- Email: [email protected]
From the Feds: Research, Programs, and Products
FROM THE FEDS
From the Feds: Research, Programs, and Products Laurie Flaherty, RN, MS, Washington, DC Department of Health and Human Services Assessment of Injuries Among Survivors of the Terrorist Attack on the World Trade Center
PUBLIC HEALTH SERVICE
Centers for Disease Control and Prevention (CDC) Emergency Medical System Responses to Suicide-related Calls in Maine
State-specific Mortality from Sudden Cardiac Death–1999
First Pocket-sized EKG Machine Cleared by FDA
Laurie Flaherty, Mid-Maryland Chapter, is Emergency Nurse, Suburban Hospital, Bethesda, Md, and a Contract Employee of the National Highway Traffic Safety Administration in Washington, DC. For reprints, write: Laurie Flaherty, RN, MS, 3519 Rittenhouse St, NW, Washington, DC 20015; E-mail: [email protected]. J Emerg Nurs 2002;28:330-2. Copyright © 2002 by the Emergency Nurses Association. 0099-1767/2002 $35.00 + 0 18/9/124992 doi:10.1067/men.2002.124992
330
Assessment of injuries among survivors of the terrorist attack on the World Trade Center: On September 11, 2001,
two jet aircraft crashed into both the north and south towers of the World Trade Center (WTC), causing thousands of injuries and deaths. To assess the injuries and use of health care services by survivors, the New York City Department of Health conducted a field investigation at the 4 hospitals closest to the crash and a fifth hospital that served as a burn referral center. The data in this report are shared to analyze the types of injuries and illnesses specific to the disaster situation posed by the WTC attack and to anticipate emergency services needed in similar future disasters. Among the 1688 ED patients who received care at the 5 hospitals, 1103 (65%) were survivors treated for injuries or illnesses related to the attack. Among these patients: • 790 were treated within 48 hours of the attack, with 50% receiving care in the first 7 hours, peaking 2 to 3 hours after the attack occurred. • a total of 810 patients (73%) were treated and released from the emergency department, 181 (16%) were admitted for additional treatment, and 4 (0.4%) died during emergency care. • rescue workers arrived later than other survivors and accounted for 59 of the survivors who came to the emergency department during the first 48 hours. • most frequent injuries included 386 patients with inhalation injuries (49%) and 204 ocular injuries (26%).
JOURNAL OF EMERGENCY NURSING
28:4 August 2002
FROM THE FEDS/Flaherty
• most patients treated for fractures (59%), burns (69%), closed head injuries (57%), or crush injuries (75%) were admitted for continuing treatment and care. • a significantly higher percentage of rescue workers sustained ocular injuries than did other survivors (39% versus 19%), and a significantly lower percentage of rescue workers sustained burns (2% versus 6%). It is useful to analyze injuries sustained after events such as the WTC attack, to anticipate emergency services needed after such incidents. Similar to other terrorist attacks on buildings, most survivors of the WTC incident sustained injuries that were treated on an outpatient basis.1,2 As with survivors of the Murrah federal building bombing in Oklahoma City, Oklahoma, the hospital admission rate in New York City was also approximately 20%.1 However, inhalation and ocular injuries were treated more frequently following the WTC attack than after the bombings in Oklahoma City and on the US Marine barracks in Beirut, Lebanon.1,3 Other multicasualty disaster reports commonly describe a first wave of survivors with minor injuries, a second wave of more severely injured survivors, and subsequent waves of survivors rescued during extrication.4 Few survivors of the WTC attack were extricated because of the overwhelming force of the collapse of the 110 story towers. These comparisons may be used to prepare disaster plans for future circumstances. This report also reinforces the need for rapid, standard, electronic data gathering. The rapid assessment of postdisaster injuries strengthens the capacity to prepare for similar subsequent disasters in a timely way. Standardized record keeping, such as the Data Elements for Emergency Department Systems (DEEDS), that facilitate the analysis and comparison process, are an integral part of effective disaster planning and response. Emergency Medical System responses to suicide-related calls in Maine: Suicide is a silent epidemic in the United
1998, 8594 were among white men.5 The numbers are staggering. The human toll on family members left behind cannot begin to be measured. The first step in strategically planning any preventive intervention to combat the problem of suicide is a complete assessment of the problem. The state of Maine, which has a suicide rate 25% higher than the national rate, included EMS data as an integral component of its statewide suicidal behavior surveillance system. Maine’s report, recently published in the CDC’s Morbidity and Mortality Weekly Report, included data collected from more than 2000 run report forms to contribute to the analysis of the problem of suicidal behavior. The report reiterates data found in previous studies in this area: • For females, age-specific rates for EMS response for suicidal behavior was highest