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First Responders (first + responder)

Distribution by Scientific Domains
Medical Sciences90%

Selected Abstracts

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

ACADEMIC EMERGENCY MEDICINE, Issue 4 2003
Craig B. Key MD
Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A before-and-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n= 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p = 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p < 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p < 0.0001). Among the 9-1-1 D/Cs with FRs only (n= 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents. [source]

Teaching Mass Casualty Triage Skills Using Immersive Three-dimensional Virtual Reality

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
Dale S. Vincent MD
Abstract Objectives:, Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Methods:, Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Results:, Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder. Conclusions:, Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience. [source]

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

ACADEMIC EMERGENCY MEDICINE, Issue 4 2003
Craig B. Key MD
Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A before-and-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n= 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p = 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p < 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p < 0.0001). Among the 9-1-1 D/Cs with FRs only (n= 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents. [source]

Methodological challenges in assessing general population reactions in the immediate aftermath of a terrorist attack

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue S2 2008
G. James Rubin
Abstract Assessing mental health needs following a disaster is important, particularly within high-risk groups such as first responders or individuals who found themselves directly caught up in the incident. Particularly following events involving widespread destruction, ingenuity and hard work are required to successfully study these issues. When considering responses among the general population following less devastating events such as a conventional terrorist attack, or following an event involving a chemical, biological, radiological or nuclear agent, other variables may become more relevant for determining the population's overall psychosocial well-being. Trust, perceived risk, sense of safety, willingness to take prophylaxis and unnecessary attendance at medical facilities will all be important in determining the overall psychological, medical, economic and political impact of such attacks. Assessing these variables can help government agencies and non-governmental organizations to adjust their communication and outreach efforts. As there is often a need to provide these data quickly, telephone surveys using short time-windows for data collection or which use quota samples are often required. It is unclear whether slower, more conventional and more expensive survey methods with better response rates would produce results different enough to these quicker and cheaper methods to have a major impact on any resulting policy decisions. This empirical question would benefit from further study. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Identifying the Gaps Between Biodefense Researchers, Public Health, and Clinical Practice in a Rural Community

THE JOURNAL OF RURAL HEALTH, Issue 3 2008
Jessica M. Van Fleet-Green BS
ABSTRACT:,Objective:It is essential for health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine how well biodefense and emerging infectious disease research information was being disseminated to rural health care providers, first responders, and public health officials. Methods: Semi-structured interviews were conducted at a federally funded research institution and a rural community in Washington state with 10 subjects, including researchers, community physicians and other health care providers, first responders, and public health officials. Results: The interviews suggest there is inadequate information dissemination regarding biodefense and emerging infectious disease research and an overall lack of preparedness for a bioterrorist event among rural clinicians and first responders. Additionally, a significant communication gap exists between public health and clinical practice regarding policies for bioterrorism and emerging infectious disease. There was, however, support and understanding for the research enterprise in bioterrorism. Conclusions: Biodefense preparedness and availability of information about emerging infectious diseases continues to be a problem. Methods for information dissemination and the relationships between public health officials and clinicians in rural communities need to be improved. [source]

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

ANAESTHESIA, Issue 12 2009
A. E. Blevin
Summary In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39,65 [8,149])) s than the facemask/airway (35 (25,53 [14,120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask/oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders. [source]

A comparative study of laws, rules, codes and other influences on nursing homes' disaster preparedness in the Gulf Coast states

BEHAVIORAL SCIENCES & THE LAW, Issue 5 2007
Professor Lisa M. Brown Ph.D.
In 2005, Hurricanes Katrina and Rita devastated several Gulf Coast states and caused many deaths. The hurricane- related deaths of 70 nursing home residents,34 believed drowned in St. Rita's Nursing Home in Louisiana and 36 from 12 other nursing homes,highlighted problems associated with poorly developed and executed disaster plans, uninformed evacuation decision-making, and generally inadequate response by providers and first responders (DHHS, 2006; Hyer, Brown, Berman, & Polivka-West, 2006). Such loss of human life perhaps could have been prevented and certainly lessened if, prior to the hurricanes, policies, regulations, and laws had been enacted, executable disaster guidelines been available, vendor contracts been honored, and sufficient planning taken place. This article discusses applicable federal and state laws and regulations that govern disaster preparedness with a particular focus on nursing homes. It highlights gaps in these laws and makes suggestions regarding future disaster planning. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Using Immersive Simulation for Training First Responders for Mass Casualty Incidents

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
William Wilkerson MD
Abstract Objectives:, A descriptive study was performed to better understand the possible utility of immersive virtual reality simulation for training first responders in a mass casualty event. Methods:, Utilizing a virtual reality cave automatic virtual environment (CAVE) and high-fidelity human patient simulator (HPS), a group of experts modeled a football stadium that experienced a terrorist explosion during a football game. Avatars (virtual patients) were developed by expert consensus that demonstrated a spectrum of injuries ranging from death to minor lacerations. A group of paramedics was assessed by observation for decisions made and action taken. A critical action checklist was created and used for direct observation and viewing videotaped recordings. Results:, Of the 12 participants, only 35.7% identified the type of incident they encountered. None identified a secondary device that was easily visible. All participants were enthusiastic about the simulation and provided valuable comments and insights. Conclusions:, Learner feedback and expert performance review suggests that immersive training in a virtual environment has the potential to be a powerful tool to train first responders for high-acuity, low-frequency events, such as a terrorist attack. [source]

The Effectiveness and Cost Effectiveness of Public-Access Defibrillation

CLINICAL CARDIOLOGY, Issue 7 2010
Roger A. Winkle MD
Many sudden cardiac deaths are due to ventricular fibrillation (VF). The use of defibrillators in hospitals or by outpatient emergency medical services (EMS) personnel can save many cardiac-arrest victims. Automated external defibrillators (AEDs) permit defibrillation by trained first responders and laypersons. AEDs are available at most public venues, and vast sums of money are spent installing and maintaining these devices. AEDs have been evaluated in a variety of public and private settings. AEDs accurately identify malignant ventricular tachyarrhythmias and frequently result in successful defibrillation. Prompt application of an AED shows a greater number of patients in VF compared with initial rhythms documented by later-arriving EMS personnel. Survival is greatest when the AED is placed within 3 to 5 minutes of a witnessed collapse. Community-based studies show increased cardiac-arrest survival when first responders are equipped with AEDs rather than waiting for paramedics to defibrillate. Wide dissemination of AEDs throughout a community increases survival from cardiac arrest when the AED is used; however, the AEDs are utilized in a very small percentage of all out-of-hospital cardiac arrests. AEDs save very few lives in residential units such as private homes or apartment complexes. AEDs are cost effective at sites where there is a high density of both potential victims and resuscitators. Placement at golf courses, health clubs, and similar venues is not cost effective; however, the visible devices are good for public awareness of the problem of sudden cardiac death and provide reassurance to patrons. Copyright © 2010 Wiley Periodicals, Inc. [source]