Prehospital Validation of the Assessment of Blood Consumption (ABC) Score.

INTRODUCTION: The Assessment of Blood Consumption (ABC) score is a previously validated scoring system designed to predict which severely injured trauma patients will require massive transfusion. When the ABC score is used in the prehospital setting to activate massive transfusion at the receiving hospital, a 23% decrease in mortality has been demonstrated. However, the ABC score was developed and validated using hospital data from the emergency department (ED). The sensitivity and specificity of the ABC score when calculated using data from the prehospital setting are unknown. We hypothesized that the sensitivity and specificity of the prehospital ABC score will be similar to the sensitivity and specificity of the ED ABC score. METHODS: A 5-year retrospective analysis (2015-2019) of highest-activation adult trauma patients arriving to a quaternary Level I trauma center by hospital-based helicopter air medical service (HEMS) was performed. Demographic, prehospital, ED triage, and blood product utilization data were collected. Prehospital ABC score was calculated using the highest heart rate, lowest systolic blood pressure, and focused assessment with sonography for trauma (FAST) exam results obtained prior to arrival at the trauma center. ED ABC score was calculated using ED triage vital signs and ED FAST results. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristics (AUROC) curve were calculated for each ABC score. RESULTS: 2,067 patients met inclusion criteria. Mean age 39 (±17) years, 76% male, 22% penetrating mechanism. Of these, 128 patients (6%) received massive transfusion using the definition from the original study. Prehospital ABC score at a cutoff of 2 was 51% sensitive and 85% specific for predicting massive transfusion, with 83% correctly classified and an AUROC = 0.73. ED ABC score at the same cutoff was 60% sensitive and 84% specific, with 83% correctly classified and an AUROC = 0.81. By logistic regression, the odds of massive transfusion increased by 2.76 for every 1-point increase in prehospital ABC score (95%CI 2.25-3.37, p < 0.001). CONCLUSIONS: The ABC score is a useful prehospital tool for identifying who will require massive transfusion. Future studies to evaluate the effect of the prehospital ABC score on clinical care and mortality are necessary.

Epidemiology of out-of-hospital pediatric airway management in the 2019 national emergency medical services information system data set.

OBJECTIVE: Airway management is an important priority in the care of critically ill children. We sought to provide updated estimates of the epidemiology of pediatric out-of-hospital airway management and ventilation interventions in the United States. METHODS: We used data from the 2019 National Emergency Medical Services Information System (NEMSIS) data set. We performed a descriptive analysis of all patients < 18 years receiving one or more of the following: bag-valve-mask ventilation (BVM), tracheal intubation (TI), supraglottic airway (SGA) insertion, continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and surgical airway placement. We determined success and complication rates for each airway procedure. RESULTS: Among 1,148,943 pediatric patient care encounters, airway and ventilation interventions occurred in 22,637 (1,970 per 100,000 pediatric Emergency Medical Services (EMS) activations), including 64% <11 years old, 56.1% male, 16.9% cardiac arrest, 16.6% injured, and 83.9% in urban areas. Airway interventions included: BVM 3,997 (17.7% of pediatric airway encounters), TI 3,165 (14.0%), SGA 582 (2.6%), CPAP/BiPAP 331 (1.5%) and surgical airway 29 (0.1%). TI success was 75.2% (95% CI 73.7-76.7%) and lowest for the 0-1 month age group (56.8%; 49.2-64.2%). SGA success was 88.0% (95% CI 85.1-90.6%). Vomiting was the most common airway complication (n = 223, 1%). CONCLUSIONS: BVM and advanced airway management occur in 1 of every 51 pediatric EMS encounters. BVM is the most commonly prehospital pediatric airway management technique, followed by TI and SGA insertion. These data provide contemporary perspectives of pediatric prehospital airway management.

Procedural Confidence and Usability of a Novel Lateral Canthotomy and Cantholysis Simulator Compared to a Traditional Porcine Model in Emergency Medicine Training.

INTRODUCTION: Retrobulbar hemorrhage (RBH) occurs in only 0.45% of ocular trauma, but failure to provide timely lateral canthotomy and cantholysis (LCC) risks permanent visual deficits. With ocular trauma rates as high as 8.5-10% amongst modern combat injuries, and more than 2,000 severe eye injuries documented over a 10 year span, this concern increases.12-15 However, given infrequent RBH occurrence in the non-combat environment, emergency medicine residents trained in stateside settings may not receive adequate LCC exposure prior to military deployment. Simulators should be evaluated for procedural confidence compared to expensive and cumbersome traditional live tissue training (LTT) options. We seek to compare procedural confidence and usability of emergency medicine military residents performing LCC on a novel simulator to those using LTT. METHODS: This study randomized 32 emergency physician and physician assistant residents to perform LCC on a simulator or LTT model. All received a standardized brief on RBH recognition and LCC, then completed an 11-question survey using a 100-mm visual numerical rating scale about their ability to correctly identify RBH and perform LCC. The survey was repeated after LCC completion. All volunteers additionally completed a 10-question survey utilizing a 5-point Likert scale on the usability of the model to which they were randomized. RESULTS: No significant difference in reported confidence changes between groups was found; however, significant increases were found across all reported confidence measures between pre- and post-trainer use in the overall sample population. LCC simulator users reported significantly higher usability in 7 of 10 ratings. CONCLUSION: The lack of a statistically significant difference between groups in procedural confidence suggests artificial LCC simulators may offer an attractive alternative to logistically-complicated porcine models. Further research is needed to evaluate non-inferiority and procedural performance.

