Western Journal of Emergency Medicine最新文献

{"title":"Clinician-documented Firearm Access and Safety Interventions for Veterans Receiving Suicide Risk Evaluation in VA Emergency Care Settings.","authors":"Joseph A Simonetti, Samuel E King, Ryan Holliday, Gabriela K Khazanov, Alexandra Smith, Nazanin Bahraini, Lisa A Brenner, Bridget B Matarazzo","doi":"10.5811/westjem.50852","DOIUrl":"10.5811/westjem.50852","url":null,"abstract":"<p><strong>Background: </strong>The success of clinical programs aimed at preventing suicide risk depends in part on whether they can be used to identify and act upon risk factors for suicide. Our aim in this study was to describe frequency of clinician documentation of firearm access and the delivery of safety interventions among patients who received a suicide risk evaluation in Veterans Health Administration (VHA) emergency departments (ED) or urgent care (UC) settings.</p><p><strong>Methods: </strong>We used electronic health record data of patients who received care in VHA ED/UC settings January 2021-October 2022 and underwent suicide risk evaluation by clinicians using the Veterans Affairs (VA) Comprehensive Suicide Risk Evaluation (CSRE) prior to discharging home. The proportion of patients with self-reported firearm access was identified from clinician-documented CSRE templates. Among those who reported firearm access, we identified the proportion who received any safety intervention (delivery of lethal means safety counseling and/or distribution of firearm cable locks per CSRE documentation, or update/creation/review of a VA Safety Plan) within 24 hours of the ED/UC encounter. We compared differences using chi-square or Fisher exact tests for categorical outcomes and analysis of variance or independent sample t-tests for continuous outcomes.</p><p><strong>Results: </strong>Of 17,194 patients who were discharged home, 15.2% were documented as having firearm access (8.5% access to \"other\" lethal means, 68.8% no lethal means access, 7.4% unknown access). Of 2,624 patients with documented firearm access, 80.6% were documented as having received a safety intervention. Of those, 56.8% received lethal means safety counseling, 13.2% received a firearm cable lock, and 88.6% reviewed or completed a new or updated VA Safety Plan.</p><p><strong>Conclusion: </strong>Among patients who underwent suicide risk evaluation prior to discharging home from a Veterans Health Administration ED/UC setting, a low percentage were documented as having firearm access. Of those with firearm access, a large majority received at least one safety intervention. System-wide strategies to encourage delivery of safety interventions can reach a large proportion of at-risk patients. Additional efforts are needed to increase reporting and documentation of firearm access.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"784-793"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in THC Positivity Rates in Adolescents Corresponding to Legalization of Recreational Marijuana in Illinois.","authors":"Eriq Gassé, April Brill","doi":"10.5811/westjem.62946","DOIUrl":"10.5811/westjem.62946","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;As public access to tetrahydrocannabinol (THC) products expands under state legalization, there is concern for increased use in adolescents under 18 years of age and its subsequent effects. Adverse effects of THC use have been documented such as epilepsy, lethargy, somnolence, and respiratory insufficiency. Additional concern has been raised regarding whether potential increases in THC intoxications presented to the emergency department (ED) would demand a simultaneous increase in resource utilization, like lab testing and hospital admission. Previous studies on the relationship between marijuana and pediatric use demonstrated mixed results, with others indicating an increase in co-ingestion rates when pediatric patients use marijuana.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate whether the incidence of THC use in pediatrics increased post-recreational marijuana legalization in 2020 (RML) and if the incidence of co-ingestion in these cases differed significantly from the pre-RML data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective cohort study examining positive urine drug screens (UDS) in pediatrics during an emergency department visit at a community hospital during fixed time periods in 2019 and 2020, on either side of Illinois' legalization of recreational marijuana on January 1st, 2020. Pediatric subjects were defined as those younger than 18 years of age and older than four weeks of age at the time of UDS collection with valid, complete, and reported laboratory results. UDS screens analyzed in