among those aged 15 to 19 years; for males, rates were highest for those 20 to 24 years of age. • Among the noninstitutional responses (those not responding to nursing homes, psychiatric, correctional or medical facilities), overdose (29.9%) and laceration (17.7%) were the most commonly documented methods of suicidal gestures, while firearm attempts comprised 3.7%. • Related circumstances included drug/substance abuse (31.7% of reported circumstances), patientreported psychiatric illness (28.8%), and domestic discord or violence (16.8%). Combined with data from emergency departments, hospital discharges, and medical examiners, EMS data can provide information about suicidal acts unavailable from other information sources. Other states attempting to develop suicide prevention strategies may do well to follow Maine’s example in including EMS data in statewide suicidal behavior surveillance systems. State-specific mortality from sudden cardiac death–1999:
States. During the year 1998 alone, 30,575 people committed suicide in this country. Overall, it was the number 8 cause of death during that year, and the third largest cause of death for people 15 to 24 years of age. Of the 3434 suicides among white people aged 15 to 24 years during 1998, 2934 were committed by white males. Of the 10,837 suicides committed by 25- to 44-year-old white people during
Each year in the United States, 400,000 to 460,000 people die of unexpected sudden cardiac death (SCD) in an emergency department or before reaching the hospital.6 The proportion of SCDs that occurs outside hospital walls has increased since 1989. The CDC recently published a report summarizing and analyzing national and state-specific data for the year 1999. This report contains some surprising results:
August 2002 28:4
JOURNAL OF EMERGENCY NURSING
331
FROM THE FEDS/Flaherty
• Women had a higher total number of cardiac deaths (375,243 versus 353,500) and a higher proportion of out-of-hospital cardiac deaths than did men (51.9% versus 41.7%). • SCDs accounted for 75% (10,460) of the 13,873 cardiac disease deaths in persons aged 35 to 44 years. • The proportion of cardiac deaths that occurred outside of the hospital increased with age, from 5.8% in persons aged 0 to 4 years of age to 61% in persons 85 years or older. The finding that cardiac deaths outside of the hospital were more likely to occur among women than men is consistent with findings that women more often delay seeking treatment for heart attack symptoms.7 It also poses some interesting implications for patient care and patient counseling. Most emergency nurses are aware of the classic symptoms and risk factors for heart disease and use them as markers to identify patients more likely to experience cardiac problems. However, the results of this report make it clear that emergency nurses should be alert for atypical symptoms of heart disease, especially among female and relatively young adult patients. Patient teaching should target women and the relatively young, who may be prone to dismissing heart disease as a problem of men and the elderly. Anyone planning prevention programs can use these data to find out how their state compares with national trends, and to target all appropriate populations for cardiac teaching and health maintenance programs.
The implications of using such a device, especially for delivering prehospital cardiac care, are obvious. Early and accurate detection of cardiac problems could mean faster treatment and efficient triage to facilities capable of delivering appropriate cardiac care. As such technology becomes more accessible, it will be possible to move patients more quickly, from chief complaint and diagnosis to care and definitive treatment, and reduce valuable time from symptom to remedy. REFERENCES 1. Hogan DD, Waeckerle JF, Dire DJ, Lillibridge SR. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34:160-7. 2. Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg 1988;208:569-76. 3. Frykberg ER, Tepas JJ, Alexander RH. The 1983 Beirut airport terrorist bombing: injury patterns and implications for disaster management. Ann Surg 1989;55:134-41. 4. Orr SM, Robinson WA. The Hyatt Regency skywalk collapse: an EMS-based disaster response. Ann Emerg Med 1983;12:601-5. 5. Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Stat Rep 1999;48(11). 6. Zheng Z-J, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001;104: 2158-63. 7. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester heart attack study. Arch Intern Med 2000;160:3217-23.
FOOD & DRUG ADMINISTRATION (FDA)
First pocket-sized EKG machine cleared by FDA: The FDA has cleared for marketing the first portable, pocket-sized version of an EKG machine. The device, called the Pocketview ECG, is a miniature version of a standard EKG machine used by health care professionals to record the heart’s electrical signals. The Pocketview consists of the pocketsized EKG device and 12 leads that are placed on the patient’s body. The data recorded by this device can be viewed or transmitted by using special software via mobile phone or other wireless networks to a computer for viewing by additional medical personnel. The Pocketview is capable of storing numerous EKGs and displaying up to 4 separate results on the computer screen for simultaneous comparison.
