252 Use of a Videolaryngoscope Amongst Emergency Medical Services Personnel

Research Forum Abstracts resources, emergency medicine attending physicians perform the key task of obtaining clinical information. Methods: An observational study was conducted at an urban, university-affiliated hospital and trauma center, which is home to an emergency medicine residency program. Eight faculty physicians were observed and audio recorded in 4-hour sessions (32 hours total) while on their shift. The data were analyzed for the information resources used, the time spent on each information source, and the resources used per patient. This study was approved by the institutional review board, and written consent was collected from each participant prior to observation. Information sources were categorized as electronic sources, Internet, paper-based documents, oral communication with patients or with other physicians, or other. Electronic sources included the electronic health record system and track board. Oral communication included: (i) information collected by asking for information or consultation with colleagues, nurses, and staff; (ii) listening to information presented by colleagues nurses, and staff; and (iii) speaking directly with patients. Other information gathering activities included physical examination, observation and direct supervision of residents, and review of patient information and diagnostic results. Physicians’ actions, location, and time spent on these information seeking activities were recorded simultaneously by an observer and by audio recording. Data were annotated based on action, collaborator, content, patients, and duration, and categorized as various information foraging actions. Results: The average time spent gathering information was 182.4 minutes per physician per 4 hour session, accounting for 55.9% (174.6 min, s.d⫽57.8 min) of the total time observed. Oral communication (49.5%, s.d.⫽ 9.7%) was the predominant means of gathering information. Specific forms of oral communication included: 21.8% of time spent hearing resident presentations, and 19.2% was spent communicating with patients. Use of electronic sources accounted for 14% of the time spent gathering information. Time spent on paper resources was minimal. Conclusions: Our findings that half of an emergency physician’s time is spent gathering information, with human communication accounting for over half of that time, suggest that physician attention must focus on strategies to foster and support effective oral information exchange. The challenge for ED information support is how to make information available in a timely and efficient manner. Our ongoing efforts include greater understanding of the content and structure of these interpersonal exchanges and the ways in which this information can be made accessible through trackboards or other technologies.

251

Pediatric and Young Adult Injuries Sustained While Ice Skating at an Urban Temporary Rink: A Prospective Observational Study

Cleary K, Levine D/NYU Langone Medical Center/Bellevue Hospital, New York, NY

Study Objective: Ice skating is a popular recreational sport, particularly during the winter season in temperate climates. There have been no known studies to date describing the injuries sustained at an individual temporary ice rink in the United States. The objective of this study is to identify patients who present to the pediatric emergency department with ice skating injuries sustained at an urban temporary ice skating rink, which has free admission for the public. The purpose is to examine the patient characteristics, patterns of injury and resource utilization of these injuries. Methods: This study was a prospective observational study from October 1, 2011 through February 28, 2012. Cases were selected by identifying patients at triage who had sustained injuries while ice skating at a particular temporary ice skating rink. Once patients under 25 years of age with injury from ice skating were identified, the pediatric emergency attending/fellow or pediatric/emergency department resident consented the patient/assented minors and asked the patient the questions on the data collection sheet. Results: A total of 95 patients were enrolled. The average age of patients who sustained an injury was 14.3 years old. Fifty-three patients (56%) were female. Fiftyone injuries (54%) were sustained during the evening hours (6PM-12AM), and 90 injuries (95%) occurred after noon. Fifty-seven injuries (60%) occurred on Friday, Saturday, or Sunday. Twenty-two patients (23%) had lacerations. Twenty-six patients (27%) sustained fractures. The lower extremities were injured in 35 patients (37%) followed by the head/neck in 34 patients (36%) followed by 23 patients (24%) with upper extremity injuries. Only one patient (1.1%) was wearing protective gear. Thirty-eight skaters (40%) were novices (never skated before), and 67 patients (71%) have skated less than ten times in their lives. One patient was admitted, and 31 patients (33%) required a consult service in the emergency department. Fifty-two patients (55%) required some follow-up. The average length of stay in the emergency department was 2.8 hours.

