Prehospital and Disaster Medicine最新文献

{"title":"Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders - A Systematic Review of the Literature.","authors":"Sara Heldring, Maria Jirwe, Jonas Wihlborg, Lukas Berg, Veronica Lindström","doi":"10.1017/S1049023X24000049","DOIUrl":"10.1017/S1049023X24000049","url":null,"abstract":"<p><strong>Introduction: </strong>First responders' training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.</p><p><strong>Methods: </strong>A systematic integrative literature review was used according to Whittemore and Knafl's descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.</p><p><strong>Results: </strong>Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.</p><p><strong>Conclusions: </strong>This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"94-105"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of the Public Safety Medical Response and Patient Encounters Within and During the Indianapolis (USA) Spring 2020 Civil Unrest.","authors":"Thomas P Arkins, Mark Liao, Daniel O'Donnell, Nancy Glober, Gregory Faris, Elizabeth Weinstein, Michael W Supples, Julia Vaizer, Benton R Hunter, Thomas Lardaro","doi":"10.1017/S1049023X24000025","DOIUrl":"10.1017/S1049023X24000025","url":null,"abstract":"<p><strong>Objective: </strong>This study describes the local Emergency Medical Services (EMS) response and patient encounters corresponding to the civil unrest occurring over a four-day period in Spring 2020 in Indianapolis, Indiana (USA).</p><p><strong>Methods: </strong>This study describes the non-conventional EMS response to civil unrest. The study included patients encountered by EMS in the area of the civil unrest occurring in Indianapolis, Indiana from May 29 through June 1, 2020. The area of civil unrest defined by Indianapolis Metropolitan Police Department covered 15 blocks by 12 blocks (roughly 4.0 square miles) and included central Indianapolis. The study analyzed records and collected demographics, scene times, interventions, dispositions, EMS clinician narratives, transport destinations, and hospital course with outcomes from receiving hospitals for patients extracted from the area of civil unrest by EMS.</p><p><strong>Results: </strong>Twenty-nine patients were included with ages ranging from two to sixty-eight years. In total, EMS transported 72.4% (21 of 29) of the patients, with the remainder declining transport. Ballistic injuries from gun violence accounted for 10.3% (3 of 29) of injuries. Two additional fatalities from penetrating trauma occurred among patients without EMS contact within and during the civil unrest. Conditions not involving trauma occurred in 37.9% (11 of 29). Among transported patients, 33.3% (7 of 21) were admitted to the hospital and there was one fatality.</p><p><strong>Conclusions: </strong>While most EMS transports did not result in hospitalization, it is important to note that the majority of EMS calls did result in a transport. There was a substantial amount of non-traumatic patient encounters. Trauma in many of the encounters was relatively severe, and the findings imply the need for rapid extraction methods from dangerous areas to facilitate timely in-hospital stabilization.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"73-77"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Smart Emergency Call Point\" Enhancing Emergency Medical Services on University Campuses.","authors":"Korakot Apiratwarakul, Lap Woon Cheung, Chatkhane Pearkao, Dhanu Gaysonsiri, Kamonwon Ienghong","doi":"10.1017/S1049023X23006647","DOIUrl":"10.1017/S1049023X23006647","url":null,"abstract":"<p><strong>Introduction: </strong>The \"Smart Emergency Call Point\" is a device designed for requesting assistance and facilitating rapid responses to emergencies. The functionality of smart emergency call points has evolved to include features as real-time photo transmission and communication capabilities for both staff and emergency personnel. These devices are being used to request Emergency Medical Services (EMS) on university campuses. Despite these developments, there has been a lack of previous studies demonstrating significant advantages of integrating smart emergency call points into EMS systems.</p><p><strong>Study objective: </strong>The primary goal of this study was to compare the response times of EMS between traditional phone calls and the utilization of smart emergency call points located on university campuses. Additionally, the study aimed to provide insights into the characteristics of smart emergency call points as a secondary objective.