SYNTHETIC CANNABINOID (SYNTHETIC MARIJUANA) WARNING FROM NYS DOH

SUMMARY
- New York State Department of Health has been informed of a recent increase in synthetic cannabinoid-related adverse events and emergency department visits, with over 160 individuals visiting health care facilities since April 8th.
- Healthcare providers should consider synthetic cannabinoid use when evaluating patients who have compatible signs and symptoms.
- Health care providers should call the Poison Control Center (PCC) (1-800-222-1222) for guidance on the management of these patients and to report adverse events associated with synthetic cannabinoids.

BACKGROUND
The New York State Department of Health has been informed of a recent increase in synthetic cannabinoid- related adverse events and emergency department visits during this month, with over 160 individuals visiting health care facilities since April 8th. Reported cases were mostly in New York City and Syracuse.

Synthetic cannabinoids are marketed as "legal" and typically consist of plant material coated by chemicals which mimic THC, the active principle of marijuana. The products are sold as incense, herbal mixtures or potpourri, online and in convenience or smoke shops, and often carry a "not for human consumption" label in order to disguise the true purpose of the substance. Synthetic cannabinoids are often referred to by different names, including: K2, Spice, Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, WickedX, AK-47, synthetic marijuana, or legal marijuana. Additional names from some recent reported
cases include: Geeked up, Ninja, Caution, Red Giant or Keisha Kole.

Healthcare providers should consider synthetic cannabinoids when evaluating patients who
have compatible signs and symptoms. Signs and symptoms of synthetic cannabinoid use
include agitation, anxiety, nausea, vomiting, high blood pressure, tremor, seizures,
hallucinations, paranoia, and violent behavior. These effects can be similar to those of
phencyclidine (PCP). It has been reported that several recent patients are also presenting with
somnolence and bradycardia, some requiring endotracheal intubation. These effects can appear
similar to those of clonidine. Synthetic cannabinoids are not detected by standard urine
toxicology screens; therefore, synthetic cannabinoid exposure should not be ruled out based on
negative screening results.

Since the exact compounds contained in synthetic cannabinoid products change frequently,
risks and adverse consequences are unpredictable. No antidote is presently available for
synthetic cannabinoid intoxication; however, symptoms are usually short-lived and self-limited.

Since the exact compounds contained in synthetic cannabinoid products change frequently,
risks and adverse consequences are unpredictable. No antidote is presently available for
synthetic cannabinoid intoxication; however, symptoms are usually short-lived and self-limited.
Health care providers should call the Poison Control Center (PCC) (1-800-222-1222) for
guidance on the management of these patients and to report adverse events associated with
synthetic cannabinoids.

Call 1-888-99-SALTS (1-888-997-2587) to report synthetic drug sale and distribution.

Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support

Interesting article where the finding seem to indicate that ALS care for out of hospital cardiac arrest results in a lower survival rate and higher incidents of neurological injury.

Follow the link below to the articles:
https://www.dropbox.com/sh/0cvvws32lzhnf3s/AAAqO2A9kKbiv9cl5EOI4b4Ma?dl=0

Thoracic Trauma - Traumatic Cardiac Tamponade

Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space /sac (Sac surrounding the heart), resulting in reduced ventricular filling and subsequent hemodynamic compromise. It can occur from both a medical and traumatic etiology.  In this post we will discuss Traumatic Cardiac Tamponade. The condition is a traumatic emergency, the complications of which include pulmonary edema, shock, and death.

The speed in which the fluid builds up in the pericardial sac is the largest factor in survival.  The faster the fluid accumulates the higher the mortality.  This is why traumatic cardiac tamponade are often more dangerous than those of a medical cause. Rapid accumulation of as little as 150mL of fluid can result in a marked increase in pericardial pressure and can severely impede cardiac output,^[2] whereas 1000 mL of fluid may accumulate over a longer period without any significant effect on diastolic filling of the heart. This is due to adaptive stretching of the pericardium over time. A more compliant pericardium can allow considerable fluid accumulation over a longer period without hemodynamic insult.

