Automatic Crash Notification’s Role in Triage

The optimal way to reduce the consequences of injuries is to prevent them. When injuries do occur, however, EMS providers must transport patients to the most appropriate health-care facility for the management of their injuries. Determining the destination facility can have a profound effect on the patient’s morbidity and mortality.

Determining the best destination hospital for an injured patient in an appropriate time frame (“right patient, right place and right time”) is the primary goal of successful field triage. This is also an area in which vehicle telematics and Advanced Automatic Collision Notification (AACN) can play a significant role.

Automatic Notification
Vehicle telematics is the integration of wireless communication into a vehicle’s electrical architecture, which allows a vehicle and its occupants to interact and communicate with other vehicles, the road, public safety answering points (PSAPs) or telematics service provider call centers. A component of vehicular telematics, AACN, is the successor to Automatic Crash Notification (ACN) and is found in an increasing number of motor vehicles.

When a vehicle’s AACN system detects a crash (as determined by vehicle sensors, airbag deployment or seatbelt pretensioners), either an urgent message is directly relayed to the local PSAP or the vehicle’s Global Positioning System (GPS) location and crash-related data—change in velocity (delta-V), principal direction of force, airbag deployment, multiple collisions and rollover determination—are automatically sent by emergency wireless call to a telematics service provider.

These methods allow injured occupants to communicate in real-time with PSAPs or the telematic service provider emergency call centers without having to initiate the call.

With a wide range of vehicle manufacturers and telematics service providers transmitting AACN information, collaboration is essential to ensure standardization. Continued cooperation is critical to ensure consistent information is being transmitted to emergency care systems and personnel. Further study, including pilot projects and research, is necessary as AACN continues its integration in our nation’s vehicles.

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References:

Bob Bailey, MA, Scott Sasser, MD, FACEP "Automatic Crash Notification’s Role in Triage - How Advanced Automatic Collision Notification can assist in the early response, triage & care of injured patients" Originally Posted: 01/01/2011 Full Article Available Online: http://www.jems.com/article/trauma-patients/automatic-crash-notification-s 

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Related Links:

• A copy of the Field Triage Decision Scheme accompanies this month’s JEMS. Also, it and the Advanced Automatic Collision Notification protocol are at www.jems.com/crashsensors

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Measurement and Feedback Tools - Monitoring CPR Quality in Real Time

Sudden cardiac arrest (SCA) continues to be a leading cause of death in the United States, claiming the lives of more than 300,000 people each year, with half of those cases occurring out of hospital. Despite advancements in defibrillation equipment and increased attention on CPR, only 5–10% of SCA victims leave the hospital alive. These bleak statistics illustrate the urgency for improving and implementing the chain of survival in order to increase the rate of survival to hospital discharge for cardiac arrest patients. The good news: Over the past few years, we have begun to see real improvements in survival rates in many communities.

Following SCA recognition and bystander assistance, EMS arrival and assumption of care becomes the most critical link in sustaining the life of a cardiac arrest victim. It cannot be overemphasized that high-quality CPR performance is essential for successful resuscitation.

In an attempt to improve performance, CPR measurement and feedback systems, such as the Philips HeartStart MRx with Q-CPR*, monitor performance and provide real-time feedback to the caregiver. Such devices measure compression rate, depth and ventilation characteristics in order to ensure high-quality CPR performance during an actual cardiac arrest. Recent studies in both EMS and hospital care have shown improved rates of pulse restoration with the use of these devices.

As CPR quality initiatives continue to grow, the practice of using real-time measurement and feedback during the resuscitation, combined with regular debriefing sessions using the data captured during patient events, has shown promising early results. Research has shown that debriefing with data obtained from measurement and feedback tools can increase subsequent CPR performance and improve outcomes from in-hospital SCA.

Strengthening the links within the cardiac chain of survival has the potential to significantly improve outcomes of cardiac arrest victims. SCA survival statistics demonstrate how detrimental a weakness can be in any one of the critical links involved in this sequence.


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References:

Benjamin S. Abella, MD, MPhil and Emily C. Esposito, BA "Strengthening the Chain of Survival Incorporating real-time quality measures improves cardiac arrest outcomes" Posted: 09/30/2009 Full Article Available Online: http://www.jems.com/article/patient-care/strengthening-chain-survival

*Q-CPR is a registered trademark of Laerdal Medical

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Advancing quality and access to emergency care in remote locations - South Tyrol, Italy

The Weisses Kreuz provides special training for a group of paramedics, nurses, and physicians to have this group better prepared to operate under extreme weather conditions that from time to time occur in the high Alps. The top paramedics undergo the following program:

• 260 hours of theoretical training
• A minimum 160 hours of practical training
• Annual refresher training and recertification within specific disciplines

To enable continuous skill improvement and to ensure safe and optimal patient care, Weisses Kreuz introduced Q-CPR (quality CPR); a concept that, via sensors placed onto the patient’s chest, provides Italian Resuscitation Council compliant feedback on the quality of compressions delivered during resuscitation. Thanks to this new technology, Weisses Kreuz is now able to ensure quality treatment within yet another field.

Projects aiming to increase chance of survival

In addition to providing EMS to the local population of South-Tyrol, Weisses Kreuz is also concerned with the millions of tourists who visit the area every year. A sincere ambition to promote safety and improve clinical outcomes spurred the organization to launch the following project:

• Dissemination of CPR training in the population and
• Dissemination of First Aid knowledge

A minimum of 4000 school children will annually be using the self-directed MiniAnne/CPRAnytime program to learn and practice CPR. This endeavour will be followed up with research conducted by Professor Uwe Kreimeier, MD; Associate professor at the University of Munich Hospital, and his team.
                       