</p><p><strong>Methods: </strong>This retrospective database analysis made use of information acquired from Thailand's EMS at Srinagarind Hospital. The data were gathered over a period of four years, specifically from January 2019 through January 2022. The study included two groups: the first group used the phone number 1669 to request EMS assistance, while the second group utilized the smart emergency call point. The primary focus was on the response times. Additionally, the study documented the characteristics of the smart emergency call points that were used in the study.</p><p><strong>Results: </strong>Among the 184 EMS operations included in this study, 60.9% (N = 56) involved females in the smart emergency call point group. Notably, the smart emergency call point group showed a higher frequency of operations between the hours of 6:00am and 6:00pm when compared to the 1669 call group (P = .020). In dispatch triage, the majority of emergency call points were categorized as non-urgent, in contrast to the phone group for 1669 which were primarily cases categorized as urgent (P = .010). The average response time for the smart emergency call point group was significantly shorter, at 6.01 minutes, compared to the phone number 1669 group, which had an average response time of 9.14 minutes (P <.001).</p><p><strong>Conclusion: </strong>In the context of calling for EMS on a university campus, the smart emergency call points demonstrate a significantly faster response time than phone number 1669 in Thailand. Furthermore, the system also offers the capability to request emergency assistance.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"32-36"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with the Number of Injured and Fatalities in Motor Vehicle Intentional Mass-Casualty Incidents: A Timely Aid for Scaling the Emergency Response.","authors":"Eva Maria Valiño, Rafael Castro-Delgado, Silvia Sola Muñoz, Barry Lynam, Pedro Castro","doi":"10.1017/S1049023X23006726","DOIUrl":"10.1017/S1049023X23006726","url":null,"abstract":"<p><strong>Introduction: </strong>Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources.</p><p><strong>Study objective: </strong>The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs.</p><p><strong>Methods: </strong>This is a retrospective, observational, analytical study on MV-IMCIs world-wide, from 2000-2021. Data were obtained from three different sources: Targeted Automobile Ramming Mass-Casualty Attacks (TARMAC) Attack Database, Global Terrorism Database (GTD), and the vehicle-ramming attack page from the Wikipedia website. Jacobs' formula was used to estimate the population density in the vehicle's route. The primary outcome variables were the total number of casualties (injured and fatalities). Associations between variables were analyzed using Spearman's correlation coefficient and simple linear regression.</p><p><strong>Results: </strong>Forty-six MV-IMCIs resulted in 1,636 casualties (1,430 injured and 206 fatalities), most of them caused by cars. The most frequent driving pattern was accelerating whilst approaching the target, with an average speed range between four to 130km/h and a distance traveled between ten to 2,260 meters. The people estimated in the MV-IMCI scenes ranged from 36-245,717. A significant positive association was found of the number affected with the estimated crowd in the scene (R²: 0.64; 95% CI, 0.61-0.67; P <.001) and the average vehicle speed (R²: 0.42; 95% CI, 0.40-0.44; P = .004).</p><p><strong>Conclusion: </strong>The estimated number of people in the affected area and vehicle's average speed are the most significant variables associated with the number of casualties in MV-IMCIs, helping to enable a timely estimation of the casualties.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"65-72"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suit Up: A Systematic Review of the Personal Protective Equipment (PPE) Recommended and Utilized by Various Classes of Responders to Nuclear Radiological Disasters at Nuclear Power Plants.","authors":"Chaverle K Noel, Erica D Bruce, Benjamin J Ryan","doi":"10.1017/S1049023X23006672","DOIUrl":"10.1017/S1049023X23006672","url":null,"abstract":"<p><strong>Introduction: </strong>Interest in nuclear power as a cleaner and alternative energy source is increasing in many countries. Despite the relative safety of nuclear power, large-scale disasters such as the Fukushima Daiichi (Japan) and Chernobyl (Ukraine) meltdowns are a reminder that emergency preparedness and safety should be a priority. In an emergency situation, there is a need to balance the tension between a rapid response, preventing harm, protecting communities, and safeguarding workers and responders. The first line of defense for workers and responders is personal protective equipment (PPE), but the needs vary by situation and location. Better understanding this is vital to inform PPE needs for workers and responders during nuclear and radiological power plant accidents and emergencies.