- Email: [email protected]
176
Research Forum Abstracts of CNP in settings that suggest the diagnosis and enable appropriate decisions to be made regarding CNP antidotal and supportive treatments.
175
An International Survey of Emergency Physicians’ Knowledge, Use, and Attitudes Towards the Canadian C-Spine Rule
Stiell IG, Eagles D, Clement CM, Brehaut J, Kelly A, Mason S, Kellerman A, Perry JJ/University of Ottawa, Ottawa, Ontario, Canada; Western Hospital, Footscray, Australia; University of Sheffield, Sheffield, United Kingdom; Emory University, Atlanta, GA
Study objectives: The derivation and validation of the Canadian C-Spine Rule (CCR) has been published in emergency medicine and general medical journals. Little, however, is known of its international diffusion and use. The purpose of this study was to determine the knowledge, attitudes and behaviour of emergency physicians (EPs) in Australasia, Canada, the UK and US regarding the CCR. Methods: A prospectively conducted self-administered email and postal survey was sent to members of 4 national EP associations using a modified Dillman technique. Random samples of members from ACEM (Australasia), CAEP (Canada), BAEM (UK) and ACEP (US) were sent a prenotification letter followed by at least 4 mailouts. Awareness, use and attitudes regarding the CCR were analyzed using descriptive and univariate statistics with 95% CIs. Results: Overall, 1043 (35.1%) responses were received. Physician demographics included: 74% male, mean age of 46 years and mean of 16 years’ experience. Conclusion: There is a very high level of knowledge of the CCR in all study countries except Australasia. The CCR was viewed favourably across multiple measured dimensions. Usage, however, varied significantly by country with Australasian EPs reporting the least use. A better understanding of the factors related to increased use of decision rules will facilitate strategies to enhance derivation, dissemination and implementation of future rules.
176
Safety of Hydroxocobalamin Use in the Prehospital Setting as an Antidote for Smoke InhalationAssociated Cyanide Poisoning
Baud F, Borron S/Hospital Lariboisiere Universite Paris, France; University of Texas Health Science Center, San Antonio, TX
Study Objectives: The cyanide antidote hydroxocobalamin was approved in France in 1996 and is under study for possible introduction in the United States. A retrospective study assessed the safety of hydroxocobalamin use in smoke inhalation victims with suspected cyanide poisoning who were admitted to intensive care units (ICUs) at the Fernand Widal and Lariboisie`re Hospitals in Paris, France. Methods: The study was a retrospective review of case records of patients admitted to ICUs who were treated with hydroxocobalamin at the fire scene and/or upon admission to the hospital following smoke inhalation from structural fires. Prehospital and hospital medical records between 1988 and 2004 were reviewed (subjects that had been part of a previous prospective study by the authors were excluded). Reports of hydroxocobalaminassociated adverse events arising during prehospital or hospital care and other available data (circumstances of smoke exposure, extent of prehospital care, hydroxocobalamin administration, carboxyhemoglobin and cyanide concentrations, patients’ demographics, clinical status pre- and post-antidote treatment and vital signs) were summarized with descriptive statistics based on the total number of patients with available data for the relevant measure. Results: Data for 61 patients (mean age 54.3 years; 51% female) administered hydroxocobalamin were reviewed. The mean blood cyanide concentration (SD) was 45.1 (51.3) mol/L (median value of 23.5, range 3.1-165.0 mol/L). Thirty four patients (56%) received hydroxocobalamin only at the fire scene, 11 patients (18%) received hydroxocobalamin only at the hospital ICU, and 16 patients (26%) received hydroxocobalamin at both sites. Hydroxocobalamin dosing varied: 36 patients (59%)
Volume , . : October
received a single dose of 5 grams, 12 patients (20%) received a total of 10 grams of hydroxocobalamin, and six patients (9.8%) received a total of 15 grams of hydroxocobalamin. For patients administered hydroxocobalamin both at the fire scene and the ICU, the mean dose (SD) was 7.1 (3.5) grams. Thirty-four (34) subjects (56%) survived and were discharged, 24 (39%) subjects died either in the ICU or in other hospital departments, and outcomes were unavailable for three patients (5%). Sixteen patients (26.2%) experienced 21 adverse events considered as possibly related to hydroxocobalamin treatment: discoloration of urine (n⫽12), skin discoloration [red to pink skin] (n⫽5), red colored plasma (n⫽2), hypertension (n⫽1), and eyelid edema (n⫽1). Incidence of adverse events was not related to hydroxocobalamin dose. No serious adverse reaction was reported for any dosage of hydroxocobalamin. Conclusion: Hydroxocobalamin has a safety profile compatible with use in prehospital settings and ICUs for management of acute cyanide poisoning caused by smoke inhalation.