To encourage more people in the general population to gain First Aid knowledge, Weisses Kreuz introduced a free-of-charge smart First Aid guide for the iPhone and/or iPod Touch. The application, also compatible with other smart-phones, comes in German, Italian and English. So far the application has been downloaded more than 250 000 times worldwide.

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References:

Weisses Kreuz EMS, South Tyrol, Italy "Advancing quality and access to emergency care in remote locations" Full article available online: http://www.laerdal.com/UserStories/43276803/Advancing-quality-and-access-to-emergency-care-in-remote-locations

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Manikins and on-the-fly scenarios help emergency responders meet increased demands for services

National EMS Academy (NEMSA), Louisiana, USA:

At the National EMS Academy (NEMSA), classes accommodate learners’ work schedules and accelerated paramedics attend training paid sessions. “We got together with the business and academic communities and identified a chronic need for paramedics and basic-EMT workers,” said Director Gifford Saravia. “Now, 175-200 students start each semester and within four months, those who complete basic-EMT training can work full time while continuing their paramedic training. In a typical college setting, you complete core courses, then specialize; we reversed that model.”

During Hurricane Katrina, Saravia assisted with evacuations and rescue operations. “It was eye-opening, a huge undertaking.” Not surprisingly, NEMSA favors on-the-fly scenarios. “As a medic, you have to be prepared for anything, and we rely heavily on simulation so students can make – and learn from – their mistakes. Most EMT training programs use simulation these days; those that don’t are missing a huge opportunity.”

“With students and instructors scattered all over Louisiana, our jobs are made a lot easier because of Laerdal technology,” Saravia said. “Our mass casualty incidents (MCI) and trauma simulations are where the rubber really meets the road.” Twice yearly, 40-50 paramedic students come to Lafayette where basic-EMT students and manikins are patients for plane crashes, school shootings or vehicle crashes into a crowd. “We bring in helicopters, fire and police departments, and the media for interagency activity. Students enjoy it – and learn – because it gives them a sense of scale and added realism.”


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References:

National EMS Academy (NEMSA), Louisiana, USA "Manikins and on-the-fly scenarios help emergency responders meet increased demands for services" Available Online: http://www.laerdal.com/us/UserStories/48061987/Manikins-and-on-the-fly-scenarios-help-emergency-responders-meet-increased-demands

 

Are you prepared...to respond?

Shelter in Place

Shelter In Place (SIP) is an immediate response to a critical incident to reduce public exposure. The order to "Shelter-In-Place" may come at any time from local emergency services. Proper pre-planning and practice is the only way to ensure your workplace, institution, or home is prepared in the event Shelter-In-Place is required.

Shelter in place is an alternative to evacuation when:

* There is not enough time to safely evacuate the public at risk
* Residents are waiting for evacuation assistance
* There is a chemical release of limited duration (e.g. a release of sour gas due to a pipeline rupture)
* The public would be at higher risk if evacuated

If you are advised to shelter in place, listen to the radio and/or watch the television for instructions from emergency officials.

In a building with a Shelter-in-Place team, follow the instructions of the team members.

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The Importance of Mass Casualty Incident Preparedness

By definition, an MCI is one where there are more casualties than responders. It can be the results of a traffic accident, an act of nature or a man-made catastrophe. No matter how it is caused, it is an unplanned event that requires an immediate and accurate response.

A first responder can be anyone from a by-stander to a trained professional who is able to immediately plug into the MCI cycle and take action.

Knowing and understanding the MCI cycle and what the expectations are at each component helps keep continuity in the response actions, especially as more help arrives and takes up their roles in the incident.

Being prepared in the event of a MCI is your first step in mitigating the human suffering and event process. Rescue Training Institute offers a comprehensive MCI Awareness course that is designed to develop a first responder's skills in each of the components of the MCI so that they and those who follow can plug into the cycle and expedite the scene.

Remember, the Pine Lake Tornado was an unplanned event, the summer floods in southern Alberta were an unplanned event, the next MCI will be an unplanned event too. It's not about the event, its the response that counts.

Are you prepared... to respond?

Wednesday, November 3, 2010

Emergency manager calls for adding Facebook and Twitter to NIMS practices

Last March, Rhode Island experienced record flooding that at one point closed nearly 100 roads and 20 bridges. The state Department of Transportation used its RIDOT website, as well as social media like Facebook and Twitter, to keep the public advised of new closures.

"On a typical day, the RIDOT site sees about 2,100 hits," said RIDOT spokesperson Dana Nolfe. "At the height of the flooding, we saw 84,000 hits." Twitter followers jumped from double digits to 1,150.

In Texas, the use of Facebook and Twitter by the Plano Department of Emergency Management allows that city to push information to local communities instantly.

"Rather than posting information to a website and hoping citizens look at it, we can engage them online where they are," said Hal Grieb, senior emergency management specialist.

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References: Homeland1. 2010. "Social media have become the elephant in the EOC" Doug Page
Posted: October 28, 2010
Available At: http://www.homeland1.com/Emergency-Management-Operations/articles/901421-Social-media-have-become-the-elephant-in-the-EOC