Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19.

Background: Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers.

Aim/objective: This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI).

Methods: Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.

Initial Validity Evidence for the American Board of Emergency Medicine Emergency Medical Services Certification Examination.

Objectives: The American Board of Emergency Medicine (ABEM) Emergency Medical Services Medicine (EMS) subspecialty was approved by the American Board of Medical Specialties on September 23, 2010. Subspecialty certification in EMS was contingent on two key elements-completing Accreditation Council for Graduate Medical Education (ACGME)-accredited EMS training and passing the subspecialty certification examination developed by ABEM. The first EMS certification examination was offered in October 2013.

Assessing experts' perspectives on challenges in substance misuse prevention, harm reduction, and treatment to shape funding priorities in New York State.

Background: Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings.

Introduction: Telemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings.

Characteristics of Patients Presenting at an Emergency Department for a Heroin Overdose vs Detoxification.

Purpose: This study compares substance use, treatment histories, and sociodemographic characteristics of patients presenting to an emergency department (ED) following a heroin overdose or seeking detoxification services for heroin and examines risk factors for a subsequent return to the ED for a substance-related problem.

Methods: A convenience sample of patients presenting for an overdose or detoxification at an urban teaching ED was recruited for this study. During their ED visit, patients were interviewed regarding demographics, substance use experiences, and treatment history.

Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation.

Introduction: Patients exhibiting signs of hyperactive delirium with severe agitation (HDSA) may require sedating medications for stabilization and safe transport to the hospital. Determining the patient's weight and calculating the correct weight-based dose may be challenging in an emergency. A fixed dose ketamine protocol is an alternative to the traditional weight-based administration, which may also reduce dosing errors.

Does Mixing Activated Charcoal With Cola Improve Tolerability Without Affecting Pharmacokinetics? A Randomized Controlled Crossover Trial.

Introduction: Activated charcoal is the most common form of gastrointestinal decontamination used for the poisoned patient. One limitation to its use is patient tolerability due to palatability. Some recommend mixing activated charcoal with cola to improve palatability.

Comparing Hypothermic and Thermal Neutral Conditions to Induce Metabolic Suppression.

Suppressing metabolism in astronauts could decrease CO production. It is unknown whether active cooling is required to suppress metabolism in sedated patients. We hypothesized that hypothermia would have an additive effect with dexmedetomidine on suppressing metabolism.

Transport Rates and Prehospital Intervals for an EMS Telemedicine Intervention.

Introduction: Emergency medical services (EMS) facilitated telemedicine encounters have been proposed as a strategy to reduce transports to hospitals for patients who access the 9-1-1 system. It is unclear which patient impressions are most likely able to be treated in place. It is also unknown if the increased time spent facilitating the telemedicine encounter is offset by the time saved from reducing the need for transport.

Social Determinants of Health in EMS Records: A Mixed-methods Analysis Using Natural Language Processing and Qualitative Content Analysis.

Social determinants of health (SDoH) are known to impact the health and well-being of patients. However, information regarding them is not always collected in healthcare interactions, and healthcare professionals are not always well-trained or equipped to address them. Emergency medical services (EMS) professionals are uniquely positioned to observe and attend to SDoH because of their presence in patients' environments; however, the transmission of that information may be lost during transitions of care.

Thermoregulation during a six-hour exposure to warm, humid hyperbaric conditions.

Purpose: In a disabled submarine scenario, a pressurized rescue module (PRM) may be deployed to rescue survivors. If the PRM were to become disabled, conditions could become hot and humid exposing the occupants to heat stress. We tested the hypothesis that the rise in core temperature and fluid loss from sweating would increase with rising dry bulb temperature.

Physical symptoms provoked by normobaric hot and humid disabled pressurized rescue module scenarios.

We tested the hypothesis that thermal discomfort will be greater, mood will be worse, and physical symptoms of heat illness will be exacerbated with elevations in dry bulb temperature during exposure to >95% relative humidity disabled pressurized rescue module simulation. On three occasions, 15 healthy males (23 ± 3 years) sat in 32.1 ± 0.

Eating Patterns among Emergency Medical Service Providers in the United States: A Qualitative Interview Study.

Emergency medical service (EMS) providers experience demanding work conditions in addition to shift work, which increases risk for nutrition related chronic disease such as metabolic syndrome, diabetes, obesity, and cardiovascular disease. The high stress, emergent, and unpredictable nature of EMS may interfere with healthy eating patterns on and off shift, however little is known about how these conditions impact dietary patterns among EMS providers. This study aimed to understand factors impacting dietary patterns through semi-structured interviews with 40 EMS providers throughout the United States.

A Qualitative Analysis of the Experiences of EMS Clinicians in Recognizing and Treating Witnessed Cardiac Arrests.

Background: Survival from out of hospital cardiac arrest (OHCA) increases when effective cardiopulmonary resuscitation (CPR) and defibrillation are performed early. Patients who suffer OHCA in front of emergency medical services (EMS) clinicians have greater likelihood of survival, but little is known about how EMS clinicians think about and experience those events. We sought to understand how EMS clinicians assessed patients who devolved to cardiac arrest in their presence and uncover the perceived barriers and facilitators associated with recognizing and treating witnessed OHCAs.

Implementing a Novel Statewide Network to Support Emergency Department-initiated Buprenorphine Treatment.

Introduction: Medications for opioid use disorder (MOUD), including buprenorphine, represent an evidence-based treatment that supports long-term recovery and reduces risk of overdose death. Patients in crisis from opioid use disorder (OUD) often seek care from emergency departments (ED). The New York Medication for Addiction Treatment and Electronic Referrals (MATTERS) network is designed to support ED-initiated buprenorphine and urgent referrals to long-term care for patients suffering from OUD.

Variability in venous gas emboli following the same dive at 3,658 meters.

Exposure to a reduction in ambient pressure such as in high-altitude climbing, flying in aircrafts, and decompression from underwater diving results in circulating vascular gas bubbles (i.e., venous gas emboli [VGE]).

Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial.

Importance: Systemic corticosteroids are commonly used in treating severe COVID-19. However, the role of inhaled corticosteroids in the treatment of patients with mild to moderate disease is less clear.

Objective: To determine the efficacy of the inhaled steroid ciclesonide in reducing the time to alleviation of all COVID-19-related symptoms among nonhospitalized participants with symptomatic COVID-19 infection.

A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries.

Background: Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.

Objectives: The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.

Eating and Physical Activity Patterns in Day and Night Shift EMS Clinicians.

EMS clinicians work in shifts to provide 24-hour care. Shift work is linked with metabolic disease and over 70% of EMS clinicians report having overweight or obesity. Inability to store food in their vehicles combined with limited overnight dining establishments, and unpredictable job demands leads to reliance on convenience and fast foods.