177
Does the Presence of Physicians at Professional Football Games Reduce the Number of Patient Transports?
Pozner CN, Levine M, Listwa T, Barker T, Zane R, Pallin D/Brigham and Women’s Hospital, Boston, MA; Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA
Study Objectives: We attempted to determine if physician staffing for fans at NFL football games reduces the need for Emergency Department (ED) evaluation. Methods: A physician, nurse, and a variety of prehospital providers staff the four first-aid stations at Gillette Stadium. Two PGY 2-4 emergency medicine (EM) residents and two EM attendings staffed each per game. We pre-defined 9 chief complaints that mandate ED evaluation per Massachusetts Emergency Medical Services (EMS) protocol at the advanced life support (ALS) level, including: altered mental status, chest pain, shortness of breath, diabetic-related emergencies, alcohol intoxication, syncope, multi-system trauma, lacerations requiring suturing, allergic reactions, and any other patient who received care at the ALS level. We reviewed all patient encounters for the 2003-2005 seasons. Patients who met the above criteria, but were not transported were considered “averted” transports. Results: During the study period, 1693 patients received care in the first aid rooms. The most common complaints were headache (435), lacerations/abrasions (411), orthopedic injuries (205), and gastrointestinal complaints including nausea, or vomiting (155). Of these 1693 patients, 866 received medication, the most common of which were: ibuprofen (289), acetaminophen (247), antacids (92), salicylates (59), and crystalloid fluids (30). A total of 156 patients received prescription medications. Seven patients were provided a written prescription upon discharge from care. Thirty patients were sutured, 5 had dislocations reduced, and 12 required eye irrigation. Two hundred and twenty-eight patients met the pre-defined criteria. Of these, 22 left against medical advice, Of the remaining 206, 56 (24.8%) were transported to an ED. Forty patients with complaints that did not meet the predefined criteria including head/face trauma, orthopedic injuries, burns, or abdominal pain, were also transported for further evaluation. Thirteen patients received intravenous fluids, but were not transported. Presentations that required ED evaluation were: altered mental status (5 evaluated, 3 transported), chest pain/shortness of breath (59 evaluated, 17 transported), diabetes- related (11 evaluated, 1 transported), alcohol intoxication (52 evaluated, 11 transported), syncope (35 evaluated, 11 transported), lacerations requiring suturing (31 evaluated, 1 transported), and allergic reactions (18 evaluated, 3 transported). All four patients with multi-system trauma were transported. Thus, a total of 155 (75.2%) were considered “averted” transports. Conclusion: On-site physician management of fan injuries at NFL football games resulted in 155 patients avoiding ED evaluation. Further analysis is needed to determine if this strategy is cost-effective.
178
Traffic Injury Surveillance Study for Children in Kurume, Japan
Nagata T, Yamashita H, Shima H, Yeong-Su J/Saint Mary’s Hospital, Kurume, Japan; Takemi Program in International Health, Harvard School of Public Health, Boston, MA
Introduction: Traffic injuries are the leading cause of death in population aged between 1 and 18 in Japan. This study aimed to investigate the epidemiological characteristics of road traffic injuries in children.