Heart with pericardial sac opened.
 


X-ray showing the heart surrounded by a fluid filled pericardia sac.

Signs and symptoms

Symptoms vary with the acuteness and underlying cause of the tamponade. Patients with acute tamponade may present with dyspnea, tachycardia, and tachypnea. Cold and clammy extremities from hypoperfusion are also observed in some patients. Other symptoms may include the following:

• Elevated jugular venous pressure (JVD)
• Pulsus paradoxus

 

Beck triad

Described in 1935 by Claude Beck, this complex of physical findings, also called the acute compression triad, refers to increased jugular venous pressure, hypotension, and diminished heart sounds. These findings result from a rapid accumulation of pericardial fluid. This classic triad is usually observed in patients with acute cardiac tamponade.

 

The concept was developed by Claude Beck, a resident and later Professor of Cardiovascular Surgery at Case Western Reserve University.^[

 

 

Management

Prehospital treatment.

The prehospital treatment of pericardial tamponade is mainly supportive.  Position of comfort if
thermodynamically stable, semifowlers in in respiratory distress, supine if in hypoperfusion,.  High concentration O2, temperature maintenance, rapid transport to the appropriate facility (trauma center).

In Hospital treatment

Removal of pericardial fluid is the definitive therapy for tamponade and can be done using the following three methods:

• Emergency subxiphoid percutaneous drainage
• Echocardiographically guided pericardiocentesis
• Percutaneous balloon pericardiotomy

The role of medication therapy in cardiac tamponade is limited.


Pericardiocentesis

Measles (Rubeola)

Measles (Rubeola)

 

We have by now all heard about the measles outbreak that started in Disneyland or Disney California Adventure Park in Anaheim, California in December, 2014.  To date there have been over 100 cases of measles linked to this out break.  cases have shown up in 14 states including New York.
below is some information about measles. 

Measles is a highly contagious respiratory disease caused by a virus. It spreads through the air through coughing and sneezing. Measles starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Signs and Symptoms

The symptoms of measles generally appear about seven to 14 days after a person is infected.
Measles typically begins with

• high fever,
• cough,
• runny nose (coryza), and
• red, watery eyes (conjunctivitis).

 

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the
mouth.

Koplik Spots ( tiny white spots in the mouth)

Mouth of a patient with Koplik spots, an early sign of measles infection.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.
After a few days, the fever subsides and the rash fades.


Measles Rash

Skin of a patient after 3 days of measles infection.

Transmission of Measles

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.
Infected people can spread measles to others from four days before to four days after the rash appears.

Measles is a disease of humans; measles virus is not spread by any other animal species.

 

Complications

Measles can be a serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.

Common Complications

Common measles complications include ear infections and diarrhea.

• Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
• Diarrhea is reported in less than one out of 10 people with measles.

Severe Complications

Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.

• As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
• About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or mentally retarded.
• For every 1,000 children who get measles, one or two will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

Frequently Asked Questions about Measles in the U.S.

 

Q: Has measles been eliminated from the United States?

A: Yes. In 2000, the United States declared that measles was eliminated from this country. The United States was able to eliminate measles because it has a highly effective measles vaccine, a strong vaccination program that achieves high vaccine coverage in children and a strong public health system for detecting and responding to measles cases and outbreaks.

Q: What does "measles elimination" mean?

A: Measles elimination is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area. Measles is no longer endemic (constantly present) in the United States.

Q: If measles is eliminated, why do people still get it in the United States?

A: Every year, measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks. This can occur in communities with unvaccinated people.
Most people in the United States are protected against measles through vaccination, so measles cases in the U.S. are uncommon compared to the number of cases before a vaccine was available. Since 2000, when measles was declared eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 644 people in 2014.

Q: Where do cases of measles that are brought into the United States come from?

