Program Evaluation of Cognitive Behavioral Therapy in Burn Survivors.

Mental health is a component of care that should be addressed for patients with burns while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within 2 business days of referral.

Community Paramedicine Intervention Reduces Hospital Readmission and Emergency Department Utilization for Patients with Cardiopulmonary Conditions.

Objective: Patients discharged from the hospital with diagnoses of myocardial infarction, congestive heart failure or acute exacerbation of chronic obstructive pulmonary disease (COPD) have high rates of readmission. We sought to quantify the impact of a community paramedicine (CP) intervention on hospital readmission and emergency department (ED) and clinic utilization for patients discharged with these conditions and to calculate the difference in healthcare costs.

Methods: This was a prospective, observational cohort study with a matched historical control.

Automated Versus Manual Cardiopulmonary Resuscitation in Flight: Are We Being Safe?

Objective: The primary purpose of this study was to compare the percentage of return of spontaneous circulation of in-flight cardiac arrest (IFCA) patients on admission to the emergency department (ED) who received in-flight standard cardiopulmonary resuscitation (s-CPR) versus automated cardiopulmonary resuscitation (a-CPR).

Setting: EMS helicopter (HEMS) service in Midwest USA.

Methods: This was a prospective, consecutive case series of adult patients who had IFCA of any cause managed with a-CPR between October 1, 2012, and February 8, 2016 (40 months), at a helicopter emergency medical service (HEMS) in the Midwestern United States.

The Use of Video Laryngoscopy Did Not Lead to Greater First-Pass or Overall Success Rates Compared to Direct Laryngoscopy in Pediatric Intubation in a Helicopter Emergency Medical Service.

Objective: We hypothesized that video laryngoscopy (VL) would significantly increase the first attempt and final success rates over direct laryngoscopy (DL) in helicopter emergency medical services.

Methods: This was a study of an emergency medical service in the Midwestern United States. Pediatric patients (age < 18 years) transported between January 1, 2010, and July 31, 2016, with an attempted intubation were identified.

Serum SNTF, a Surrogate Marker of Axonal Injury, Is Prognostic for Lasting Brain Dysfunction in Mild TBI Treated in the Emergency Department.

Mild traumatic brain injury (mTBI) causes persisting post-concussion syndrome for many patients without abnormalities on conventional neuroimaging. Currently, there is no method for identifying at-risk cases at an early stage for directing concussion management and treatment. SNTF is a calpain-derived N-terminal proteolytic fragment of spectrin (α-spectrin1-1176) generated in damaged axons following mTBI.

Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults.

Introduction: Blunt head trauma is a common cause of increased intracranial pressure (ICP). Ultrasound measurement of the optic nerve sheath diameter (OSND) is an accurate and non-invasive way to detect increased ICP. Blunt trauma patients are often immobilized in a rigid cervical spine collar.

Intraosseous Pressure Monitoring in Healthy Volunteers.

Study Objective: Invasively monitoring blood pressure through the IO device has not been thoroughly demonstrated. This study attempted to establish baseline values of IO pressure in a healthy human population.

Methods: This was a prospective, healthy volunteer, observational study.

The association of health status and providing consent to continued participation in an out-of-hospital cardiac arrest trial performed under exception from informed consent.

Objectives: Emergency medical research performed under federal regulation 21 § CFR 50.24 provides a means to protect human subjects and investigate novel time-sensitive treatments. Although prospective individual consent is not required for studies conducted under this regulation, consent from a legally authorized representative (LAR) or the patient at the earliest feasible opportunity is required to obtain short- and long-term outcome data.

Debunking three rape myths.

Background: Stereotypes and prejudicial misconceptions are prevalent regarding sexual assaults and victims' responses. These are collectively referred to as rape myths. This study examines three rape myths purporting that sexual assault victims (1) immediately report the crime, (2) experience severe physical and/or anogenital injuries, and (3) forcefully resist their assailant.

Evaluation of intraosseous pressure in a hypovolemic animal model.

Background: In emergent situations, access to the vascular bed is frequently required for fluid and medication administration. Central venous catheter placement is associated with risk and may slow resuscitation in the unstable patient. The purpose of this study was to determine whether intraosseous pressure (IOP) could be consistently recorded and how similar this pressure was to central venous and arterial pressure in a porcine hemorrhagic shock model.

Comparison of success rates between two video laryngoscope systems used in a prehospital clinical trial.

Objectives: The primary aims of this study were to compare paramedic success rates and complications of two different video laryngoscopes in a prehospital clinical study.

Methods: This study was a multi-agency, prospective, non-randomized, cross over clinical trial involving paramedics from four different EMS agencies. Following completion of training sessions, six Storz CMAC™ video laryngoscopes and six King Vision™ (KV) video laryngoscopes were divided between agencies and placed into service for 6 months.

Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device.

Background: A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD+ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD+ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology.

Methods: This is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial.

Supraglottic airway device use as a primary airway during rapid sequence intubation.

Introduction: This study compared first-attempt placement success rates of the King LTS-D as a primary airway for patients requiring medication-assisted airway management (MAAM) against historical controls.

Setting: Rotor-wing division of a single critical care transportation company

Methods: 53 providers (RNs/EMT-P) consented to participation and were trained in the use of the King LTS-D. All patients in need of MAAM per agency treatment guidelines were screened for inclusion and exclusion criteria.

Evaluation of the Storz CMAC®, Glidescope® GVL, AirTraq®, King LTS-D™, and direct laryngoscopy in a simulated difficult airway.