Annals of Emergency Medicine S55
175
An International Survey of Emergency Physicians’ Knowledge, Use, and Attitudes Towards the Canadian C-Spine Rule
Stiell IG, Eagles D, Clement CM, Brehaut J, Kelly A, Mason S, Kellerman A, Perry JJ/University of Ottawa, Ottawa, Ontario, Canada; Western Hospital, Footscray, Australia; University of Sheffield, Sheffield, United Kingdom; Emory University, Atlanta, GA
Study objectives: The derivation and validation of the Canadian C-Spine Rule (CCR) has been published in emergency medicine and general medical journals. Little, however, is known of its international diffusion and use. The purpose of this study was to determine the knowledge, attitudes and behaviour of emergency physicians (EPs) in Australasia, Canada, the UK and US regarding the CCR. Methods: A prospectively conducted self-administered email and postal survey was sent to members of 4 national EP associations using a modified Dillman technique. Random samples of members from ACEM (Australasia), CAEP (Canada), BAEM (UK) and ACEP (US) were sent a prenotification letter followed by at least 4 mailouts. Awareness, use and attitudes regarding the CCR were analyzed using descriptive and univariate statistics with 95% CIs. Results: Overall, 1043 (35.1%) responses were received. Physician demographics included: 74% male, mean age of 46 years and mean of 16 years’ experience. Conclusion: There is a very high level of knowledge of the CCR in all study countries except Australasia. The CCR was viewed favourably across multiple measured dimensions. Usage, however, varied significantly by country with Australasian EPs reporting the least use. A better understanding of the factors related to increased use of decision rules will facilitate strategies to enhance derivation, dissemination and implementation of future rules.
176
Safety of Hydroxocobalamin Use in the Prehospital Setting as an Antidote for Smoke InhalationAssociated Cyanide Poisoning
Baud F, Borron S/Hospital Lariboisiere Universite Paris, France; University of Texas Health Science Center, San Antonio, TX
Study Objectives: The cyanide antidote hydroxocobalamin was approved in France in 1996 and is under study for possible introduction in the United States. A retrospective study assessed the safety of hydroxocobalamin use in smoke inhalation victims with suspected cyanide poisoning who were admitted to intensive care units (ICUs) at the Fernand Widal and Lariboisie`re Hospitals in Paris, France. Methods: The study was a retrospective review of case records of patients admitted to ICUs who were treated with hydroxocobalamin at the fire scene and/or upon admission to the hospital following smoke inhalation from structural fires. Prehospital and hospital medical records between 1988 and 2004 were reviewed (subjects that had been part of a previous prospective study by the authors were excluded). Reports of hydroxocobalaminassociated adverse events arising during prehospital or hospital care and other available data (circumstances of smoke exposure, extent of prehospital care, hydroxocobalamin administration, carboxyhemoglobin and cyanide concentrations, patients’ demographics, clinical status pre- and post-antidote treatment and vital signs) were summarized with descriptive statistics based on the total number of patients with available data for the relevant measure. Results: Data for 61 patients (mean age 54.3 years; 51% female) administered hydroxocobalamin were reviewed. The mean blood cyanide concentration (SD) was 45.1 (51.3) mol/L (median value of 23.5, range 3.1-165.0 mol/L). Thirty four patients (56%) received hydroxocobalamin only at the fire scene, 11 patients (18%) received hydroxocobalamin only at the hospital ICU, and 16 patients (26%) received hydroxocobalamin at both sites. Hydroxocobalamin dosing varied: 36 patients (59%)
Volume , . : October
received a single dose of 5 grams, 12 patients (20%) received a total of 10 grams of hydroxocobalamin, and six patients (9.8%) received a total of 15 grams of hydroxocobalamin. For patients administered hydroxocobalamin both at the fire scene and the ICU, the mean dose (SD) was 7.1 (3.5) grams. Thirty-four (34) subjects (56%) survived and were discharged, 24 (39%) subjects died either in the ICU or in other hospital departments, and outcomes were unavailable for three patients (5%). Sixteen patients (26.2%) experienced 21 adverse events considered as possibly related to hydroxocobalamin treatment: discoloration of urine (n⫽12), skin discoloration [red to pink skin] (n⫽5), red colored plasma (n⫽2), hypertension (n⫽1), and eyelid edema (n⫽1). Incidence of adverse events was not related to hydroxocobalamin dose. No serious adverse reaction was reported for any dosage of hydroxocobalamin. Conclusion: Hydroxocobalamin has a safety profile compatible with use in prehospital settings and ICUs for management of acute cyanide poisoning caused by smoke inhalation.