</p><p><strong>Study objective: </strong>The aim of this study was to identify and describe the PPE used by different categories of workers and responders during nuclear and radiological power plant accidents and emergencies.</p><p><strong>Methods: </strong>A systematic literature review format following the PRISMA 2020 guidelines was utilized. Databases SCOPUS, PubMed, EMBASE, INSPEC, and Web of Science were used to retrieve articles that examined the PPE recommended or utilized by responders to nuclear radiological disasters at nuclear power plants (NPPs).</p><p><strong>Results: </strong>The search terms yielded 6,682 publications. After removal of duplicates, 5,587 sources continued through the systematic review process. This yielded 23 total articles for review, and five articles were added manually for a total of 28 articles reviewed in this study. Plant workers, decontamination or decommissioning workers, paramedics, Emergency Medical Services (EMS), emergency medical technicians, military, and support staff were the categories of responders identified for this type of disaster. Literature revealed that protective suits were the most common item of PPE required or recommended, followed by respirators and gloves (among others). However, adherence issues, human errors, and physiological factors frequently emerged as hinderances to the efficacy of these equipment in preventing contamination or efficiency of these responders.</p><p><strong>Conclusion: </strong>If worn correctly and consistently, PPE will reduce exposure to ionizing radiation during a nuclear and radiological accident or disaster. For the best results, standardization of equipment recommendations, clear guidelines, and adequate training in its use is paramount. As fields related to nuclear power and nuclear medicine expand, responder safety should be at the forefront of emergency preparedness and response planning.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"85-93"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139467120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nation-Wide Variation in Presence of Legislation or Protocols for EMS Care of Operational Canines.","authors":"David W Schoenfeld, Caroline E Thomas, Lee Palmer, William Justice, Esther Hwang, Kate D Zimmerman, Jeffrey M Goodloe, Jonathan D Shecter, Stephen H Thomas","doi":"10.1017/S1049023X24000074","DOIUrl":"10.1017/S1049023X24000074","url":null,"abstract":"<p><strong>Background & aims: </strong>Deployment of law enforcement operational canines (OpK9s) risks injuries to the animals. This study's aim was to assess the current status of states' OpK9 (veterinary Emergency Medical Services [VEMS]) laws and care protocols within the United States.</p><p><strong>Methods: </strong>Cross-sectional standardized review of state laws/regulations and OpK9 VEMS treatment protocols was undertaken. For each state and for the District of Columbia (DC), the presence of OpK9 legislation and/or care protocols was ascertained. Information was obtained through governmental records and from stakeholders (eg, state EMS medical directors and state veterinary boards).The main endpoints were proportions of states with OpK9 laws and/or treatment protocols. Proportions are reported with 95% confidence intervals (CIs). Fisher's exact test (<i>P</i> <.05) assessed whether presence of an OpK9 law in a given jurisdiction was associated with presence of an OpK9 care protocol, and whether there was geographic variation (based on United States Census Bureau regions) in presence of OpK9 laws or protocols.</p><p><strong>Results: </strong>Of 51 jurisdictions, 20 (39.2%) had OpK9 legislation and 23 (45.1%) had state-wide protocols for EMS treatment of OpK9s. There was no association (<i>P</i> = .991) between presence of legislation and presence of protocols. There was no association (<i>P</i> = .144) between presence of legislation and region: Northeast 66.7% (95% CI, 29.9-92.5%), Midwest 50.0% (95% CI, 21.1-78.9%), South 29.4% (95% CI, 10.3-56.0%), and West 23.1% (95% CI, 5.0-53.8%). There was significant (<i>P</i> = .001) regional variation in presence of state-wide OpK9 treatment protocols: Northeast 100.0% (95% CI, 66.4-100.0%), Midwest 16.7% (95% CI, 2.1-48.4%), South 47.1% (95% CI, 23.0-72.2%), and West 30.8% (95% CI, 9.1-61.4%).</p><p><strong>Conclusion: </strong>There is substantial disparity with regard to presence of OpK9 legal and/or clinical guidance. National collaborative guidelines development is advisable to optimize and standardize care of OpK9s. Additional attention should be paid to educational and training programs to best utilize the limited available training budgets.