Crossing the line: access to trauma care across state borders.

Objective: This study investigates the challenge posed by state borders by identifying the population, injury, and geographic scope of areas of the country where the closest trauma center is out-of-state, and by collating state emergency medical services (EMS) policies relevant to cross-border trauma transport.

Methods: We identified designated levels I, II, and III trauma centers using data from American Trauma Society. ArcGIS was used to map the distance between US census block groups and trauma centers to identify the geographic areas for which cross-border transport may be most expedient.

Preparedness Tested: Severe Cerebral Malaria Presenting as a High-Risk Person Under Investigation for Ebola Virus Disease at a US Hospital.

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a "wet" person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation.

Optimizing the patient handoff between emergency medical services and the emergency department.

Study Objective: Patient handoffs are known as high-risk events for medical error but little is known about the professional, structural, and interpersonal factors that can affect the patient transition from emergency medical services (EMS) care to the emergency department (ED). We study EMS providers' perspectives to generate hypotheses to inform and improve this handoff.

Methods: We conducted focus groups with EMS providers recruited at 3 national and regional conferences from January to March 2011 until theme saturation was reached; 7 focus groups were conducted with 48 EMS providers.

Team effort: collaboration makes survival possible for thoracic injury patient.

Although most blunt aortic transection cases that present to the trauma bay have contained hematomas, this isn't always the case. This case illustrates the advancement of trauma care in the 21st century. Cases of free aortic rupture rarely end with such positive results.

Injury-adjusted mortality of patients transported by police following penetrating trauma.

Background: More than a decade ago, the city of Philadelphia began allowing police transport of penetrating trauma patients.

Objectives:   The objective was to determine the relation between prehospital mode of transport (police department [PD] vs. Philadelphia Fire Department (PFD) emergency medical services [EMS]) and survival in subjects with proximal penetrating trauma.

Effect of night vision goggles on performance of advanced life support skills by emergency personnel.

Night vision goggles (NVGs) are used by military personnel operating in low-light environments. It is not known whether NVGs can be used by medical personnel to provide emergency care under such conditions. This was a randomized controlled study to determine the effect of NVGs on the performance of intravenous line insertion (IVI) and endotracheal intubation (El) on training manikins.

Dealing with DIG. A comprehensive review of digoxin and its therapeutic and toxic effects.

Toxicity due to cardiac glycosides is a common and potentially life-threatening problem. Treatment of such toxicity presents unique challenges to the pre-hospital provider, because many of the tools commonly used to treat patients in the field may lead to disaster if inappropriately applied. But with better understanding of the mechanism of digitalis toxicity, prehospital providers can avoid pitfalls of treatment and render lifesaving care.

Outcome of travelers who refuse transport after emergency medical services evaluation at an international airport.

Objective: To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport.

Methods: This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information.

The utility of tympanic versus oral temperature measurements of firefighters in emergency incident rehabilitation operations.

Objectives: Emergency incident rehabilitation (EIR) is the process by which firefighters receive medical screening and monitoring as well as oral rehydration while on the scene of intense or extended fire or rescue operations. A crucial parameter in EIR medical monitoring is temperature determination because heat-related illnesses are common. The objective of this study was to compare the use of oral temperature versus infrared tympanic temperature determinations of firefighters in the outdoor environment of EIR operations.

Necessity of fire department response to the scene of motor vehicle crashes.

The purpose of this study was to identify how often fire department (FD) response to the scene of motor vehicle crashes (MVCs) is necessary for rescue and fire suppression. A retrospective review of MVCs between January 1, 1997 and December 13, 2000 occurring in a suburban municipality (population 79,000, 13 FDs) was conducted. Data abstracted included the total number of reported MVCs, MVCs with personal injury (PIAC), MVCs to which the FD responded, MVCs requiring any extrication, MVCs requiring extensive extrication, and MVCs requiring fire suppression.

Injuries from assaults on paramedics and firefighters in an urban emergency medical services system.

Objective: To determine the nature and frequency of injuries resulting from assaults on paramedics and firefighters in a large, fire department-based emergency medical services (EMS) system.

Methods: This was a descriptive study involving retrospective analysis of an occupational injury database. All injury reports involving assaults from 1996 to 1998 were reviewed.