A: Measles can be brought into the United States from any country where the disease still occurs or where outbreaks are occurring including Europe, Africa, Asia, and the Pacific. In recent years, many measles cases have been brought into the United States from common U.S. travel destinations, such as England, France, Germany, India, and, during 2014, from the Philippines and Vietnam.

 

Q: Why have there been more measles cases in the United States in recent years?

A: In 2008, 2011, 2013 and 2014, there were more reported measles cases compared with previous years. CDC experts attribute this to:

• more measles cases than usual in some countries to which Americans often travel (such as England, France, Germany, India, the Philippines and Vietnam), and therefore more measles cases coming into the US, and/or
• more spreading of measles in U.S. communities with pockets of unvaccinated people.

 

Q: How effective is the measles vaccine?

A: The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus and two doses is about 97% effective.

Q: Could I still get measles if I am fully vaccinated?

A: Very few people—about three out of 100—who get two doses of measles vaccine will still get measles if exposed to the virus. Experts aren’t sure why; it could be that their immune systems didn’t respond as well as they should have to the vaccine. But the good news is, fully vaccinated people who get measles are much more likely to have a milder illness, and they are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems.

Q: Do I ever need a booster vaccine?

A: No. People who received two doses of measles vaccine as children according to the U.S. vaccination schedule are considered protected for life and do not ever need a booster dose.
Adults need at least one dose of measles vaccine, unless they have evidence of immunity. Adults who are going to be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers, should make sure they have had two doses separated by at least 28 days.
If you’re not sure whether you were vaccinated, talk with your doctor.

Q: Am I protected against measles?

A: You are considered protected from measles if you have written documentation (records) showing at least one of the following:

• You received two doses of measles-containing vaccine, and you are a(n)—
  • school-aged child (grades K-12)
  • adult who was not vaccinated as a child and will be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers.
• You received one dose of measles-containing vaccine, and you are a(n)—
  • preschool-aged child
  • adult who was not vaccinated as a child and will not be in a high-risk setting for measles transmission.
• A laboratory confirmed that you had measles at some point in your life.
• A laboratory confirmed that you are immune to measles.
• You were born before 1957.

Q: What should I do if I’m unsure whether I’m immune to measles?

A: If you’re unsure whether you’re immune to measles, you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with measles-mumps-rubella (MMR) vaccine. Another option is to have a doctor test your blood to determine whether you’re immune, but this option is likely to cost more and will take two doctor’s visits. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles (or mumps or rubella).

Q: How common was measles in the United States before the vaccine?

A: Before the measles vaccination program started in 1963, we estimate that about 3 to 4 million people got measles each year in the United States. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) from measles.

Q: Is measles a concern for the United States?

A: Yes. Since measles is still common in many countries, this disease will continue to be brought into the United States. Measles is highly contagious, so anyone who is not protected against measles is at risk of getting the disease. People who are unvaccinated for any reason, including those who refuse vaccination, risk getting infected with measles and spreading it to others, including those who cannot get vaccinated because they are too young or have specific health conditions.

Q: Could measles ever re-establish itself in the United States?

A: Yes, it is possible that measles could become endemic (constant presence of a disease in an area) in the United States again, especially if vaccine coverage levels drop. This can happen when people

• forget to get vaccinated on time,
• don’t know that they need a vaccine dose (this is most common among adults), or
• refuse vaccines for religious, philosophical or personal reasons.

Research shows that people who refuse vaccines tend to group together in communities. When measles gets into communities with pockets of unvaccinated people, outbreaks are more likely to occur. These communities make it difficult to control the spread of the disease and make us vulnerable to having the virus re-establish itself in our country.
High sustained measles vaccine coverage and rapid public health response are critical for preventing and controlling measles cases and outbreaks.

 

Q: Will the United States ever get rid of measles completely?

A: Yes, it's possible. The first step is to eliminate measles from each country and region of the world. Once this happens, there will be no place from which measles can spread.
All member states in the six World Health Organization regions have committed to eliminating measles by the year 2020. Once a disease has been eliminated from every country, it is considered "eradicated" from the world. See the Measles and Rubella Initiative for more information.

