Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident.

Objective: Whenever a mass casualty incident (MCI) occurs, it is essential to anticipate the final number of victims to dispatch the adequate number of ambulances. In France, the custom is to multiply the initial number of prehospital victims by 2-4 to predict the final number. However, no one has yet validated this multiplying factor (MF) as a predictive tool. We aimed to build a statistical model to predict the final number of victims from their initial count. Methods: We observed retrospectively over 30 years of MCIs triggered in a large urban area. We considered three types of events: explosions, fires, and road traffic accidents. We collected the initial and final numbers of victims, with distinction between deaths, critical victims (T1), and delayed or minimal victims (T2-T3). The MF was calculated for each category of victims according to each type of event. Using a Poisson multivariate regression, we calculated the incidence risk ratio (IRR) of the final number of T1 as a function of the initial deaths and the initial T2-T3 counts, while controlling for potential confounding variables. Results: Sixty-eight MCIs were included. The final number of T1 increased with the initial incidence of deaths [IRR: 1.8 (1.4-2.2)], the initial number of T2-T3 being greater than 12 [IRR: 1.6 (1.3-2.1)], and the presence of one or more explosion [IRR: 1.4 (1.1-1.8)]. Conclusion: The MF seems to be an appealing decision-making tool to anticipate the need for ambulance resources. In explosive MCIs, we recommend multiplying T1 by 1.4 to estimate final count and the need for supplementary advanced life support teams. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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TIER competency-based training course for the first receivers of CBRN casualties: a European perspective.

Introduction: Education and training are key elements of health system preparedness vis-a-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events. Objective: The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method. Methods: This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts' consensus, core competencies for hospital staff - as CBRN casualty receivers - were determined, and training curricula and delivery methods were defined. Results: The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen. Conclusion: By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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How to read a medical research article

An emergency medicine physician and educator shares his process for reading and analyzing a medical journal article

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Maurice Davis Band - The Wrong Goodbye

The Wrong Goodbye is the brain child of singer/songwriter Maurice Davis. The mission is to raise awareness, remove the stigmatism that keeps people silent and help bring suicide to an end.

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How to read a medical research article

An emergency medicine physician and educator shares his process for reading and analyzing a medical journal article

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Maurice Davis Band - The Wrong Goodbye

The Wrong Goodbye is the brain child of singer/songwriter Maurice Davis. The mission is to raise awareness, remove the stigmatism that keeps people silent and help bring suicide to an end.

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How to read a medical research article

An emergency medicine physician and educator shares his process for reading and analyzing a medical journal article

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Maurice Davis Band - The Wrong Goodbye

The Wrong Goodbye is the brain child of singer/songwriter Maurice Davis. The mission is to raise awareness, remove the stigmatism that keeps people silent and help bring suicide to an end.

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EMT-B & Dispatchers Needed, Philadelphia, PA - L&P Care Ambulance Inc.

Job Summary: Performs professional and technical duties to render basic life support care in the emergency and non-emergency transportation setting. Education: High school diploma or equivalent required. Certifications: Pennsylvania state certified EMT-B. BCLS certification (CPR). Driver's License - current and valid driver's license. Employees must adhere to all procedural guidelines in HR Policy 1-13 ...

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How to read a medical research article

An emergency medicine physician and educator shares his process for reading and analyzing a medical journal article

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Maurice Davis Band - The Wrong Goodbye

The Wrong Goodbye is the brain child of singer/songwriter Maurice Davis. The mission is to raise awareness, remove the stigmatism that keeps people silent and help bring suicide to an end.

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Full-time Paramedic $3500 Sign-on - EMSA/AMR

Paramedic – EMSA/Oklahoma City (Relocation Bonus Available) Want to make a real difference in the world and improve your own paramedic skills in the process" EMSA is seeking ambitious, resourceful caregivers to work full-time in our fast-paced, ALS, 911 system. We challenge paramedics by setting high performance standards and implementing innovative treatment protocols; we reward our team by offering ...

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Full-time Paramedic $3500 Sign-on - EMSA/AMR

Paramedic – EMSA, Tulsa, OK (Relocation Bonus Available) Want to make a real difference in the world and improve your own paramedic skills in the process" EMSA is seeking ambitious, resourceful caregivers to work full-time in our fast-paced, ALS, 911 system. We challenge paramedics by setting high performance standards and implementing innovative treatment protocols; we reward our team by offering ...