this study were collected in the ED of a suburban community hospital from pediatric charts housed on the electronic medical record, where there was a clinical indication for UDS collection and regardless of disposition. UDS may have been obtained for either medical or psychiatric concerns, but the reason for the UDS or patient visit was not collected or analyzed. UDS was considered positive if either amphetamines, benzodiazepines, opiates, Phencyclidine (PCP), cocaine, or barbiturates were identified as present in the urine sample and negative if none of these substances were detected in the urine sample. Both negative and positive UDS were assessed using chi-square and odds ratios to investigate these differences and compare across sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 169 patients with a mean age of 14 years included. Mean age in 2019 (14.1 ± 3.2 years) was comparable to mean age in 2020 (14.7 ± 2.0 years) (two-sample t-test: 0.143 &gt; 0.05). Sex demographics were also not significantly different between cohorts, with 53.4% being female in 2019 and 50.6% in 2020 (chi-square: 0.1318; significance: 0.1318 &gt; 0.05). Between the two time periods, we found no significant difference in pediatric presentation to the ED with THC positive testing (2019: 16 positive UDS of 88 collected [18.18%]; 2020: 17 positive UDS of 81 collected [20.99%]; chi square: 0.211; Significance: 0.646 &gt; 0.05; odd ratio betwee","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"838-839"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Considerations on the Randomized Trial of Self-Selected Music for Musculoskeletal Back Pain in the Emergency Department.","authors":"Süleyman Gökhan Kara, Güneş Özlü","doi":"10.5811/westjem.61381","DOIUrl":"10.5811/westjem.61381","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"831-832"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fellowship Training After Four-year Emergency Medicine Residency.","authors":"Michael R Ehmann, Eili Y Klein, Gabor D Kelen","doi":"10.5811/westjem.62105","DOIUrl":"10.5811/westjem.62105","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"833-834"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fellowship Training After Four-Year Emergency Medicine Residency.","authors":"Richard J Hamilton, Lance B Becker, Richard E Wolfe","doi":"10.5811/westjem.63063","DOIUrl":"10.5811/westjem.63063","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"835-836"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child Opportunity Index Levels and Disparities in Access to Pediatric-ready Emergency Departments.","authors":"Mary E Bernardin, Paul Schuler, Emily Morales, Elizabeth Kendrick, Danielle Zoellner, Timothy Staed","doi":"10.5811/westjem.53096","DOIUrl":"10.5811/westjem.53096","url":null,"abstract":"<p><strong>Introduction: </strong>Increased pediatric readiness has been shown to decrease pediatric mortality, although disparities in access to pediatric-ready emergency departments (ED) have not been studied. The Child Opportunity Index (COI) is a comprehensive measure of the quality of neighborhood resources impacting child health and development. Our objective was to determine whether low-resourced areas with low COI levels are associated with farther travel distances to the nearest pediatric-ready ED.</p><p><strong>Methods: </strong>In this retrospective, cross-sectional study we evaluated the 2021 National Pediatric Readiness Project (NPRP) assessments of 91 EDs throughout the state of Missouri in relationship to COI 3.0 U.S. census tract data. The EDs were classified into quartiles based on weighted pediatric readiness scores (wPRS). Our primary outcome measure was travel distances to the nearest ED, which were obtained by measuring the shortest distance from the geographic center of each U.S. census tract to the closest ED. We used the Kruskal-Wallis H test to assess distances from the geographic center of each census tract to the nearest EDs. P values were adjusted for multiple comparisons using Dunn-Bonferroni post hoc tests.</p><p><strong>Results: </strong>Of the 113 EDs in Missouri that were invited to take the 2021 NPRP assessment, 91 (81%) participated and 22 (19%) were nonrespondent. Child Opportunity Index data were available for all 1,393 Missouri U.S. census tracts. When compared to low-resourced, low COI census tracts, well-resourced, very high COI census tracts were found to have significantly shorter travel distances to the nearest ED (6 vs 2.9 miles, [95% CI, 3.03-3.6; P < .001]). Families living in low COI census tracts travel 4.6 times farther (18 additional miles) to reach an ED in the highest wPRS quartile compared to families living in very high COI census tracts (23.3 vs 5.1 miles, [95% CI, 5.6-6.5; P < .001]). Families living in low COI census tracts travel 4.4 times farther (48 additional miles) to reach the nearest of the top three most pediatric-ready EDs [62.6 vs 14.4 miles, [95% CI, 14.6-19.1; P < .001].