 

 

Thoracic Trauma - Flail Segment and Pulmonary Contusions

Flail Segment

 

 

 

 

Flail Chest

 

 

A flail chest occurs when a segment of the thoracic (rib) cage is separated from the rest of the chest wall. This is usually defined as at least two fractures per rib (producing a free segment), in at least two ribs. A segment of the chest wall that is flail is unable to contribute to lung expansion. Large flail segments will involve a much greater proportion of the chest wall and may extend bilaterally or involve the sternum. In these cases the disruption of normal pulmonary mechanics may be large enough to require mechanical ventilation

 

.The main significance of a flail chest however is that it indicates the presence of an underlying pulmonary contusion. In most cases it is the severity and extent of the lung injury that determines the care need and the possible requirement for mechanical ventilation. Thus the management of flail chest consists of standard management of the rib fractures and of the pulmonary tusions underneath.

 

Diagnosis

Most significant chest wall injuries will be identified by physical examination. Bruising, grazes or seat-belt signs are visible on inspection, and palpation may reveal the crepitus associated with broken ribs. Awake patients will complain of pain on palpation of the chest wall or on inspiration.

A flail chest is identified as paradoxical movement of a segment of the chest wall - ie indrawing on inspiration and moving outwards on expiration. This is often better noted by palpation than by inspection.

 

Pulmonary Contusion

 

 

 

 A pulmonary contusion is an injury to lung tissue, leading to edema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance. There is also a significant inflammatory reaction to blood components in the lung, and 50-60% of patients with significant pulmonary contusions will develop bilateral Acute Respiratory Distress Syndrome (ARDS).

 

Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Infants can also have respiratory distress syndrome.

Causes

ARDS can be caused by any major direct or indirect injury to the lung. Common causes include:

• Breathing vomit into the lungs (aspiration)
• Inhaling chemicals
• Lung transplant
• Pneumonia
• Septic shock (infection throughout the body)
• Trauma

ARDS leads to a buildup of fluid in the air sacs (alveoli). This fluid prevents enough oxygen from passing into the bloodstream.
The fluid buildup also makes the lungs heavy and stiff, which decreases the lungs' ability to expand. The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from a ventilator through a endotracheal tube.

 

Pulmonary contusions occur in approximately 20% of blunt trauma patients and it is the most common chest injury in children. The reported mortality ranges from 10 to 25%, and 40-60% of patients will require mechanical ventilation. The complications of pulmonary contusion are ARDS, as mentioned, and respiratory failure, atelectasis.

 

(Atelectasis (at-uh-LEK-tuh-sis) is a condition in which one or more areas of your alveoli collapse or don't inflate properly. If only a small area or a few small areas of the alveoli are affected, you may have no signs or symptoms.

If a large area or several large areas of the alveoli are affected, they may not be able to deliver enough oxygen to your blood.)

 

Diagnosis

 

Pulmonary contusions are rarely diagnosed on physical examination. The mechanism of injury may suggest blunt chest trauma, and there may be obvious signs of chest wall trauma such as bruising, rib fractures or flail chest. These suggest the presence of an underlying pulmonary contusion. Crackles may be heard on auscultation but are rarely heard in the emergency room and are non-specific.

Severe bilateral pulmonary contusions may present with hypoxia - but more usually hypoxia develops as the pulmonary contusions blossom or as a result of subsequent ARDS.

 

In hospital radiological testing (plain chest x-ray or CAT scan) is best way to diagnose a pulmonary contusion. 

CPAP for NYS EMTs is coming

                                                                  CPAP FOR EMS

Continuous Positive Airway Pressure (CPAP) devices will be coming to NYS EMT's shortly.  Here is a short guide to CPAP.  Since we do not know yet how the NYS BLS Protocols will permit EMTs to use CPAP we will keep it very general for now. It will obviously be used in Acute Pulmonary Edema, but it is unclear if it will be allowed in other emergency situation.

