Implementation of an EMS-based naloxone distribution program: A qualitative evaluation.

Objectives: We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD).

Impact of drone-specific dispatch instructions on the safety and efficacy of drone-delivered emergency medical treatments: A randomized simulation pilot study.

Introduction: Medical drones have potential for improving the response times to out-of-hospital emergencies. However, widespread adoption is hindered by unanswered questions surrounding medical dispatch and bystander safety. This study evaluated the impact of novel drone-specific dispatch instructions (DSDI) on bystanders' ability to interact effectively with a medical drone and provide prompt, safe, and high-quality treatment in a simulated emergency scenario.

Bystander interaction with a novel multipurpose medical drone: A simulation trial.

Intro: Medical drones are an emerging technology which may facilitate rapid treatment in time-sensitive emergencies. However, drones rely on lay rescuers, whose interactions with multipurpose medical drones have not been studied, and the optimal drone design remains unclear.

Methods: We conducted 24 simulations of adult out-of-hospital cardiac arrest (OHCA) and pediatric anaphylaxis with a prototype drone equipped with spoken and visual cues and a multipurpose medical kit.

Curvilinear walking elevates fall risk and modulates slip and compensatory step attributes after unconstrained human slips.

While much attention has been paid to understanding slip-related falls in humans, little has been focused on curvilinear paths despite their prevalence, distinct biomechanical demands and increased slipping threat. We determined the mechanics, compensatory stepping reactions and fall risk associated with slips during fixed-speed walking across ranges of path curvature, slipped foot and slip onset phase contexts possible in the community, which builds upon previous work by examining speed-independent effects of curvilinear walking. Twenty-one participants experienced 15 unconstrained slips induced by a wearable friction-reducing device as motion capture and harness load cell data were recorded.

Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders.

Background Of the more than 250 000 emergency medical services-treated out-of-hospital cardiac arrests that occur each year in the United States, only about 8% survive to hospital discharge with good neurologic function. Treatment for out-of-hospital cardiac arrest involves a system of care that includes complex interactions among multiple stakeholders. Understanding the factors inhibiting optimal care is fundamental to improving outcomes.

Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study.

Introduction: Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR.

Objective: We examined the barriers to initiation of T-CPR.

Treating Prehospital Pain in Children: A Retrospective Chart Review Comparing the Safety and Efficacy of Prehospital Pediatric Ketamine and Opioid Analgesia.

Prior to 2020, pain management in the Washtenaw/Livingston County Medical Control Authority (W/L MCA) Emergency Medical Service (EMS) system in Southeast Michigan was limited to morphine, fentanyl, ketorolac, and acetaminophen. Based on the increasing evidence describing its safety and efficacy, ketamine was added to local protocols for pain management. This study aimed to evaluate differences in pain management and adverse effects of ketamine and opioid administration.

Current summary of the evidence in drone-based emergency medical services care.

Interventions for many medical emergencies including cardiac arrests, strokes, drug overdoses, seizures, and trauma, are critically time-dependent, with faster intervention leading to improved patient outcomes. Consequently, a major focus of emergency medical services (EMS) systems and prehospital medicine has been improving the time until medical intervention in these time-sensitive emergencies, often by reducing the time required to deliver critical medical supplies to the scene of the emergency. Medical indications for using unmanned aerial vehicles, or drones, are rapidly expanding, including the delivery of time-sensitive medical supplies.

Slipping mechanics during walking along curved paths depend on the biomechanical context at slip onset.

Curvilinear walking is common, causing limb- and radius-dependent asymmetries that distinguish it from straight walking and elevated friction demands that increase slip-and-fall risk. However, it is unclear how aspects of curvilinear walking influence the slip perturbations experienced. We cross-sectionally examined how three biomechanical slip contexts (slip onset phase, slipped foot relative to the path, path radius) influence slip direction, distance, and peak velocity.

Severity of Unconstrained Simultaneous Bilateral Slips: The Impact of Frontal Plane Feet Velocities Relative to the Center of Mass to Classify Slip-Related Falls and Recoveries.

Targeted interventions to prevent slip-related falls may be informed by specific kinematic factors measured during the reactive response that accurately discriminate recoveries from falls. But reactive responses to diverse slipping conditions during unconstrained simultaneous bilateral slips, which are closely related to real-world slips, are currently unknown. It is challenging to identify these critical kinematic factors due to the wide variety of upper and lower body postural deviations that occur following the slip, which affect stability in both the sagittal and frontal planes.

Comparison of 3D printed anatomical model qualities in acetabular fracture representation.