</p><p><strong>Conclusion: </strong>Families from resource-limited communities with low Child Opportunity Index levels must travel significantly farther to access pediatric-ready EDs compared to families from well-resourced communities. Dissemination of pediatric-readiness improvement efforts, especially to under-resourced areas, may help address disparities in healthcare access and promote health equity.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"794-803"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project.","authors":"Sedlak Marian, Petras Tomas, Berta Imrich, Ivanov Gaston, Karas Jozef","doi":"10.5811/westjem.52829","DOIUrl":"10.5811/westjem.52829","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Efficient allocation of physician-staffed emergency medical services (EMS) is crucial for optimal resource use in urban prehospital systems. The rendezvous model differs fundamentally from the traditional ambulance model: It deploys a lighter, nontransport-capable, passenger vehicle that may offer operational advantages, although comparative evidence with regard to traditional models remains limited. In this study we aimed to evaluate the impact of a physician-staffed rendezvous model on response times and physician-staffed crew availability within the EMS system in Košice, Slovak Republic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective, cross-sectional study, analyzing all primary responses by physician-staffed EMS units in the Košice region from January 2023-March 2025. In August 2024, one of three traditional, physician-staffed transport units was replaced by a physician-staffed rendezvous unit, yielding a post-intervention system with two transport units and one rendezvouz unit, a faster, physician-staffed non-transport vehicle that provides specialized medical care on scene. We extracted time intervals in minutes-response time, time on scene, time to transport initiation, and total time until crew availability-from the national EMS database and compared them to the pre- and post-introduction of the rendezvous model. We analyzed data using non-parametric statistical tests (Mann-Whitney U test, Kruskal-Wallis test), and we conducted a multivariable ordinary least squares regression to adjust for potential confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 11,347 eligible cases, 11,094 met the inclusion criteria (8,389 patients treated during the pre-intervention period and 2,705 during the post-intervention period). Of these, 488 patients (4.4% of the overall cohort and 18.0% of the post-intervention cases) were managed by the rendezvous unit. Following rendezvous unit implementation, the mean response time was reduced compared to that of the standard physician-staffed transport units (-0.77 minutes per response; P &lt; .001). The rendezvous unit demonstrated reductions in time to crew availability across districts, with absolute decreases ranging from 11.12 to 18.01 minutes; these differences were statistically significant in all districts except the undefined/border region (P &lt; .001 for each comparison). The time spent on scene was slightly longer for the rendezvous unit in most districts, although these differences did not reach statistical significance. The time to transport initiation showed mixed trends. Ordinary least squares regression confirmed the independent association between rendezvous unit implementation and shorter response times.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Replacing a standard physician-staffed ambulance with a lighter, faster, non-transport rendezvous vehicle improved operational efficiency by reducing response times and expediting physician-staffed crew availability. These fi","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"715-724"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Awareness of Excessive Use of Force on the Psychological Well-being and Workplace Environment of Emergency Physicians: A Pilot Study.","authors":"Anisha Turner, Thomas Medrano, Kevin-Dat Nguyen, Xiaofan Huang, Richina Bicette, Vidya Eswaran, Adedoyin Adesina","doi":"10.5811/westjem.48904","DOIUrl":"10.5811/westjem.48904","url":null,"abstract":"<p><strong>Introduction: </strong>Excessive use of force by law enforcement officers is a critical public health issue linked to serious health consequences such as hypertension, post-traumatic stress disorder (PTSD), and depression. While emergency physicians (EP) are often the first to treat patients with excessive use of force-related injuries, the work-life and psychological toll of witnessing these incidents remains underexplored. In this study, we examine how awareness of and exposure to excessive use of force affects the psychological well-being and professional environment of EPs.