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"59-64"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139735930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxic Fumes Exposure-More than Just an Airway Concern - RETRACTION.","authors":"Shu Fang Ho, Mingwei Ng, Terence Chong, Kenneth Tan","doi":"10.1017/S1049023X23006441","DOIUrl":"10.1017/S1049023X23006441","url":null,"abstract":"","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"119"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake.","authors":"Buğra İlhan, Oğuz Eroğlu, Hüseyin Çanak, Abdullah Arıkan, Münir Sakallı, Serkan Tursun, Turgut Deniz","doi":"10.1017/S1049023X2300674X","DOIUrl":"10.1017/S1049023X2300674X","url":null,"abstract":"<p><strong>Background: </strong>After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed.</p><p><strong>Methods: </strong>This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded.</p><p><strong>Results: </strong>A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively).</p><p><strong>Conclusions: </strong>Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"20-24"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kahramanmaraş-Pazarcık Earthquake 2023: Characteristics of Patients Presented to the Emergency Department of a Tertiary Hospital Far from the Region and Infection Characteristics in Hospitalized Patients.","authors":"Özlem Çakın, Melike Yüce Aktepe, Samet Acar, Süleyman İbze","doi":"10.1017/S1049023X24000062","DOIUrl":"10.1017/S1049023X24000062","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to determine the demographic, clinical characteristics, and outcomes of the patients who applied to the emergency department (ED) of Akdeniz University Faculty of Medicine Hospital (Antalya, Türkiye) after the Kahramanmaraş-Pazarcık earthquake dated February 6, 2023, as earthquake victims were included in the study. The results of the study could be a guide in terms of emergency health services and the healthy management of disasters.</p><p><strong>Methods: </strong>The study included patients over the age of 18 who presented as earthquake victims to the ED of Akdeniz University Medical Faculty Hospital from February 6, 2023 through March 8, 2023. The demographic data of the patients, including age, gender, earthquake zone, time and manner of arrival to the ED, time under debris, length-of-stay (LOS) in the service and intensive care unit (ICU), infection rates, culture results, and mortality, were retrospectively analyzed using the hospital automation system.</p><p><strong>Results: </strong>A total of 1,833 earthquake victims presented to the ED. Of these patients, 1,294 were adults and 539 were children. Services and the ICU admitted a total of 137 adult patients. In the first week, 414 (31.99%) of the patients presented to the ED, while 82 (59.85%) of the hospitalized patients were admitted.Hatay ranked first with 573 (44.28%) patients in the distribution of patients presented to the ED according to earthquake regions. In the distribution of hospitalized patients by earthquake regions, the patients requiring the most hospitalization were from the province of Hatay, with 68 (49.63%) patients.During hospital observations, the medical staff took 132 culture samples based on the positive clinic of the patient. The microorganisms detected in the culture studies were different from the flora of the hospital. The mortality at seven days was two (1.45%), and at the end of 30 days, the mortality was six (4.37%).</p><p><strong>Conclusions: </strong>The ED evaluated all affected cases, with most patients being brought by their relatives using their own means, and had low mortality rates despite presenting with fewer injuries. New environmental conditions that developed after the earthquake caused unexpected results, especially in terms of community-acquired agents.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"25-31"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Algorithm for Improving the Prehospital Diagnostic Accuracy of ST-Segment Elevation Myocardial Infarction.","authors":"Mat Goebel, Lauren M Westafer, Stephanie A Ayala, El Ragone, Scott J Chapman, Masood R Mohammed, Marc R Cohen, James T Niemann, Marc Eckstein, Stephen Sanko, Nichole Bosson","doi":"10.1017/S1049023X23006635","DOIUrl":"10.1017/S1049023X23006635","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting.</p><p><strong>Methods: </strong>A dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics.</p><p><strong>Results: </strong>There were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r² = 0.90) and specificity (r² = 0.85) with increasing number of criteria.</p><p><strong>Conclusions: </strong>Prehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":" ","pages":"37-44"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10922545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}