Prehospital and Disaster Medicine

Challenges and Clinical Impact of Medical Search and Rescue Efforts Following the Kahramanmaraş Earthquake
Celikmen MF, Tatliparmak AC, Tunaligil V and Yilmaz S
This study assesses the operational challenges and clinical outcomes encountered by a university-based Emergency Medical Team (EMT) during the medical search and rescue (mSAR) response to the February 2023 earthquakes in Kahramanmaraş, Turkey.
Prehospital Care Under Fire: Strategies for Evacuating Victims from the Mega Terrorist Attack in Israel on October 7, 2023
Jaffe E, Dadon Z and Alpert EA
On October 7, 2023, somewhere around 1,500-3,000 terrorists invaded southern Israel killing 1,200 people, injuring 1,455, and taking 239 as hostages resulting in the largest mass-casualty event (MCE) in the country's history. Most of the victims were civilians who suffered from complex injuries including high-velocity gunshot wounds, blast injuries from rocket-propelled grenades, and burns. Many would later require complex surgeries by all disciplines including general surgeons, vascular surgeons, orthopedists, neurosurgeons, cardiothoracic surgeons, otolaryngologists, oral maxillofacial surgeons, and plastic surgeons. Magen David Adom (MDA) is Israel's National Emergency Prehospital Medical Organization and a member of the International Red Cross. While there are also private and non-profit ambulance services in Israel, the Ministry of Health has mandated MDA with the charge of managing an MCE. For this event, MDA incorporated a five-part strategy in this mega MCE: (1) extricating victims from areas under fire by bulletproof ambulances, (2) establishing casualty treatment stations in safe areas, (3) ambulance transport from the casualty treatment stations to hospitals, (4) ambulance transport of casualties from safe areas to hospitals, and (5) helicopter transport of victims to hospitals. This is the first time that MDA has responded to a mega MCE of this magnitude and lessons are continually being learned.
Ambulance Transports from NCAA Division 1 Football Games
Shekhar AC, Alexander A, Simms M, Jahan M, Haugen A, Lu M, Ball R and Clement J
There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings.
Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study - CORRIGENDUM
April MD, Fisher AD, Rizzo JA, Wright FL, Winkle JM and Schauer SG
Bleeding Control Protections Within US Good Samaritan Laws - CORRIGENDUM
Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA and Margolis AM
Brain Injury Associated Shock: An Under-Recognized and Challenging Prehospital Phenomenon
Partyka C, Alexiou A, Williams J, Bliss J, Miller M and Ferguson I
Hemodynamic collapse in multi-trauma patients with severe traumatic brain injury (TBI) poses both a diagnostic and therapeutic challenge for prehospital clinicians. Brain injury associated shock (BIAS), likely resulting from catecholamine storm, can cause both ventricular dysfunction and vasoplegia but may present clinically in a manner similar to hemorrhagic shock. Despite different treatment strategies, few studies exist describing this phenomenon in the early post-injury phase. This retrospective observational study aimed to describe the frequency of shock in isolated TBI in prehospital trauma patients and to compare their clinical characteristics to those patients with hemorrhagic shock and TBI without shock.
After the Türkiye Earthquake: The Experience of a Pediatric Emergency Department in a University Hospital Distant from the Disaster Area
Akbaba B, Yiğit H, Güngör E, Kaynak MO, Kahya HH, Birbilen AZ, Kesici S, Düzova A, Bayrakçı B and Tekşam Ö
Earthquakes rank among the most deadly natural disasters, and children are particularly affected due to their inherent vulnerability. Following an earthquake, there is a substantial increase in visits to emergency services. These visits stem not only from patients seeking care for physical traumas resulting from the earthquake and its subsequent complications, but also from individuals affected by the circumstances created by the disaster.
Impact of Collegiate Football Games on Emergency Response Intervals: A Case Study of College Station, Texas (USA)
Blackburn CC and Rico M
Little is known about how mass gatherings affect emergency response intervals. Previous research suggests that college football games increase ambulance transport intervals, but their impact on emergency response intervals is unexplored. This study examines how collegiate home football games in College Station, Texas (USA) affect emergency vehicle response intervals.
The Impact of Alcohol-Related Presentations to Emergency Departments on Days with a Public Holiday or Sporting Event: A Retrospective Cohort Study
Hagan SR, Crilly J and Ranse J
The consumption of alcohol within the Australian community continues to rise, impacting care delivery in already over-burdened emergency departments (EDs).
A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures
O'Connor L, Zamani S, Ding X, McGeorge N, Latiff S, Liu C, Acevedo Herman J, LoConte M, Milsten A, Weiner M, Boardman T, Reznek M, Hall M and Broach JP
Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care.