</p><p><strong>Methods: </strong>An observational cross-sectional survey was developed by EPs and psychiatrists to assess work-life and psychological impacts of awareness of excessive use of force on EPs. The survey included multiple-choice and Likert-scale questions and used the Impact of Event Scale-Revised (IES-R). It was distributed anonymously to EPs at three Texas academic institutions. We used the Fisher exact test and the Wilcoxon rank-sum test to compare groups. Our primary outcome measure was psychological distress, assessed with the IES-R. Secondary outcome measures included self-reported effects of awareness of excessive use of force on subjects' work environments, patient care, and interactions with law enforcement.</p><p><strong>Results: </strong>Of 282 surveys sent to EPs, 43 responded (15%). Eighteen of 40 (45%) reported experiencing work-life impacts and 15 of 40 (37.5%) experienced psychological distress; three did not comment. Abnormal IES-R scores were found in seven (19.6%) of 35 participants; eight did not respond. Participants who noted work-life effects of excessive use of force were more likely than those whose work-life was not affected to report modified patient care approaches (61% vs 0%, P < .001), altered interactions with law enforcement (83% vs 0%, P < .001), and altered interactions with patients (50% vs 0%, P < .001). Psychological distress was more prevalent among participants with personal exposure to excessive use of force compared to those without personal exposure (47% vs 12%, P = .02), and among those with second-hand exposure compared to those without second-hand exposure to excessive use of force (80% vs 56%, P = .04).</p><p><strong>Conclusion: </strong>This pilot study demonstrates that exposure to excessive use of force is associated with psychological distress and professional impact among emergency physicians, influencing interactions with patients and law enforcement. These findings underscore the need for further characterization of the effects of awareness of and exposure to excessive use of force on EPs. This, in turn, may inform institutional interventions and national protocols aimed at mitigating psychological burden, supporting physician resilience, and promoting high-quality, equitable patient care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"688-697"},"PeriodicalIF":2.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Through the Prism: Shining Light on LGBTQIA+ Applicant Identities and Influences.","authors":"Kayla Iuliucci, Lea Moujaes, David Rudolph, Peter Fredericks, Blake Denley, Samuel Paskin, Arlene S Chung, Jaime Jordan, Edgardo Ordonez, Laura Smylie, Simiao Li-Sauerwine, P Logan Weygandt","doi":"10.5811/westjem.50598","DOIUrl":"10.5811/westjem.50598","url":null,"abstract":"<p><strong>Introduction: </strong>Program diversity impacts rank-list creation for emergency medicine (EM)-bound applicants, but how lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual and gender minorities (LGBTQIA+) identities influence residency selection is unknown. This study investigates general patterns in EM applicant LGBTQIA+ identities, disclosure of those identities, and how LGBTQIA+ factors impact residency selection. Additionally, we present data exploring the relationship between medical school location and the location of top-ranked programs for LGBTQIA+ and non-LGBTQIA+ identifying applicants.</p><p><strong>Methods: </strong>We surveyed 2,287 EM-bound United States MD/DO applicants who applied to one of five author EM programs and programs affiliated with the Emergency Medicine Education Research Alliance from May 16-June 30, 2024. The survey included multiple-choice, free-text, and Likert scale questions. Data were explored with descriptive statistics, and we used chi-square and Fisher exact tests to compare differences in proportions. We also analyzed applicants' medical school state and a graphical representation of the top three positions on their residency rank lists, using inverse-proportional weighting.