Before we start just remember that CPAP cannot be used in any patient with any of the following conditions EVEN if they are in respiratory distress:

1. Decreased Mental Status / Inability to sit up / Altered Mental Status
2. Respiratory arrest / Apnea /  Respiratory failure / poor inspiratory effort
3. Pneumothorax / Trauma to the thorax / Subcutaneous Emphysema
4. Any form of Shock / Hypotension
5. Nausea / Vomiting / any risk of aspiration
6. Facial Trauma / Abnormalities

How CPAP Works:

Continuous Positive Airway Pressure, (CPAP), is the maintenance of positive pressure throughout the complete respiratory cycle, (inspiration and expiration), when breathing spontaneously. CPAP is not the same as Positive End Expiratory Pressure or PEEP. PEEP only provides pressure on the expiratory side by offering resistance to exhalation using a spring-loaded valve or air flow.

 

1. During the inspiratory phase, patients in distress will have to create a higher flow rate of air to meet their needs, this will present as an increase in work-of-breathing (WOB). Patients in respiratory distress may need to achieve inspiratory flow rates greater than 65 liters per min (LPM). With the inspiratory support of CPAP, the patient does not have to work as hard to inhale and overcoming the auto PEEP in the lung. Auto-PEEP represents the abnormal, and usually undetected, residual pressure above atmospheric remaining in the alveoli at end-exhalation due to air trapping.  The auto PEEP has to be overcome each time a person inhales, for a healthy person the work is minimal and goes unnoticed. However, those patients with stiff lungs, (CHF and Pulmonary Fibrosis), have to work extremely hard to overcome the increased auto PEEP on every breath.

 

2. The increased inspiratory pressure also increases the size, therefore the surface area of the

alveoli, providing a greater opportunity for gas exchange or respiration. The process increases the

Functional Residual Capacity (FRC) of the lung. The FRC is the area where gas exchange takes place.

 

3. Since a greater oxygen percentage is able to reach the alveoli during CPAP, the partial pressure

of the oxygen molecule will be greater. The higher partial pressure will allow more oxygen to

diffuse into the blood stream improving oxygenation.

 

4. Fluid in the alveolar space cannot only make the lung stiff, (increasing inspiratory

work-of-breathing), it also creates a barrier that can reduce gas exchange. The pressure from CPAP

can reduce the fluid by forcing fluid out of the alveolar space back into the interstitium.

 

5. During the expiratory phase, the patient will breathe against a threshold of resistance that

works as a pneumatic splint to hold the airways open. Patients with chronic lung disease have

weakened airways that have a tendency to collapse on expiration, causing air trapping. Having the

airways stinted open during exhalation will make inspiration on the next breath less difficult.

 

6. The resistance during exhalation can open non-ventilated areas of the lung recruiting alveoli

that have collapsed due to atelectasis, (a collapse of lung tissue affecting part, or all, of one

lung effecting gas exchange).

 7. CPAP decreases pre-load and after-load on the heart reducing the heart’s workload. However, a reduction in pre-load and after-load will have an effect on the patient’s blood pressure. Patients

should have a systolic blood pressure of at least 100 mmHg before starting CPAP.

 

What Types of Patients Are NOT Candidates for CPAP?

Being able to assess and determine who is, and who is not, a candidate for CPAP has a great impact on whether CPAP will be effective or not. CPAP can be a very effective treatment for patients in respiratory distress but is not indicated for patients in respiratory failure. Respiratory distress patients are still compensating even though they may be working hard. It is not uncommon for respiratory distress patients to have oxygen saturations (SpO2 ) and carbon dioxide, (CO2), levels within normal range. Key determinants include; is the patient alert, (even though they are working hard), and can they follow directions. Patients that have gone into respiratory failure may exhibit a decrease in work-of-breathing, CO2 levels climbing, oxygen saturations falling, and their level of consciousness declining, (most likely from CO2 narcosis). CPAP is not indicated for respiratory failure patients.