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Risk factors for and prediction of mortality in critically ill medical–surgical patients receiving heparin thromboprophylaxis

Previous studies have suggested that prediction models for mortality should be adjusted for additional risk factors beyond the Acute Physiology and Chronic Health Evaluation (APACHE) score. Our objective was ...

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Paramedic students help crash victims leaving EMS conference

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Risk Factors for Longer Hospital Stay Following the Fontan Operation.

Objectives: Children with functional single ventricle undergoing the Fontan operation consume considerable resources. The purpose of this study is to evaluate pre- and intraoperative risk factors for longer hospital stay and to describe the perioperative course at a single institution over a 15-year period. Design: Retrospective cohort study. Setting: A single pediatric cardiac ICU. Patients: All consecutive patients undergoing a first-time Fontan operation from 2000 to 2014. Interventions: None. Measurements and Main Results: Prolonged length of stay was defined as hospital stay greater than 75 percentile at our institution after surgery. Of 218 patients who met inclusion criteria, median length of stay was 10 days (interquartile range, 8-14 d); prolonged length of stay was defined greater than or equal to 15 days. Independent pre- and intraoperative risk factors for prolonged length of stay included higher hemoglobin (odds ratio, 1.29; p = 0.003), higher mean pulmonary artery pressure (odds ratio, 1.14; p = 0.037), and lower aortic saturation (odds ratio, 0.92; p = 0.008) in the entire group. When patients with hepatic vein inclusion (following previous Kawashima) were excluded, higher hemoglobin (odds ratio, 1.24; p = 0.027), lower aortic saturation (odds ratio, 0.92; p = 0.017), and placement of a fenestration (odds ratio, 2.438; p = 0.021) were associated with prolonged length of stay. Fifty-eight patients (26.6%) had major complications defined by Pediatric Cardiac Critical Care Consortium. Placement of a fenestration (odds ratio, 2.297; p = 0.014) and longer aortic cross-clamp time (odds ratio, 1.015; p = 0.003) were independently associated with Pediatric Cardiac Critical Care Consortium major complications. Conclusions: In this series, 75% of patients had a postoperative length of stay less than or equal to 2 weeks. Preoperative factors suggesting worse hypoxemia/decreased pulmonary blood flow (higher hemoglobin and lower oxygen saturation) and increased pulmonary artery pressure were associated with prolonged length of stay. These findings may help risk stratify this complex patient population, provide more accurate family counseling, and provide preliminary data for changes in preoperative timing of the Fontan and/or changes to postoperative management strategies for those at high risk for increased ICU morbidity. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Modes of Death in a Pediatric Cardiac ICU.

Objective: To determine epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe. Design: Retrospective chart review. Setting: Single-center institution. Patients: We concurrently identified 57 consecutive patients who died prior to discharge from the cardiac ICU. Interventions: None. Measurements and Main Results: Over the study period, there were 57 deaths for a combined mortality rate of 2.4%. Four patients (7%) were declared brain dead, 25 patients (43.8%) died after a failed resuscitation attempt, and 28 patients (49.1%) died after withholding or withdrawal of life-sustaining treatment. Cardiorespiratory failure was the most frequent proximate cause of death (39, 68.4%) followed by brain injury (14, 24.6%) and septic shock (4, 7%). Older age at admission, presence of mechanical ventilation and/or device-dependent nutrition support, patients on a left-ventricular assist device and longer cardiac ICU stay were more likely to have life support withheld or withdrawn. Conclusions: Almost half of the deaths in the cardiac ICU are predictable, and they are anticipated by the decision to limit life-sustaining treatments. Brain injuries play a direct role in the death of 25% of patients who die in the cardiac ICU. Patients with left-ventricular assist device are associated with withdrawal of treatment. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Functional Status in ICU Survivors and Out of Hospital Outcomes: A Cohort Study.