177
Does the Presence of Physicians at Professional Football Games Reduce the Number of Patient Transports?
Pozner CN, Levine M, Listwa T, Barker T, Zane R, Pallin D/Brigham and Women’s Hospital, Boston, MA; Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA
Study Objectives: We attempted to determine if physician staffing for fans at NFL football games reduces the need for Emergency Department (ED) evaluation. Methods: A physician, nurse, and a variety of prehospital providers staff the four first-aid stations at Gillette Stadium. Two PGY 2-4 emergency medicine (EM) residents and two EM attendings staffed each per game. We pre-defined 9 chief complaints that mandate ED evaluation per Massachusetts Emergency Medical Services (EMS) protocol at the advanced life support (ALS) level, including: altered mental status, chest pain, shortness of breath, diabetic-related emergencies, alcohol intoxication, syncope, multi-system trauma, lacerations requiring suturing, allergic reactions, and any other patient who received care at the ALS level. We reviewed all patient encounters for the 2003-2005 seasons. Patients who met the above criteria, but were not transported were considered “averted” transports. Results: During the study period, 1693 patients received care in the first aid rooms. The most common complaints were headache (435), lacerations/abrasions (411), orthopedic injuries (205), and gastrointestinal complaints including nausea, or vomiting (155). Of these 1693 patients, 866 received medication, the most common of which were: ibuprofen (289), acetaminophen (247), antacids (92), salicylates (59), and crystalloid fluids (30). A total of 156 patients received prescription medications. Seven patients were provided a written prescription upon discharge from care. Thirty patients were sutured, 5 had dislocations reduced, and 12 required eye irrigation. Two hundred and twenty-eight patients met the pre-defined criteria. Of these, 22 left against medical advice, Of the remaining 206, 56 (24.8%) were transported to an ED. Forty patients with complaints that did not meet the predefined criteria including head/face trauma, orthopedic injuries, burns, or abdominal pain, were also transported for further evaluation. Thirteen patients received intravenous fluids, but were not transported. Presentations that required ED evaluation were: altered mental status (5 evaluated, 3 transported), chest pain/shortness of breath (59 evaluated, 17 transported), diabetes- related (11 evaluated, 1 transported), alcohol intoxication (52 evaluated, 11 transported), syncope (35 evaluated, 11 transported), lacerations requiring suturing (31 evaluated, 1 transported), and allergic reactions (18 evaluated, 3 transported). All four patients with multi-system trauma were transported. Thus, a total of 155 (75.2%) were considered “averted” transports. Conclusion: On-site physician management of fan injuries at NFL football games resulted in 155 patients avoiding ED evaluation. Further analysis is needed to determine if this strategy is cost-effective.
178
Traffic Injury Surveillance Study for Children in Kurume, Japan
Nagata T, Yamashita H, Shima H, Yeong-Su J/Saint Mary’s Hospital, Kurume, Japan; Takemi Program in International Health, Harvard School of Public Health, Boston, MA
Introduction: Traffic injuries are the leading cause of death in population aged between 1 and 18 in Japan. This study aimed to investigate the epidemiological characteristics of road traffic injuries in children.
Annals of Emergency Medicine S55