 

CPAP and Congestive Heart Failure (CHF):

The treatment of Congestive Heart Failure, (CHF), by EMS has changed significantly in the last couple of years. The mainstays of CHF treatment (ALS) in the pre-hospital setting are CPAP and nitroglycerin. The efficacy of Lasix and Morphine is under scrutiny and has been removed from many EMS ALS protocols. Many systems that adopt CPAP start with CHF. The effects of CPAP are well suited for the physiologic issues associated with this disease. Pulmonary edema, associated with CHF, makes the lungs stiff and it is difficult for the patient to inhale; and can be observed as difficulty breathing during the inspiratory phase of ventilation or inspiratory shortness-of-breath. Since CHF is primarily a heart problem, CPAP addresses the side effects of a failing heart and its impact on the lungs.  CHF is a process that will continue to spiral down the cardiogenic shock pathway until the cycle is broken. As the patient’s heart fails, more fluid ends up in the lungs. With more fluid in the lungs, less oxygen makes it to the heart muscle, so the heart fails even more. The first step in stopping the cycle is the early use of CPAP. If the patient does not have lung disease then the airways should function normally and not collapse on exhalation. In this case, the inspiratory pressure will force the fluid out of the lungs, expand the alveoli which, in turn, will increase gas exchange (respirations) improving oxygenation.In addition, with the airways being held open by the expiratory resistance, the patient does not have to overcome

the auto PEEP at the beginning of each breath. With the improvement of gas exchange and reduced impact of auto PEEP, the patient’s work-of-breathing will be reduced. With the reduced work, there will be less stress on the heart. A key factor in the initiation of CPAP is the patient’s blood pressure. It is recommended that the systolic blood pressure be at least 100 mmHg before starting CPAP due to the reduction in pre-load and after-load.

 

More to come after the protocols are released.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Survival Rates Similar for Gunshot, Stabbing Victims Whether Brought to the Hospital by Police or EMS

 

Interesting Study:

This study just reinforces that staying on the scene with an accessible trauma patient is inappropriate. Excessive time spent immobilizing, splinting, and otherwise "stabilizing" trauma patients is detrimental to their survival. With the concept of "permissive hypotension" (future post) and fluid resuscitation caused hypothermia there is no reason to stay on the scene.  IV's should be started en-route and depending on your protocol; fluid may be kept to "keep vein open" (KVO) rate (slow). Excessive fluid administration prior to internal bleeding being controlled has been shown to cool the trauma patient.  This cooling leads to worse coagulation.  There are numerous other issues surrounding fluid resuscitation that we will get into in other posts.

A couple of points we should consider about this study.  The patients were for the most part being transported to Level 1 and Level 2 trauma centers that actually handle trauma on a regular basis. The second point is that transport times were relatively short.

Survival Rates Similar for Gunshot, Stabbing Victims Whether Brought to the Hospital by Police or EMS

Philadelphia “Scoop and Run” Penetrating Trauma Victims Studied over Five-Year Period

Released: 1/2/2014 9:00 AM EST
Source Newsroom: Perelman School of Medicine at the University of Pennsylvania

more news from this source

Newswise — PHILADELPHIA - A new study from the Perelman School of Medicine at the University of Pennsylvania has found no significant difference in adjusted overall survival rates between gunshot and stabbing (so-called penetrating trauma injuries) victims in Philadelphia whether they were transported to the emergency department by the police department or the emergency medical services (EMS) division of the fire department.

“This study is an examination of current prehospital practices with an eye toward improving patient care and is by no means intended as a criticism of the highly trained and dedicated professionals of the Philadelphia Fire Department who provide outstanding care under difficult circumstances,” said lead author Roger Band, MD, assistant professor of Emergency Medicine at the Hospital of the University of Pennsylvania. “The Fire Department, the Police Department, and health care professionals all share the same goal: learn all we can in order to continually improve the care and services we provide to patients and the community.”