Integrating Disaster and Dignitary Medicine Principles into a Medical Framework for Organizational Travel Health and Security Planning
Tin D, Granholm F, Guirguis M, Almulhim M and Ciottone G
This Editorial explores organizational travel risk management and advocates for a comprehensive approach to fortify health security for travelers, emphasizing proactive risk management, robust assessments, and strategic planning. Leveraging insights from very important persons (VIP) protocols, organizations can enhance duty of care and ensure personnel safety amidst global travel complexities.
The Ethical Principles in Ethical Guidance Documents during the COVID-19 Pandemic in the United Kingdom and the Republic of Ireland: A Qualitative Systematic Review
Raajakesary K, Galvin L, Prendiville K, Newport S, MacAnulty C and Hussein G
The sudden onset of the coronavirus disease 2019 (COVID-19) pandemic was accompanied by a myriad of ethical issues that prompted the issuing of various ethical guidance documents for health care professionals in clinical, research, and public health settings throughout the United Kingdom (UK) of Great Britain and Northern Ireland and the Republic of Ireland. The aim of this review was to identify the main principles in ethical guidance documents published in the UK and Ireland during the COVID-19 pandemic.
Applications and Performance of Machine Learning Algorithms in Emergency Medical Services: A Scoping Review
Alrawashdeh A, Alqahtani S, Alkhatib ZI, Kheirallah K, Melhem NY, Alwidyan M, Al-Dekah AM, Alshammari T and Nehme Z
The aim of this study was to summarize the literature on the applications of machine learning (ML) and their performance in Emergency Medical Services (EMS).
Rapid Ultrasonography for Shock and Hypotension Protocol Performed using Handheld Ultrasound Devices by Paramedics in a Moving Ambulance: Evaluation of Image Accuracy and Time in Motion
Azapoglu Kaymak B and Eksioglu M
Handheld ultrasound (US) devices have become increasingly popular since the early 2000s due to their portability and affordability compared to conventional devices. The Rapid Ultrasonography for Shock and Hypotension (RUSH) protocol, introduced in 2009, has shown promising accuracy rates when performed with handheld devices. However, there are limited data on the accuracy of such examinations performed in a moving ambulance. This study aimed to assess the feasibility and accuracy of the RUSH protocol performed by paramedics using handheld US devices in a moving ambulance.
Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study
April MD, Fisher AD, Rizzo JA, Wright FL, Winkle JM and Schauer SG
Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients.
Bleeding Control Protections Within US Good Samaritan Laws
Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA and Margolis AM
In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders.
Quantitative Metrics in Mass-Gathering Studies: A Comprehensive Systematic Review
Çalışkan C, Kuday AD, Özcan T, Dağ N and Kınık K
Mass gatherings are events where many people come together at a specific location for a specific purpose, such as concerts, sports events, or religious gatherings, within a certain period of time. In mass-gathering studies, many rates and ratios are used to assess the demand for medical resources. Understanding such metrics is crucial for effective planning and intervention efforts. Therefore, this systematic review aims to investigate the usage of rates and ratios reported in mass-gathering studies.
Purposeful Sampling: Advantages and Pitfalls
Stratton SJ
This editorial monograph explores the advances and pitfalls of the common forms of purposeful sampling. Purposeful sampling is a common research design in qualitative research.
Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review
Lulla A, Dickson R, Wells M, Gilbert M, Rogers Keene K and Patrick C
Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.
From Didactics to Disasters: Unveiling CBRNe and Counter-Terrorism Medicine Training in US Medical Schools
Lane JE, Tin D, Ali A and Ciottone G
The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties.
Humanitarian Aeromedical Retrieval using a Long-Range Commercial Aircraft: A Field Report
Ghio FE, Zoli A, Stucchi R, Serini C, Della Torre S, Tomaselli A, Di Leo A and Carenzo L
This field report presents the planning and execution of a large-scale aeromedical refugee retrieval operation amid the on-going Russia-Ukraine crisis. The retrieval was coordinated by the Italian Department of Civil Protection and led by the Centrale Remota Operazioni Soccorso Sanitario (CROSS), a governmental facility overseeing medical assistance. An Airbus A320 was chosen for its capacity of 165 passengers, with one emergency stretcher maintaining maximum seating. The aircraft was equipped with an Advanced Life Support kit, and specific considerations for medical equipment compliance were made. Special cases, including patients with on-going chemotherapy and end-stage kidney disease, underwent fit-to-fly screening. The boarding process in Lublin, Poland involved triage and arrangements for passengers with gastroenteric symptoms. Notably, 22 passengers with recent episodes of illness were isolated. The successful operation, demonstrating the viability of evacuating vulnerable individuals via commercial airlines, underscores the importance of precise planning and coordination in crisis situations.