Volume , .  : October 

Conclusion: We can conclude from this study that injured skaters from one urban temporary ice skating rink evaluated at this institution’s pediatric emergency department were novice skaters, not wearing any protective gear. Furthermore, preliminary data analysis suggests that the evening hours on weekends were the time frames during which the most injuries occurred. This may pose a significant public health concern for individuals ice skating at this temporary ice skating rink. In addition, patients with injuries from ice skating at this one particular rink accrued 254 hours of patient care in the pediatric emergency department, which is a large utilization of resources.

252

Use of a Videolaryngoscope Amongst Emergency Medical Services Personnel

Corfield AR, Thomson S, Daly S, Curatolo L, Kennedy A, Proctor J, Sinclair N, EMRS Research group/Royal Alexandra Hospital, Paisley, United Kingdom; Southern General Hospital, Glasgow, United Kingdom; Emergency Medical Retrieval Service, Glasgow, United Kingdom

Study Objectives: Video laryngoscopy is becoming a more widely used aid to tracheal intubation in emergency medicine. Aeromedical emergency medical services teams work in clinically isolated environments, often dealing with polytrauma patients. Polytrauma patients often have difficult airways due to cervical immobilisation and facial trauma. Video laryngoscopy may be a useful tool to augment advanced airway skills in this setting. The study aim was to ascertain if video laryngoscopy is more effective than standard laryngoscopy in a simulated difficult scenario amongst aeromedical emergency medical services team members. Methodology: A 3-way randomised crossover trial was conducted amongst all medical and paramedical staff in a national aeromedical emergency medical services. All participants were competent intubators using standard oral intubation techniques and a MacIntosh laryngoscope. All participants were given a brief written tutorial on the use of each video laryngoscope. Participants were randomised to conduct 3 intubations in a different sequence. In all scenarios a Laerdal Sim-man was set up with the tongue inflated and a Laerdal Stiffneck adjustable collar fitted to limit neck movement, to simulate a difficult intubation scenario. The 3 devices used were MacIntosh laryngoscope with size 4 blade, Glidescope Ranger (GLR) videolaryngoscope and McGrath EMS (MEMS) videolaryngoscope (Aircraft Medical Systems, Edinburgh). Outcome measures: Primary: Success of intubation and time to intubation. Success of intubation was defined as confirmed placement of endotracheal tube. Time to intubation was defined as time from intubator stating they were happy to commence until time when intubator stated that the tube was correctly placed. Secondary: Ease of use score (Visual analogue score). Ease of use score was marked on an unmarked 100mm strip by the intubator immediately after completion of the intubation. The mark was then measured by the study invigilator. Results: Twenty five participants entered and completed the study. Outcome measures for each group are given in Table 1. Conclusion: Our data shows that in a simulated difficult airway scenario, members of an aeromedical critical care team were able to intubate a mannequin significantly more often using with a MEMS videolaryngoscope or GLR videolaryngoscope compared with a Standard MacIntosh laryngoscope. Participants found a MEMS videolaryngoscope as easy to use as a standard laryngoscope. Participants found a GLR videolaryngoscope significantly less easy to use compared with either a MEMS videolaryngoscope or MacIntosh laryngoscope. Intubation using MEMS or GLR took significantly longer than with a MacIntosh laryngoscope. This study supports a further evaluation of videolaryngoscopy in a clinical EMS scenario. Results of Intubation using 3 different techniques

p

Mean time to intubation (seconds)

11 (44%) 19 (76%)

18 (72%)

Number of successful intubations Standard MacIntosh MacGrath EMS videolaryngoscope (MEMS) Glidescope Ranger Videolaryngoscope (GLR)

p

Visual Analogue Score

p

⬍0.01

52 115

⬍0.01

28 33

0.51

⬍0.01

116

⬍0.01

44

0.01

Annals of Emergency Medicine S91