Early Neurologic Recovery, Practice Pattern Variation, and the Risk of Endotracheal Intubation Following Established Status Epilepticus.

Objective: To quantify the association between early neurologic recovery, practice pattern variation, and endotracheal intubation during established status epilepticus, we performed a secondary analysis within the cohort of patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).

Methods: We evaluated factors associated with the endpoint of endotracheal intubation occurring within 120 minutes of ESETT study drug initiation. We defined a blocked, stepwise multivariate regression, examining 4 phases during status epilepticus management: (1) baseline characteristics, (2) acute treatment, (3) 20-minute neurologic recovery, and (4) 60-minute recovery, including seizure cessation and improving responsiveness.

Performance Standards of Comprehensive Airway Management for Emergency Medicine Residents.

Background: The Emergency Medicine (EM) Milestone Project provides guidance for assessment of resident trainee airway management proficiency (PC10). Although milestones provide a general structure for assessment, they do not define performance standards. The objective of this project was to establish comprehensive airway management performance standards for EM trainees at both novice and mastery levels of proficiency.

A Randomized Comparison of In-hospital Rescuer Positions for Endotracheal Intubation in a Difficult Airway.

Introduction: Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited.

CALM Interventions: Behavioral Health Crisis Assessment, Linkage, and Management Improve Patient Care.

Emergency departments (EDs) have seen rising numbers of patients in psychiatric crises, patient boarding, and throughput delays. This study describes and evaluates the impact of a Crisis Assessment Linkage and Management (CALM) service designed to manage behavioral health crises. A year-to-year comparison was performed before (n = 2211 ED visits) and after implementation of CALM (n = 2387).

Airway Management Proficiency Checklist for Assessing Paramedic Performance.

Objective: To develop and derive an instrument for assessing airway management proficiency for paramedics.

Methods: Using a validated difficult airway model simulation, we recorded responses to a standard traumatic brain injury scenario requiring airway management in 197 certified paramedics. Discrete items (N = 131) were developed by an expert panel, and referenced to three performance standard subscales (i.

Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation.

Unlabelled: Introduction Endotracheal intubation (ETI) is a complex clinical skill complicated by the inherent challenge of providing care in the prehospital setting. Literature reports a low success rate of prehospital ETI attempts, partly due to the care environment and partly to the lack of consistent standardized training opportunities of prehospital providers in ETI. Hypothesis/Problem The availability of a mobile simulation laboratory (MSL) to study clinically critical interventions is needed in the prehospital setting to enhance instruction and maintain proficiency.

Improving Outcomes in Patients With Sepsis.

Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period.

Effect of prior cardiopulmonary resuscitation knowledge on compression performance by hospital providers.

Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest.

Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin.

Immediate and 1-year chest compression quality: effect of instantaneous feedback in simulated cardiac arrest.

Introduction: Several studies have demonstrated subpar chest compression (CC) performance by trained health care professionals. The objective of this study was to determine the immediate and sustained effect of instantaneous audiovisual feedback on CC quality.

Methods: A prospective, randomized, crossover study measuring the effect of audiovisual feedback training on the performance of CCs by health care providers and medical students in a simulated cardiopulmonary arrest scenario was performed.

Computer simulation as a tool for assessing decision-making in pandemic influenza response training.

Introduction: We sought to develop and test a computer-based, interactive simulation of a hypothetical pandemic influenza outbreak. Fidelity was enhanced with integrated video and branching decision trees, built upon the 2007 federal planning assumptions. We conducted a before-and-after study of the simulation effectiveness to assess the simulations' ability to assess participants' beliefs regarding their own hospitals' mass casualty incident preparedness.

Multimedia education increases elder knowledge of emergency department care.

Introduction: Elders who utilize the emergency department (ED) may have little prospective knowledge of appropriate expectations during an ED encounter. Improving elder orientation to ED expectations is important for satisfaction and health education. The purpose of this study was to evaluate a multi-media education intervention as a method for informing independently living elders about ED care.

Hospital-based coalition to improve regional surge capacity.

Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response.

