Prehospital Traction Splint Use in Midthigh Trauma Patients.

Context: Traction splint (TS) use during emergency medical system transport has been theorized to relieve pain, limit continued injury from loose bone fragments, and decrease potential bleeding space in the injured thigh.

Aims: This study aimed to evaluate the benefit of prehospital TS (PTS) application, using data from the trauma registry at a large Level 1 trauma center.

Methods: A retrospective review of patients from the NTRACS and Trauma One registry at an American College of Surgeons-verified Level 1 trauma center was conducted.

Assessment of Physician Well-being, Part One: Burnout and Other Negative States.

Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting.

Teaching Methods Utilized During Medical Resuscitations in an Academic Emergency Department.

Introduction: One important skill that an emergency medicine trainee must learn is the resuscitation of the critically ill patient. There is research describing clinical teaching strategies used in the emergency department (ED), but less is known about specific methods employed during actual medical resuscitations. Our objective was to identify and describe the teaching methods used during medical resuscitations.

Needle Thoracostomy: Does Changing Needle Length and Location Change Patient Outcome?

Background: Needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma. The purpose of this study is to compare outcomes, efficacy, and complications after a change in policy related to NT in a four-county Emergency Medical Services (EMS) system with a catchment area of greater than 1.6 million people.

Needle Thoracostomy in the Prehospital Setting: A Retrospective Observational Study.

Background: The use of needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma; however, controversy surrounds its use. The purpose of this study is to compare outcomes, effectiveness, and complications of NT in an Emergency Medical Services (EMS) system that includes urban, rural, and wilderness environments.

Methods: This is a retrospective observational study of all patients who had NT performed in a four county EMS system with a catchment area of greater than 1.

Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study.

Unlabelled: Introduction The use of prehospital needle thoracostomy (NT) is controversial. Some studies support its use; however, concerns exist regarding misplacement, inappropriate patient selection, and iatrogenic injury. Even less is known about its efficacy in situations where there is a delay to definitive care.

Core content for wilderness medicine fellowship training of emergency medicine graduates.

Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships.

Where wilderness, medicine, technology, and religion collide.

We report a case of a man injured in Yosemite National Park (YNP) whose use of technology and refusal of medical care, based on his Christian Science religious beliefs, created multiple challenges to the providers working to rescue and care for him. This case illustrates how our increasingly diverse and complex world requires flexibility and openness to provide the optimal care, both in the wilderness and in the front country.

Improvised traction splints: a wilderness medicine tool or hindrance?

Objectives: To investigate whether a traction splint made from improvised materials is as efficacious as commercially available devices in terms of traction provided and perceived comfort and stability.

Methods: This was a prospective randomized crossover study utilizing 10 healthy, uninjured volunteers. The subjects were randomized to be placed in 4 different traction devices, in differing order, each for 30 minutes.

Motion sickness: comparison of metoclopramide and diphenhydramine to placebo.

Objectives: This is an evaluation of the efficacy of metoclopramide (MTCP) or diphenhydramine (DPH) to relieve symptoms of motion sickness in patients being transported via ambulance in a mountainous setting.

Methods: This is a prospective, randomized, double-blinded, placebo-controlled study of patients transported by ambulance in the Sierra Nevada mountains of Fresno County. Consenting patients who met the inclusion criteria were asked to rate their motion sickness every five minutes using a visual analog scale (VAS) during transport.

Lightning safety awareness of visitors in three California national parks.

Objective: To assess the level of lightning safety awareness among visitors at 3 national parks in the Sierra Nevada Mountains of California.

Methods: A 12-question, short answer convenience sample survey was administered to participants 18 years of age and over concerning popular trails and points of interest with known lightning activity. There were 6 identifying questions and 5 knowledge-based questions pertaining to lightning that were scored on a binary value of 0 or 1 for a total of 10 points for the survey instrument.

The effect of mandatory nurse ratios on patient care in an emergency department.

Background: In 2004, California enacted mandatory nurse-to-patient ratios in an effort to improve patient care.

Objectives: The aim of the study was to look at the association between nursing ratios and quality of care in an urban teaching Emergency Department (ED).

Methods: This was an observational study, looking at indicators of quality care before and after the introduction of nursing ratios in an urban California ED serving a mainly indigent population.

Antiemetics in the ED: a randomized controlled trial comparing 3 common agents.

We sought to compare the efficacy of 3 intravenous antiemetic medications in ED patients complaining of moderate to severe nausea. This randomized, placebo-controlled, double-blind trial compares 1.25 mg droperidol, 10 mg metoclopramide, 10 mg prochlorperazine, and saline placebo.

The incidence and treatment of prehospital motion sickness.

Objectives: The authors' objectives were: 1) to determine the incidence of motion sickness during ambulance transport on a mountainous route in healthy volunteers, and 2) to determine if droperidol alleviated the signs and symptoms of motion sickness in those volunteers who developed it.

Methods: This was a prospective, randomized, double-blind, placebo-controlled trial. Subjects were healthy volunteers over age 18 and not currently taking an antiemetic.