POSTER 15
NEUROMUSCULAR BLOCKADE FOR PEDIATRIC INTUBATIONS BY A HELICOPTER AMBULANCE PROGRAM William Fales, Kenneth Robinson, John Skiendzielewski L i f e F l i g h t , Geisinger Medical Center D a n v i l l e , PA 17822-2005 INTRODUCTION: Neuromuscular blockade (NMB)-assisted emergency endotracheal i n t u b a t i o n has been shown to be safe and e f f e c t i v e in the a d u l t p o p u l a t i o n . It has been recommended f o r use in p e d i a t r i c p a t i e n t s despite l i m i t e d published c l i n i c a l data supporting i t s use. We report the experience of a r u r a l h e l i c o p t e r ambulance program using NMB-assisted i n t u b a t i o n s in the p e d i a t r i c p o p u l a t i o n . METHODS: The records of a r u r a l a i r ambulance program were reviewed f o r a 3 year p e r i o d ( 4 / 8 9 to 3 / 9 2 ) . NMB-assisted p e d i a t r i c i n t u b a t i o n s by the h e l i c o p t e r medical crew were i d e n t i f i e d . These were analyzed in terms o f : age, type of f l i g h t , medical problem, i n d i c a t i o n f o r i n t u b a t i o n , NMB agent, use of s e d a t i o n , crew composition, o p e r a t o r , number of attempts and c o m p l i c a t i o n s . RESULTS: T h i r t y - t h r e e consecutive cases of NMB-assisted i n t u b a t i o n s were reviewed. I n t u b a t i o n was successful in a l l of the p a t i e n t s . Two (6%) of the procedures involved c o m p l i c a t i o n s . One c o m p l i c a t i o n was bradycardia which responded to a t r o p i n e . The second c o m p l i c a t i o n involved three attempts to place the endotracheal tube. CONCLUSION: NMB can be s a f e l y used by ~ r ~ l personnel to f a c i l i t a t e emergency p e d i a t r i c endotracheal i n t u b ation. F u r t h e r studies w i l l be done to compare p e d i a t r i c i n t u b a t i o n s with and w i t h o u t NMB.
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POSTER 16
UTlUZATION REVIEW FROM A LEVEL 1 TRAUMA CENTER TO IMPROVE SCENE TRIAGE Edward T. Rupert, J. Duncan Harviel, Grace S. Rozycki, Howard R. Champion. MedSTAR, Washington Hospital Center, I10 Irving St. N.W., Washington, D.C. 20010 Introduction: The objectives of this ongoing study are to determine whether providing standardized, comprehensive patient data and survival probabilities from a regional trauma I center to referring emergency care providers: 1) aids in I their evaluation of ongoing scene triage decisions, and 2) ultimately results in decreased overtriage and increased acuity level of patients transferred to trauma centers. Methods: A retrospective review was conducted of 236 adult trauma victims who had been referred from the scene to a Level 1 trauma center by EMS personnel. These patients represented 12 EMS jurisdictions. Admission Injury Severity Score (ISS) and Revised Trauma Score (RTS), mechanism of injury, admission diagnosis and tests performed, surgical procedures performed, consulting services utilized, intensive care unit length of stay (LOS), total hospital LOS, and patient outcome data were collected from admission charts and from the hospitars morbidity and mortality reviews. Survival probabilities were calculated for each patient using the TRISS methodology. Patient data, estimated survival probabilities, and a bar graph showing ISS values were I distributed to the 24 physician and non-physician EMS directors in the 12 EMS jurisdictions represented. Results; Initial telephone followup yielded extremely favorable responses. All respondents viewed the information as invaluable in determining the appropriateness of the decision to transport the patient to a Level I facility. ~Although 75% (18/24) of respondents had difficulty using severity scores to evaluate the triage process, 83% (20/24) indicated that introduction/reinforcement of this concept through educational outreach could improve jurisdictional utilization of trauma centers. Conclusion: Subsequently, the authors initiated several educational outreach activities that, based on these preliminary results, are expected to result in improved scene triage and better utilization of medevacs and trauma center resources.
The Journal of Air Medical Transport • October 1992