Background: Acetabular fractures account for 10% of pelvis injuries, which are especially difficult to treat in developing countries with less access to resources. 3D printing has previously been shown to be a beneficial method of surgical planning, however the steep initial costs associated with purchasing a 3D printer may prevent some facilities form utilizing this technique. The purpose of this study was to develop 3D printed models for acetabular surgery using methodologies of varying cost to determine differences in model accuracy and overall quality.

Assessment of telecommunicator cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest using a standardized tool for audio review.

Objective: Telecommunicator cardiopulmonary resuscitation (T-CPR) is a critical component of optimized out-of-hospital cardiac arrest (OHCA) care. We assessed a pilot tool to capture American Heart Association (AHA) T-CPR measures and T-CPR coaching by telecommunicators using audio review.

Methods: Using a pilot tool, we conducted a retrospective review of 911 call audio from 65 emergency medical services-treated out-of-hospital cardiac arrest (OHCA) patients.

Novel Negative Pressure Procedural Tent Reduces Aerosolized Particles in a Simulated Prehospital Setting.

Background/objective: The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.

Novel Negative Pressure Helmet Reduces Aerosolized Particles in a Simulated Prehospital Setting.

Background/objective: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.

Outdoor walking exhibits peak ankle and knee flexion differences compared to fixed and adaptive-speed treadmills in older adults.

Background: Walking mechanics recorded with a traditional treadmill may not be the same as the mechanics exhibited during activities of daily living due to constrained walking speeds. Adaptive-speed treadmills allow for unconstrained walking speeds similar to outdoor walking. The aim of this study was to determine differences in kinematic walking parameters of older adults between adaptive-speed treadmill (AST), fixed-speed treadmill (FST) and outdoor walking.

Acrobatic squirrels learn to leap and land on tree branches without falling.

Arboreal animals often leap through complex canopies to travel and avoid predators. Their success at making split-second, potentially life-threatening decisions of biomechanical capability depends on their skillful use of acrobatic maneuvers and learning from past efforts. Here, we found that free-ranging fox squirrels () leaping across unfamiliar, simulated branches decided where to launch by balancing a trade-off between gap distance and branch-bending compliance.

Unconstrained slip mechanics and stepping reactions depend on slip onset timing.

Slips can occur at any time during stance. Accordingly, time-dependent tangential ground reaction forces likely produce a diverse range of slipping foot mechanics when traction is lost, thus requiring flexible recovery strategies to prevent falls. However, previous research has focused on slip onset in early stance, often with experimental anteroposterior constraints on the slipping foot, despite the diversity of environmental slips and falls.

A novel wearable device to deliver unconstrained, unpredictable slip perturbations during gait.

Background: Task-specific perturbation training is a widely studied means of fall prevention, utilizing techniques that induce slips or slip-like perturbations during gait. Though effective, these methods only simulate narrow ranges within the larger space of possible slipping conditions encountered in daily life. Here we describe and test a novel, wearable apparatus designed to address these limitations and simulate a diverse range of slipping disturbances.

Comparing single and multi-joint methods to detect knee joint proprioception deficits post primary unilateral total knee arthroplasty.

Background: The use of various single-joint proprioception measurements has resulted in contradictory findings after knee arthroplasty. The use of balance as a surrogate measure to assess knee proprioception post-operation has resulted in further confusion. The aim of this study was to measure single joint knee proprioception in participants after unilateral knee arthroplasty, and compares it to multi-joint balance.

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking.

A U-shaped relationship between cognitive demand and gait control may exist in dual-task situations, reflecting opposing effects of external focus of attention and attentional resource competition. The purpose of the study was twofold: to examine whether gait control, as evaluated from step-to-step variability, is related to cognitive task difficulty in a U-shaped manner and to determine whether age modifies this relationship. Young and older adults walked on a treadmill without attentional requirement and while performing a dichotic listening task under three attention conditions: non-forced (NF), forced-right (FR), and forced-left (FL).

The influence of auditory-motor coupling on fractal dynamics in human gait.

Humans exhibit an innate ability to synchronize their movements to music. The field of gait rehabilitation has sought to capitalize on this phenomenon by invoking patients to walk in time to rhythmic auditory cues with a view to improving pathological gait. However, the temporal structure of the auditory cue, and hence the temporal structure of the target behavior has not been sufficiently explored.

The appropriate use of approximate entropy and sample entropy with short data sets.

Approximate entropy (ApEn) and sample entropy (SampEn) are mathematical algorithms created to measure the repeatability or predictability within a time series. Both algorithms are extremely sensitive to their input parameters: m (length of the data segment being compared), r (similarity criterion), and N (length of data). There is no established consensus on parameter selection in short data sets, especially for biological data.