Objective: The aim of this study was to compare first-attempt and overall success rates and success rates in relation to placement time among 5 different airway management devices: Storz CMAC, Glidescope GVL, AirTraq, King LTS-D, and direct laryngoscopy (DL).

Methods: Emergency medical technician basic (EMT-B), EMT-paramedics (EMT-P), and emergency medicine residents and staff physicians placed each of the 5 devices in a random order into an AirSim (TruCorp, Belfast, UK) part-task training manikin. The difficult airway scenario was created by fixing the manikin head to a stationary object and introducing simulated emesis into the hypopharynx.

Comparison of prehospital insertion success rates and time to insertion between standard endotracheal intubation and a supraglottic airway.

Objective: To compare paramedic insertion success rates and time to insertion between standard ETI and a supraglottc airway device (King LTS-D™) in patients needing advanced airway management.

Methods: Between June 2008 and June 2009, consented paramedics from 4 EMS systems performed ETI or placed a King LTS-D according to a predetermined randomization calendar. Data collection occurred following each placement via telephone.

Neurodevelopmental effects of early deprivation in postinstitutionalized children.

The neurodevelopmental sequelae of early deprivation were examined by testing (N = 132) 8- and 9-year-old children who had endured prolonged versus brief institutionalized rearing or rearing in the natal family. Behavioral tasks included measures that permit inferences about underlying neural circuitry. Children raised in institutionalized settings showed neuropsychological deficits on tests of visual memory and attention, as well as visually mediated learning and inhibitory control.

Use of the King LTS-D during medication-assisted airway management.

Objective: This case series evaluated provider use of the King LTS-D as a primary airway in patients requiring rapid-sequence intubation (RSI).

Methods: Twenty-seven paramedics completed a one-hour training session on the use of the device. All patients meeting the service's standard criteria for medication-assisted airway management were included in the study.

Use of the pediatric EZ-IO needle by emergency medical services providers.

Objective: The aim of this study was to examine emergency medical services providers' use of a new intraosseous needle designed for pediatric patients.

Methods: This prospective pilot study was conducted between May 2006 and October 2007. After completing an initial training session, the EZ-IO PD was deployed for use on patients.

Developmental changes in hypothalamus-pituitary-adrenal activity over the transition to adolescence: normative changes and associations with puberty.

Home baseline and laboratory stressor (Trier Social Stress Test for Children) measures of salivary cortisol were obtained from 82 participants (40 girls) aged 9, 11, 13, and 15 years. Measures of pubertal development, self-reported stress, parent reports of child depressive symptoms and fearful temperament, and cardiac measures of sympathetic and parasympathetic activity were also obtained. Significant increases in the home cortisol baselines were found with age and pubertal development.

Moderate versus severe early life stress: associations with stress reactivity and regulation in 10-12-year-old children.

Early life stress (ELS) is expected to increase reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis; however, several recent studies have shown diminished cortisol reactivity among adults and children with ELS exposure. The goal of this study was to examine cortisol activity in 10-12-year-old internationally adopted children to determine if moderate and severe ELS have different impacts on the HPA axis. Salivary cortisol and two measures of autonomic activity were collected in response to the Trier Social Stress Test for Children (TSST-C).

Explicit memory performance in infants of diabetic mothers at 1 year of age.

The aim of the present research was to investigate the impact of abnormal fetal environment on explicit memory performance. Based on animal models, it was hypothesized that infants of diabetic mothers (IDMs) experience perturbations in memory performance due to exposure to multiple neurologic risk factors including: chronic hypoxia, hyperglycemia/reactive hypoglycemia, and iron deficiency. Memory performance, as measured by the elicited/deferred imitation paradigm, was compared between 13 IDMs (seven females, six males; mean age 365 days, SD 11) and 16 typically developing children (seven females, nine males; mean age 379 days, SD 9).

Iron deficiency alters auditory recognition memory in newborn infants of diabetic mothers.

Infants of diabetic mothers (IDMs) are at risk for perinatal brain iron deficiency that may target the developing hippocampus. The objective of this study was to evaluate hippocampally based recognition memory and infant development in IDMs with suspected brain iron deficiency (BID; cord ferritin 34 microg/L) using event-related potentials (ERPs). ERPs assessed neonatal auditory cortical responses to sounds and auditory recognition memory in response to the mother's voice compared with a stranger's voice.

Electrophysiologic evidence of impaired cross-modal recognition memory in 8-month-old infants of diabetic mothers.

Objectives: Previous studies have shown deficits in auditory and visual recognition memory in infants of diabetic mothers. The purpose of this study was to further investigate memory development in infants of diabetic mothers (IDMs) by evaluating cross-modal recognition memory followed by behavioral memory testing at 8 months of age.

Study Design: Cross-modal (tactile to vision) recognition memory was evaluated using event related potentials.

Influences of postconceptional age and postnatal experience on the development of auditory recognition memory in the newborn infant.

We evaluated the effects of postconceptional age and postnatal experience on the development of neonatal auditory recognition memory. Three groups were tested: a premature newborn group (tested at 35-38 weeks postconceptional age, < or = 1 week old), a full-term newborn group (tested at 39-42 weeks postconceptional age, < or = 1 week old), and a full-term experienced group (tested at 39-42 weeks postconceptional age, > 1 week old; range 8-30 days). Event-related potentials were collected while infants listened to the maternal voice alternating with a stranger's voice.