Facial burns and inhalation injury

Abstract The chapter provides an overview of the challenges facing the emergency physician dealing with a patient who is involved in a fire and may have facial burns and a potential airway problem. The chapter highlights the potential pitfalls in diagnosis of a potential airway burn. It examines the evidence base for three clinical questions: who in a suspected inhalational injury requires intubation;which patients should a cyanide antidote be administered to; and which antidote should be used. The third clinical question discusses which patients with suspected carbon-monoxide poisoning require hyperbaric oxygen therapy.Fluid recommendations and inhalational therapies are discussed.</jats:p

Outcome measures, predictive performance and impact of prehospital dispatch triage algorithms to trauma – a scoping review protocol

The aim of this scoping review is to gather together studies that seek to improve the accuracy of dispatch system to allocate appropriate resources to the injured patients, whether computer-aided dispatch, staff-lead phone call systems, non-computer aided (e.g. flip-card) systems. This includes the identification of patients at high or low risk of adverse outcomes either in the prehospital phase on after arrival at hospital. These studies will then be evaluated with in clinical prediction rule framework

Critical appraisal for FCEM /

The ability to read a paper, judge its quality, the importance of its results, and make a decision about whether to change practice based on the information given, is a core skill for all doctors. To be able to do this quickly and efficiently is, without a doubt, a skill needed by all time-pressured emergency doctors and one which is tested in the Fellowship of the College of Emergency Medicine (FCEM) examination

Spatial analysis of HEMS prehospital incidents

Miller, M., Delroy-Buelles, I., Bootland, D. et al. A Spatial Analysis of Incident Location and Prehospital Mortality for Two United Kingdom Helicopter Emergency Medical Services (HEMS). Appl. Spatial Analysis 13, 575–590 (2020). https://doi.org/10.1007/s12061-019-09318-2 Most trauma and out of hospital cardiac arrest (OHCA) deaths occur prior to arrival at hospital, with increased risk for rural compared to urban patients. Essex and Hertfordshire Air Ambulance Trust (EHAAT) and Kent Surrey Sussex Air Ambulance Trust (KSS) provide a physician-paramedic Helicopter Emergency Medical Service (HEMS) in two regions of the United Kingdom. We investigated whether an association exists between prehospital mortality and distance from care in HEMS patients. We performed a retrospective study using spatial statistics to investigate the geographic distribution of scene outcome (alive versus deceased). We also performed multiple logistic regression of outcome against quartiles of distance from base to scene and a relative risk (RR) estimation over the operational areas. Organisations were analysed separately to assess consistency of spatial relationships. 2680 EHAAT and 4213 KSS patients met the inclusion criteria. Ripley’s K and Cross K functions indicated that outcomes (death and leaving the scene alive) cluster together. For KSS distance was not associated with outcome, for EHAAT distance was a significant predictor of mortality at furthest distance (41 to 95 km; OR 5.82, 95%CI 1.63 to 37.18, p = 0.019). Only one area of KSS and no areas of EHAAT had an increased RR of mortality. In contrast to previous research of pre-hospital patients, we found little evidence of geographic difference in scene outcome for trauma patients attended by the two HEMS services. Increased mortality risk for OHCA at the furthest distance from helicopter base was found in one organisation; a single area of increased RR of mortality was found for the other organisation

Outcome measures, predictive performance and impact of prehospital dispatch triage algorithms to trauma – a scoping review protocol

published at: Miller, M., Bootland, D., Jorm, L., and Gallego, B. Improving ambulance dispatch triage to trauma: A scoping review using the framework of development and evaluation of clinical prediction rules. Injury 53 (2022) 1746–55. doi:10.1016/j.injury.2022.03.02

Spatial analysis of HEMS prehospital incidents

Miller, M., Delroy-Buelles, I., Bootland, D. et al. A Spatial Analysis of Incident Location and Prehospital Mortality for Two United Kingdom Helicopter Emergency Medical Services (HEMS). Appl. Spatial Analysis 13, 575–590 (2020). https://doi.org/10.1007/s12061-019-09318-2 Most trauma and out of hospital cardiac arrest (OHCA) deaths occur prior to arrival at hospital, with increased risk for rural compared to urban patients. Essex and Hertfordshire Air Ambulance Trust (EHAAT) and Kent Surrey Sussex Air Ambulance Trust (KSS) provide a physician-paramedic Helicopter Emergency Medical Service (HEMS) in two regions of the United Kingdom. We investigated whether an association exists between prehospital mortality and distance from care in HEMS patients. We performed a retrospective study using spatial statistics to investigate the geographic distribution of scene outcome (alive versus deceased). We also performed multiple logistic regression of outcome against quartiles of distance from base to scene and a relative risk (RR) estimation over the operational areas. Organisations were analysed separately to assess consistency of spatial relationships. 2680 EHAAT and 4213 KSS patients met the inclusion criteria. Ripley’s K and Cross K functions indicated that outcomes (death and leaving the scene alive) cluster together. For KSS distance was not associated with outcome, for EHAAT distance was a significant predictor of mortality at furthest distance (41 to 95 km; OR 5.82, 95%CI 1.63 to 37.18, p = 0.019). Only one area of KSS and no areas of EHAAT had an increased RR of mortality. In contrast to previous research of pre-hospital patients, we found little evidence of geographic difference in scene outcome for trauma patients attended by the two HEMS services. Increased mortality risk for OHCA at the furthest distance from helicopter base was found in one organisation; a single area of increased RR of mortality was found for the other organisation