</p><p><strong>Results: </strong>Of 445 respondents (19.4%), 59 (13.3%) identified as LGBTQIA+. Gender identities included 173 cisgender men (38.9%), 254 cisgender women (57.1%), one transgender man (0.2%), one transgender woman (0.2%), four non-binary (0.9%), one genderqueer (0.2%), and seven \"preferred not to answer\" (1.6%). Among LGBTQIA+ respondents, seven (11.9%) disclosed their status within the application, nine (15.3%) during the interview, 18 (30.5%) in both, and 25 (42.4%) did not disclose. Among 56 respondents, 36 (64.3%) supported adding LGBTQIA+ status to the residency application; 20 (35.7%) did not. Of the program factors considered, program diversity (91.1%) and commitment to underserved communities (96.4%) were significantly more important for LGBTQIA+ respondents (P < .01), while proximity to partner(s) (64.3%; P < .01) and program length (66.1%; P = .02) were significantly less important compared with non-LGBTQIA+ respondents. Additional factors that influenced LGBTQIA+ applicants' rank list included political environment, friendliness of the learning environment, and presence/absence of anti-LGBTQIA+ laws.</p><p><strong>Conclusion: </strong>Many LGBTQIA+ applicants do not disclose their identities when applying for residency. LGBTQIA+ respondents value program diversity and commitment to underserved communities, and they consider LGBTQIA+-specific factors such as the presence of anti-LGBTQIA+ legislation. These insights can inform residency programs and recruitment practices.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"698-708"},"PeriodicalIF":2.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of Optimal Magill Forceps Hand Position and Laryngoscope Type to Remove a Simulated Foreign Body Airway Obstruction.","authors":"Michael Berkenbush, Coco Thomas, Michael Mysh, John Rutledge, Raymond Dwyer, Scott Kansky","doi":"10.5811/westjem.49101","DOIUrl":"10.5811/westjem.49101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Foreign body removal for airway obstruction is an infrequent skill performed by paramedics, and Magill forceps for removal of a foreign body from the airway is reserved for patients with persistent obstruction. Traditional paramedic instruction uses direct laryngoscopy to visualize foreign body removal. Our objective in this study was to evaluate time to removal of an obstruction comparing hand position and hyperangulated video laryngoscopy vs direct laryngoscopy with Magill forceps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A foreign body airway obstruction station was included in paramedics' annual competency assessment over a two-year period as a quality improvement project. Paramedics were randomized to remove the foreign body with either direct laryngoscopy or hyperangulated video laryngoscopy with a handheld video laryngoscope. Our primary outcome measure was time from blade insertion to foreign body removal. The paramedics had further training regarding hand position prior to the second year's annual competency assessment. After fitting a mixed-effects statistical model to the data, we included fixed effects of competency assessment year, device used, hand position, and random effect of paramedic. We evaluated the significance of these predictors on the dependent variable of time for removal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We observed 245 foreign body airway obstruction removals, 77 in year 1 and 168 in year 2. The direct laryngoscopy (n = 123) and hyperangulated video laryngoscopy (n = 122) groups were nearly equal. During year 1, hand position was noted to be an important factor for removal time, as paramedics were seen to use different hand positions. Recording of hand position began during year 1, which excluded 95 earlier observations from year 1. Competency training year was not a significant factor for time to removal. However, direct laryngoscopy was faster at 14.9 seconds [sec], (95% CI 12.9-17.1) than hyperangulated video laryngoscopy at 19.2 sec [16.9-22]; P &lt; .001. Of the four possible hand positions, forceps grasped by the right thumb and either middle or fourth finger, with the hand in a handshake position, and with the forceps superior to the hand was associated with the shortest time to foreign body removal. This optimal hand position was significantly better than the other grasping methods, with a mean of 11.2 sec (95% CI, 10.2-12.4) vs underhand method, 17.5 sec (14.7-21); overhand method, 15.1 sec (10.7-21.2); and multiple positions (27.5 sec, 22-34.5); P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We found that hand positioning for Magill forceps significantly affected time to foreign body removal. In addition, direct laryngoscopy outperformed hyperangulated video laryngoscopy. Given these findings, training on removal of foreign body airway obstruction with Magill forceps should emphasize optimal hand positioning. Paramedics may also consider the use of direct laryngoscopy over hyperangulated v","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"709-714"},"PeriodicalIF":2.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}