Pushing Yourself to the Maximum: What Do Prehospital Interventions Do to the Heart Rates of the Prehospital Team Involved? A Case Report.

Little is known about the heart rate changes of prehospital clinicians when performing potentially "stressful" interventions. This case report demonstrates the heart rate changes of two prehospital clinicians when performing a resuscitative thoracotomy. It demonstrates the peak heart rates correlating to the main intervention performed. This highlights areas for future research including the effect heart rate has on optimal performance.

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma.

BACKGROUND: Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment. METHODS: The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant. RESULTS: Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs. CONCLUSION: Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.

Cervical spine immobilization during extrication of the awake patient: a narrative review.

Techniques for extricating vehicle occupants after road-traffic collisions have evolved largely through fear of worsening a cervical spine injury, rather than being evidence-based. Recent research has looked at the safety of allowing the alert patient to self-extricate, rather than being assisted with equipment such as long spinal boards and semirigid cervical collars. This review aims to elucidate whether it is safe to allow an alert, ambulant patient to self-extricate from a vehicle with minimal or no cervical spine immobilization. A literature search was conducted looking for papers that discussed cervical spine motion during extrication from a vehicle. Five papers were yielded, and their methodology, results and limitations were assessed. Motion capture studies suggest that a patient who is allowed to self-extricate from a vehicle will move their cervical spine no more than a patient who is extricated by traditional methods, and may move their neck up to four times less. Furthermore, an alert patient with a neck injury will demonstrate a self-protection mechanism, ensuring injuries are not worsened. Evidence is now building that self-extrication in alert patients with minimal or no cervical spine immobilization is safe. Self-extrication should become more commonplace, conferring not only a potential safety benefit but also advantages in time to definitive care and resource use.

The Need for a UK Helicopter Emergency Medical Service by Night: A Prospective, Simulation Study.

BACKGROUND: Major trauma commonly occurs at night. Helicopter emergency medical services (HEMS) can provide advanced prehospital care to victims of major trauma but do not routinely operate at night in the United Kingdom. We sought to prospectively examine the need for a night HEMS service in Kent, Surrey, and Sussex in the United Kingdom. METHODS: A 4-month, prospective study was conducted (July 1, 2012-October 31, 2012). HEMS dispatch paramedics were present in the ambulance dispatch center and undertook simulated HEMS activations when a suitable case was identified. All trauma cases from the 4-month study period were collated. Five independent HEMS clinicians reviewed the simulated tasking and trauma cases and gave an opinion on whether the patient met HEMS activation criteria. RESULTS: A mission rate of 1 case per night was predefined as cost-effective. During the prospective study, 145 calls were identified by the HEMS dispatch paramedic as appropriate for an HEMS response. If HEMS had deployed to all 145 incidents, this would have resulted in an average mission rate of 1.2 activations per night. Two hundred eight incidents were identified as potentially appropriate for HEMS activation. Responding to all 208 incidents would have resulted in a mean activation rate of 1.7 per night. CONCLUSION: This study justifies the need for Kent, Surrey and Sussex Air Ambulance Trust to operate a service at night for a trial period, with an estimated average mission load of 1 per night spread over the entire night period. Further research is warranted to determine the potential impact of a night HEMS service on outcome from major trauma.

The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective.

Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has been done on parental presence it often focuses primarily on the parents or staff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the emotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping with post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental accompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether accompaniment would be of benefit to their patient population. The lack of published data does not enable a formal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the preference in land based conveyance. Future research is needed into the emotional recovery of children after trauma, as well as the experiences of patient, parent and staff during conveyance.