Femoral Pulse Ultrasound Assessment Accuracy by Emergency Medicine Trainees on a Porcine Model.

of care ultrasound (POCUS) is increasingly used in emergency medicine (EM), including EM physician residents and EM physician assistant (EMPA) residents. Scant literature assesses accuracy and duration of POCUS pulse assessment by this group during cardiac resuscitation given recommendations for minimal pauses in chest compressions. Evaluation is needed for accuracy and duration of pulse interpretation in EM trainees utilizing POCUS. METHODS: We conducted a double-blind observational study of EM clinician trainee POCUS assessment of pulses using porcine models. Volunteers were blinded to the cardiac status of 5 porcine models randomized as deceased or living and performed femoral artery evaluation using color power Doppler POCUS. The primary outcome was accuracy of pulse assessment. Secondary outcomes included time to verbalization and differences based on reported duration of EM training, experience with ultrasound, and cardiac arrest resuscitation experience. RESULTS: 17 EM and EMPA trainees completed 85 total POCUS pulse assessments with 98.82% accuracy (n=84). Mean verbalization time was 6.95 seconds, and most verbalized interpretations were within 10-seconds (82.4%, n=70). This was grossly consistent between living and deceased models. Subgroup analysis found no significant differences of accuracy or verbalization time based on reported demographics. CONCLUSION: EM clinician trainees demonstrate a high degree of accuracy and low average time for verbalized interpretation of femoral artery pulse assessment, most within recommended time guidelines. Further study is needed to correlate these findings in human patients.

Airway ultrasound for the confirmation of endotracheal tube placement in cadavers by military flight medic trainees - A pilot study.

OBJECTIVE: Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model. METHODS: We conducted a prospective, randomized trial in a human cadaver model. Participants received a brief didactic and hands-on presentation on airway US techniques. Each participant then performed transtracheal US on cadaver models which were randomly assigned to tracheal or esophageal intubation; time to verbalize ETT location was also recorded. Participants were then asked whether they felt airway US would be a useful adjunctive skill in their practice. RESULTS: Thirty-two military flight medic trainees were enrolled. US had a sensitivity of 66.7% and a specificity of 76.4% for identification of esophageal intubations. The positive predictive value was 71.4% and the negative predictive value was 72.2%. Mean time to report ETT placement was 47.3s. Time did not vary between medics with accurate identification versus inaccurate identification (p=0.176). 83% of participants felt airway US would be a useful adjunctive skill for the confirmation of ETT placement. CONCLUSIONS: Military flight medic trainees can rapidly use airway US to identify ETT placement after a short educational session with moderate sensitivity and specificity. These advanced military medics are interested in learning and implementing this skill into their practice.

Fall risk and prevention needs assessment in an older adult Latino population: a model community global health partnership.

BACKGROUND: The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population. OBJECTIVES: The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project. METHODS: A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics. RESULTS: We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively). CONCLUSION: Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.

Cardiovascular risk profile: comparison between white and Southeast Asian youth in Wausau SCHOOL Project.

INTRODUCTION: The Wausau School Children Have Early Onset Of Leading Risk Factors of Cardiovascular Disease and Diabetes Mellitus (SCHOOL) Project is a community-based effort to assess the cardiovascular (CV) health of students in the Wausau School District (WSD). It has been previously demonstrated that risk factors for CV disease are prevalent and increase with age. Wausau is also a major relocation center for Southeast Asian (SEA) immigrants. Few data are available on the CV health of SEA immigrants. This investigation compares the relative frequency of CV risk factors in SEA and white students in the WSD. METHODS: A random selection of 2nd, 5th, 8th, and 11th grade students provided demographic data, health history, sex-adjusted body mass index (BMI), fasting glucose levels, blood pressure levels, and nuclear magnetic resonance lipid profiles (Liposcience). This included 519 white and 48 SEA students. To assess for CV disease risk factors, study participants were examined for dyslipidemia, hypertension, impaired fasting glucose levels, above-normal body weight, and history of smoking. RESULTS: Risk factors for CV disease increased with age for both white and SEA participants. The mean number of risk factors in SEA participants was 1.63 compared to 1.12 for white participants (P=0.016). The mean number of risk factors also increased significantly across grade levels (P=0.001). There was no difference in mean BMI values (P=0.58). No significant differences were found in triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, blood pressure, or glucose values. Dyslipidemia was present in 53% of SEA students and 42% of white students (P=0.14). CONCLUSION: CV risk factors are common in school-age children, and the number of risk factors increases with age. SEA students presented a greater prevalence of CV risk factors than white students, but were not significantly more overweight. Interestingly, in a relatively short time period after immigration, first-generation SEA youth have developed a number of CV risk factors equal to or greater than those of their white counterparts.