Rural Embedded Assistants for Community Health (REACH) network: first-person accounts in a community-university partnership.

Community research and action projects undertaken by community-university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community-university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network.

Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements.

Study Objective: Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences.

Developing consensus on appropriate standards of disaster care for children.

Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.

Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process.

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 1: rationale and methodology for the impedance threshold device (ITD) protocol.

Aim: The primary aim of this study is to compare survival to hospital discharge with a modified Rankin score (MRS)< or =3 between standard cardiopulmonary resuscitation (CPR) plus an active impedance threshold device (ITD) versus standard CPR plus a sham ITD in patients with out-of-hospital cardiac arrest. Secondary aims are to compare functional status and depression at discharge and at 3 and 6 months post-discharge in survivors.

Design: Prospective, double-blind, randomized, controlled, clinical trial.

Two patients subdued with a TASER® device: cases and review of complications.

In the United States, an increasing number of law enforcement agencies have employed the use of TASER® (TASER International Inc., Scottsdale, AZ) devices to temporarily immobilize violent subjects. There are reports in the lay press of adverse outcomes occurring in patients on whom TASER® devices have been deployed.

Agroterrorism: where are we in the ongoing war on terrorism?

The U.S. agricultural infrastructure is one of the most productive and efficient food-producing systems in the world.

Research methods of inquiry.

Incidents of significant consequence that create surge may require special research methods to provide reliable, generalizable results. This report was constructed through a process of literature review, expert panel discussion at the journal's consensus conference, and iterative development. Traditional clinical research methods that are well accepted in medicine are exceptionally difficult to use for surge incidents because the incidents are very difficult to reliably predict, the consequences vary widely, human behaviors are heterogeneous in response to incidents, and temporal conditions prioritize limited resources to response, rather than data collection.

Available ventilation monitoring methods during pre-hospital cardiopulmonary resuscitation.

High quality cardiopulmonary resuscitation (CPR) in the pre-hospital setting has been associated with improved survival rates during cardiopulmonary arrest (CPA). Recent documentation of hyperventilation associated deterioration in hemodynamics during CPR, suggests that guided or controlled ventilation strategies may contribute to improved hemodynamics and increased survival. This article briefly reviews the mechanical methods, advantages, and disadvantages of the available ventilation monitoring methods currently available for clinical use, with an emphasis on pre-hospital implementation.

Adverse events associated with lay emergency response programs: the public access defibrillation trial experience.

Unlabelled: The adverse event (AE) profile of lay volunteer CPR and public access defibrillation (PAD) programs is unknown. We undertook to investigate the frequency, severity, and type of AE's occurring in widespread PAD implementation.

Design: A randomized-controlled clinical trial.

Relationship between knowledge of cardiopulmonary resuscitation guidelines and performance.

Objective: Despite widespread training with CPR guidelines, CPR is often poorly performed. We explore relationships between knowledge of CPR guidelines and performance (compression rate, compression depth, compression to ventilation ratio, and ventilation volume).

Methods: Sixty professional EMTs were sampled at 26 randomly ordered EMS response stations from an urban system of 31 stations.

First do no harm: managing antihistamine impairment in patients with allergic rhinitis.

Antihistamines are effective medications that have been used for decades in the management of allergic rhinitis; however, they may be administered or selected in an inappropriate fashion and may be the source of drug-related morbidity. Our objective is to present relevant background information and an expert consensus statement on the use of antihistamines in treatment of allergic rhinitis. In July 2002, 14 experts in allergy, clinical immunology, pharmacology, and impairment assessment were invited to participate in a roundtable conference to present current concepts and develop a consensus statement on the clinical management of allergic rhinitis with antihistamines.

Future challenges in preparing for and responding to bioterrorism events.

The future success of our preparations for bioterrorism depends on many issues as presented in this article. If these issues are properly addressed, the resulting improvements in bioterrorism preparations will allow us to better deter and mitigate a bioterrorism incident and will also provide us with the added benefit of improvements in early detection, diagnosis, and treatment of natural disease outbreaks. Emergency physicians must take an active leading role in working with the various disciplines to produce a better-prepared community.