332
JOURNAL OF EMERGENCY NURSING
28:4 August 2002
From the Feds: Research, Programs, and Products Laurie Flaherty, RN, MS, Washington, DC Department of Health and Human Services Assessment of Injuries Among Survivors of the Terrorist Attack on the World Trade Center
PUBLIC HEALTH SERVICE
Centers for Disease Control and Prevention (CDC) Emergency Medical System Responses to Suicide-related Calls in Maine
State-specific Mortality from Sudden Cardiac Death–1999
First Pocket-sized EKG Machine Cleared by FDA
Laurie Flaherty, Mid-Maryland Chapter, is Emergency Nurse, Suburban Hospital, Bethesda, Md, and a Contract Employee of the National Highway Traffic Safety Administration in Washington, DC. For reprints, write: Laurie Flaherty, RN, MS, 3519 Rittenhouse St, NW, Washington, DC 20015; E-mail: [email protected]. J Emerg Nurs 2002;28:330-2. Copyright © 2002 by the Emergency Nurses Association. 0099-1767/2002 $35.00 + 0 18/9/124992 doi:10.1067/men.2002.124992
330
Assessment of injuries among survivors of the terrorist attack on the World Trade Center: On September 11, 2001,
two jet aircraft crashed into both the north and south towers of the World Trade Center (WTC), causing thousands of injuries and deaths. To assess the injuries and use of health care services by survivors, the New York City Department of Health conducted a field investigation at the 4 hospitals closest to the crash and a fifth hospital that served as a burn referral center. The data in this report are shared to analyze the types of injuries and illnesses specific to the disaster situation posed by the WTC attack and to anticipate emergency services needed in similar future disasters. Among the 1688 ED patients who received care at the 5 hospitals, 1103 (65%) were survivors treated for injuries or illnesses related to the attack. Among these patients: • 790 were treated within 48 hours of the attack, with 50% receiving care in the first 7 hours, peaking 2 to 3 hours after the attack occurred. • a total of 810 patients (73%) were treated and released from the emergency department, 181 (16%) were admitted for additional treatment, and 4 (0.4%) died during emergency care. • rescue workers arrived later than other survivors and accounted for 59 of the survivors who came to the emergency department during the first 48 hours. • most frequent injuries included 386 patients with inhalation injuries (49%) and 204 ocular injuries (26%).
JOURNAL OF EMERGENCY NURSING
28:4 August 2002
FROM THE FEDS/Flaherty
• most patients treated for fractures (59%), burns (69%), closed head injuries (57%), or crush injuries (75%) were admitted for continuing treatment and care. • a significantly higher percentage of rescue workers sustained ocular injuries than did other survivors (39% versus 19%), and a significantly lower percentage of rescue workers sustained burns (2% versus 6%). It is useful to analyze injuries sustained after events such as the WTC attack, to anticipate emergency services needed after such incidents. Similar to other terrorist attacks on buildings, most survivors of the WTC incident sustained injuries that were treated on an outpatient basis.1,2 As with survivors of the Murrah federal building bombing in Oklahoma City, Oklahoma, the hospital admission rate in New York City was also approximately 20%.1 However, inhalation and ocular injuries were treated more frequently following the WTC attack than after the bombings in Oklahoma City and on the US Marine barracks in Beirut, Lebanon.1,3 Other multicasualty disaster reports commonly describe a first wave of survivors with minor injuries, a second wave of more severely injured survivors, and subsequent waves of survivors rescued during extrication.4 Few survivors of the WTC attack were extricated because of the overwhelming force of the collapse of the 110 story towers. These comparisons may be used to prepare disaster plans for future circumstances. This report also reinforces the need for rapid, standard, electronic data gathering. The rapid assessment of postdisaster injuries strengthens the capacity to prepare for similar subsequent disasters in a timely way. Standardized record keeping, such as the Data Elements for Emergency Department Systems (DEEDS), that facilitate the analysis and comparison process, are an integral part of effective disaster planning and response. Emergency Medical System responses to suicide-related calls in Maine: Suicide is a silent epidemic in the United
1998, 8594 were among white men.5 The numbers are staggering. The human toll on family members left behind cannot begin to be measured. The first step in strategically planning any preventive intervention to combat the problem of suicide is a complete assessment of the problem. The state of Maine, which has a suicide rate 25% higher than the national rate, included EMS data as an integral component of its statewide suicidal behavior surveillance system. Maine’s report, recently published in the CDC’s Morbidity and Mortality Weekly Report, included data collected from more than 2000 run report forms to contribute to the analysis of the problem of suicidal behavior. The report reiterates data found in previous studies in this area: • For females, age-specific rates for EMS response for suicidal behavior was highest among those aged 15 to 19 years; for