The study, published online ahead of print in the Annals of Emergency Medicine, examined 4,122 patients taken to eight Level I and Level II adult trauma centers in Philadelphia between January 1, 2003 and December 31, 2007. Of these, 2,961 were transported by EMS and 1,161 by the police. The overall mortality rate was 27.4 percent. Just over three quarters (77.9 percent) of the victims suffered gunshot wounds, and just under a quarter (22.1 percent) suffered stab wounds. The majority of patients in both groups (84.1 percent) had signs of life on delivery to the hospital. A third of patients with gunshot wounds (33.0 percent) died compared with 7.7 percent of patients with stab wounds.
Although patients transported by the police department were more likely to die compared with those transported by EMS (29.8 percent versus 26.5 percent), these findings appear to be explained by the more severely injured population that the police typically transport to the hospital and not the mode of transport itself.

The Penn study also found that severely injured gunshot victims transported by the police were more likely to survive. “There could be many factors contributing to this finding, such as the fact that police may have shorter response times to an event simply by virtue of how they patrol,” said Band.
While previous studies suggest that trauma victims have similar mortality rates whether brought to the hospital by emergency medical services or police, the current Penn study is the largest investigation to date examining the relationship between method of transport and mortality in penetrating trauma.

More than 25 years ago, the Philadelphia Police Department began allowing police department transport of individuals with penetrating trauma to the hospital, commonly referred to as a “scoop and run.” A current department directive states: “Police personal will transport: Persons suffering from a serious penetrating wound, e.g., gunshot, stab wound … to the nearest accredited trauma center. Transportation will not be delayed to await the arrival of the Fire Department paramedics.” While EMS follows citywide protocols, no formal policy outlines how care should be provided to injured patients transported by police. Typically, individuals transported by police have not been rendered care, including direct pressure on bleeding extremity wounds. However, the Philadelphia Police Department has recently issued tourniquets to every police officer in the city.
For decades, there has been heavy debate among medical professionals on how to best balance the potentially competing priorities of fast transport to the emergency department (possibly in first-arriving, traditional police vehicles) with the benefits of transport by specially trained emergency medical personnel in expressly equipped vehicles. Previous studies have shown survival benefit for EMS-type transport in such cases as myocardial infarction (heart attack), respiratory arrest, cardiac arrest, and perhaps trauma.

“It is critically important to remember that our study focuses on a very specific type of patient with a specific disease process, in a densely populated urban environment and we in no way are suggesting that patients with serious medical symptoms, such as chest pain or difficulty breathing, do anything but call 911 and await the highly trained EMS personnel who have the skill and equipment to deal with the situation and any potential problems,” said senior study author, Brendan Carr, MD, MS, assistant professor Emergency Medicine and Biostatistics and Epidemiology at Penn.
The research team notes that additional prospective studies in different large cities in the U.S. could help to validate the safety and efficacy of the “scoop and run” approach used in Philadelphia

ZOLL LifeVest Wearable Defibrillator

ZOLL Lifevest

 Interesting device that we may encounter..

The LifeVest wearable defibrillator is a treatment option for sudden cardiac arrest that offers patients advanced protection and monitoring as well as improved quality of life.
The LifeVest is the first wearable defibrillator. Unlike an implantable cardioverter defibrillator (ICD), the LifeVest is worn outside the body rather than implanted in the chest. This device continuously monitors the patient's heart with dry, non-adhesive sensing electrodes to detect life-threatening abnormal heart rhythms. If a life-threatening rhythm is detected, the device alerts the patient prior to delivering a treatment shock, and thus allows a conscious patient to delay the treatment shock. If the patient becomes unconscious, the device releases a Blue™ gel over the therapy electrodes and delivers an electrical shock to restore normal rhythm.

See the two links below for more information.

http://lifevest.zoll.com/medical-professionals/how-lifevest-works.asp

Medical-professionals/how-lifevest-works

http://lifevest.zoll.com/medical-professionals/first_responder_resources.asp

medical-professionals/first responder resources