineteen percent reported injuries while on duty or in training. Ninety percent of units that responded use existing agency protocols and have no special protocols related to the bicycle team. Eighty percent of the units are dispatched through the normal agency procedures. Eighty-five percent of respondents coordinate for transport units via dispatch. Reported response times were under two minutes for special event responses. These were within established agency response times. In approximately 25% of the responses, the patients refused transport, and another 65% of the responses were for relatively minor injuries or complaints that did not require transport to a hospital.
Conclusion:
This survey begins to characterize the utilization of bicycles as a tool to gain patient access in specialized situations. The use of bicycle-medics may be cost-effective, may help to improve employee morale, and possibly reduce employee health-care costs. Further study is needed to determine the impact of bicycle-medics on patient outcomes and response times.
This study compares the performance of two commercially available devices (Ambu. TubeChek™ and SCOTI™ in establishing endotracheal (ET) tube position (oesophageal vs. tracheal) in a mannequin and in miniature pigs. The Ambu TubeChek is a syringe-type, Oesophageal Detector Device (ODD) that fits to the endotracheal tube connector. Air is aspirated easily from the rigid trachea, but not from the collapsing esophagus. The Sonomatic Confirmation of Tracheal Intubation device (SCOTI) is a lightweight battery-powered, sonomatic device. It emits sound waves into the tube and analyzes the reflection. The SCOTI purports to enable a user-independent and carbon-dioxide-independent assessment of tube position following intubation.
Intubation followed by tube position assessment with Ambu TubeChek (ODD) was significantly faster and easier with the ODD than with the SCOTI. The SCOTI cannot differentiate tracheal from oesophageal ET-tube position in mini-pigs.
In situations in which capnometry is not available or the CO2 production and transport are compromised (CPR), we recommend the use of an Oesophageal Detector Device (ODD) rather than the SOCTI.
The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States.
Design:
Confidential, 20-question survey tool, Medical Personnel Stress Survey-Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test.
Interventions:
None.
Results:
A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3±6.3 for the total stress scores was very high Mean values for the subset scores were: somatic distress = 19.6±3.3; organizational stress = 17.3±2.4; job dissatisfaction = 17.0±2.6; negative attitudes towards patients = 15.5±2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town.
Conclusion:
Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.
An evaluation of the opioid analgesic tramadol (Zydol, Searle United Kingdom) was carried-out by ambulance paramedics to assess its efficacy in providing pain relief in the prehospital situation.
Methods:
Type of subjects—Patients suffering severe pain from any cause uncontrolled by other simple methods.
Number of subjects—101 patients received tramadol and 41 patients served as a control. Study design—Random, open study.
Statistical tests—Pain score at scene and on arrival at hospital were compared using Fisher's exact tests (2 sides). Logistic regression analyses also were applied to other factors.
Results:
Pain scores improved for 93.1% of the tramadol treated patients and for 44.0% of the controls. A total of 30.7% of patients treated with tramadol complained of nausea after treatment compared with 17.1% before treatment and with 12.2% of the control patients.
Conclusion:
Pain was significantly decreased by the administration of tramadol. It was safe with only minimal side effects, the major one being nausea. Suggestions are made for areas of further study.
A mass gathering always presents a challenge to the medical providers of a city since preparations must be made to cover any potential disasters, big or small. With a prediction of several hundred thousand people coming to the New York City area to participate in the Papal Masses, the New York City-Emergency Medical Services readied its forces of physicians, paramedics, and emergency medical technicians from throughout the region. Extensive multiagency planning involving a Total Quality Management process was integral to the success of covering the events.
To measure blood levels of morphine and additional drugs in patients suspected of intravenous (IV) heroin abuse and to evaluate the effects of antidote treatment.
Design:
Prehospital blood sampling in 52 patients.
Results:
Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses.
Conclusion:
This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.
This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.
There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion.
The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.
Each Emergency Medical Services (EMS) system is unique in its development and scope of practice. In many instances, incorporates components of other models, It is important to the intellectual growth of the Emergency Medical Technicians that they visualize EMS design from an international perspective. This article describes the EMS system that exists in Hong Kong. It explores the changes that are occurring, defines the relationship between Hong Kong and China, and considers the influence that this evolving model might have on China after 1997.