males, rates were highest for those 20 to 24 years of age. • Among the noninstitutional responses (those not responding to nursing homes, psychiatric, correctional or medical facilities), overdose (29.9%) and laceration (17.7%) were the most commonly documented methods of suicidal gestures, while firearm attempts comprised 3.7%. • Related circumstances included drug/substance abuse (31.7% of reported circumstances), patientreported psychiatric illness (28.8%), and domestic discord or violence (16.8%). Combined with data from emergency departments, hospital discharges, and medical examiners, EMS data can provide information about suicidal acts unavailable from other information sources. Other states attempting to develop suicide prevention strategies may do well to follow Maine’s example in including EMS data in statewide suicidal behavior surveillance systems. State-specific mortality from sudden cardiac death–1999:
States. During the year 1998 alone, 30,575 people committed suicide in this country. Overall, it was the number 8 cause of death during that year, and the third largest cause of death for people 15 to 24 years of age. Of the 3434 suicides among white people aged 15 to 24 years during 1998, 2934 were committed by white males. Of the 10,837 suicides committed by 25- to 44-year-old white people during
Each year in the United States, 400,000 to 460,000 people die of unexpected sudden cardiac death (SCD) in an emergency department or before reaching the hospital.6 The proportion of SCDs that occurs outside hospital walls has increased since 1989. The CDC recently published a report summarizing and analyzing national and state-specific data for the year 1999. This report contains some surprising results:
August 2002 28:4
JOURNAL OF EMERGENCY NURSING
331
FROM THE FEDS/Flaherty
• Women had a higher total number of cardiac deaths (375,243 versus 353,500) and a higher proportion of out-of-hospital cardiac deaths than did men (51.9% versus 41.7%). • SCDs accounted for 75% (10,460) of the 13,873 cardiac disease deaths in persons aged 35 to 44 years. • The proportion of cardiac deaths that occurred outside of the hospital increased with age, from 5.8% in persons aged 0 to 4 years of age to 61% in persons 85 years or older. The finding that cardiac deaths outside of the hospital were more likely to occur among women than men is consistent with findings that women more often delay seeking treatment for heart attack symptoms.7 It also poses some interesting implications for patient care and patient counseling. Most emergency nurses are aware of the classic symptoms and risk factors for heart disease and use them as markers to identify patients more likely to experience cardiac problems. However, the results of this report make it clear that emergency nurses should be alert for atypical symptoms of heart disease, especially among female and relatively young adult patients. Patient teaching should target women and the relatively young, who may be prone to dismissing heart disease as a problem of men and the elderly. Anyone planning prevention programs can use these data to find out how their state compares with national trends, and to target all appropriate populations for cardiac teaching and health maintenance programs.
The implications of using such a device, especially for delivering prehospital cardiac care, are obvious. Early and accurate detection of cardiac problems could mean faster treatment and efficient triage to facilities capable of delivering appropriate cardiac care. As such technology becomes more accessible, it will be possible to move patients more quickly, from chief complaint and diagnosis to care and definitive treatment, and reduce valuable time from symptom to remedy. REFERENCES 1. Hogan DD, Waeckerle JF, Dire DJ, Lillibridge SR. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34:160-7. 2. Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg 1988;208:569-76. 3. Frykberg ER, Tepas JJ, Alexander RH. The 1983 Beirut airport terrorist bombing: injury patterns and implications for disaster management. Ann Surg 1989;55:134-41. 4. Orr SM, Robinson WA. The Hyatt Regency skywalk collapse: an EMS-based disaster response. Ann Emerg Med 1983;12:601-5. 5. Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Stat Rep 1999;48(11). 6. Zheng Z-J, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001;104: 2158-63. 7. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester heart attack study. Arch Intern Med 2000;160:3217-23.
FOOD & DRUG ADMINISTRATION (FDA)
First pocket-sized EKG machine cleared by FDA: The FDA has cleared for marketing the first portable, pocket-sized version of an EKG machine. The device, called the Pocketview ECG, is a miniature version of a standard EKG machine used by health care professionals to record the heart’s electrical signals. The Pocketview consists of the pocketsized EKG device and 12 leads that are placed on the patient’s body. The data recorded by this device can be viewed or transmitted by using special software via mobile phone or other wireless networks to a computer for viewing by additional medical personnel. The Pocketview is capable of storing numerous EKGs and displaying up to 4 separate results on the computer screen for simultaneous comparison.
332
JOURNAL OF EMERGENCY NURSING
28:4 August 2002