Objectives: Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge. Design: Single-center retrospective cohort study. Setting: Academic Medical Center. Patients: Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization. Interventions: None. Measurements and Main Results: The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p

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Paramedic students help crash victims leaving EMS conference

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Paramedic students help crash victims leaving EMS conference

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EMS Billing, eCPR Software & Services

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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Our Company, Our People, Our Customers

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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ImageTrend to Demonstrate Elite Community Health™ at EMS Today

AKEVILLE, MINN. and BALTIMORE, MD. - ImageTrend, Inc. announced the public introduction of the enrollment feature in Elite Community Health, which helps agencies enroll community paramedicine patients into the optimal program, at EMS Today in Baltimore. Elite Community Health is the company’s patient-centric community paramedicine solution, which is based on ImageTrend Elite’s multi-platform ...

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Firefighter in Chagrin Falls Ohio Discovers a New Way to Lift Patient with Weak Shoulders

Binder Lift prevents possible trip to the ED >The Situation While conducting a 30-day field trial on the Binder Lift, Chagrin Falls firefighters responded to a woman who was found sitting on the floor and in need of lift assistance. Even though there was no injury to be found, the woman was anxious and tearful. After further assessment paramedic Ben Speidel learned that she had bilateral rotator ...

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Paramedic students help crash victims leaving EMS conference

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EMS Billing, eCPR Software & Services

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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Our Company, Our People, Our Customers

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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EMS Billing, eCPR Software & Services

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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Our Company, Our People, Our Customers

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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EMS Billing, eCPR Software & Services

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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Our Company, Our People, Our Customers

AIM strives to be the trusted national leader in the delivery of mission critical EMS software and services.

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Fire/EMS Chief - Rio Blanco Fire Protection District

FIRE/EMS CHIEF wanted for a small Volunteer Fire & Rescue Department in Meeker, CO. Population of approximately 2500. Service area of approximately 1940 square miles. Only serious applicants need apply. Please send resume and job description requests to vcrawford@meekerrescue.com or contact Vicki Crawford at Rio Blanco Fire Protection District, 970-878-3443. Application deadline 3/24/2016 at 4:00pm ...

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29 best tips, books and resources for EMS providers

Our dedication as EMS professionals is partly reflected in the checklists we keep, tips we share and resources we reference.

To celebrate Leap Year 2016, we bring you a list of 29 EMS1 lists.

Patient care
1. 3 reasons to use ketamine for prehospital analgesia
2. 4 important considerations for victims of collapsed structures
3. 5 errors that are giving you incorrect blood pressure readings
4. 5 things to know about capnography and respiratory distress
5. 6 questions medics should ask on every auto accident scene
6. 10 intravenous access tips for medics and students

Legal and documentation
7. 3 ways to protect yourself from EMS patient lawsuits
8. 5 answers that could save your EMS career
9. Avoid a lawsuit with these 7 public expectations of EMS

Leadership

10. 5 surefire ways to ruin an EMS field supervisor
11. 5 things great EMS supervisors do differently
12. 7 traits of great field supervisors

Education and training

13. 5 reasons you should NOT become an EMT and 5 reasons critical care paramedic training will make you a better medic
14. 6 training tips to reach unengaged EMTs
15. 10 tips to make sure you succeed on the NREMT exam
16. 10 books every paramedic should own

User tips, tricks and contributions

17. 10 tips for learning pharmacology
18. 15 habits paramedics can’t shake
19. 15 awesome EMS tattoos
20. Playlist: 30 songs for EMS providers and 50 awesome songs to listen to in the ambulance

Advocacy

21. 5 things civilians need to know about EMS
22. 6 cultural changes made by successful volunteer agencies
23. 7 community health care services Uber drivers could deliver

Safety, health, fitness and survival

24. 4 tips to safely lift patients
25. 5 healthy on-the-go meals for medics
26. Psych patient transport: 5 tips to make it safe for providers and patients
27. 6 fat-burning tips for busy EMTs

Humor

28. The top 10 'Ambulance Driver’s Perspective' top 10 lists and 10 more of the Ambulance Driver’s Perspective 'Top 10' lists
29. 6 worst uses of an ambulance

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PulmCrit- Top ten problems with the new sepsis definition

A satisfactory clinical definition of sepsis has been eluding us since the ancient Greeks first coined the term. Current definitions of sepsis attempt to achieve two goals: to provide a rapid screening test to detect sepsis and to render a definitive diagnosis of sepsis. However, it remains unclear whether any definition can achieve this.

EMCrit by Josh Farkas.

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