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Use of an improvised portable reusable heat exchanger for warming IV fluids
97
NAEMSP ANNUAL MEETING ABSTRACTS
all simulated ambulance patients, there were no significant differences for 4 out of the 6 vehicles. For the two vehicles that demonstrated a difference, EMTs showed greater accuracy than EMT-Ps for one of the two. Preliminary analysis revealed a tendency for underestimation to exceed the overestimation. For all vehicles, 17 estimates (of a possible 270) were correct or within one pound of the actual weight. SPSS was used to analyze the data. Pearson’s correlation, t tests, and chi-square were used. Number of years of experience was associated with the highest degree of accuracy, followed by age. There were no significant differences in the level of training. When the level of training was controlled, the association of experience and age with accuracy remained. Conclusion: There is no difference in the accuracy of weight estimation of adult patients in the prehospital setting with respect to level of training. 49 USE OF AN IMPROVISED PORTABLE REUSABLE HEAT EXCHANGER FOR WARMING IV FLUIDS Richard B. Schwartz, Douglas Olson, Brad Z. Reynolds, Medical College of Georgia Objective: In military and wilderness settings, warming IV fluids can be very difficult. We proposed that IV fluids could be warmed sufficiently (at the time of use) by an improvised heat exchanger. Methods: The heat pack is made from a solution of sodium acetate in a sealed flexible plastic cover. When activated the heat pack becomes a semi-solid and warms to a temperature of approximately 548C. We wrapped this heat pack with IV extension tubing of various lengths and placed it in an insulated bag to create the heat exchanger. Liter bags of normal saline and the heat packs were cooled overnight in a refrigerated room to a temperature of 7.58C. Length of IV extension tubing and the flow rate were both varied. Trials were run to determine the ideal length of tubing to achieve optimal fluid temperature at variable flow rates. Results: Two trials were run, the first with 5.5 meters of extension tubing and the second with 11 meters of extension tubing. In each trial normal saline was infused at 100 cc/hr, 500 cc/hr, and at bolus rate. In the first trial at 100 cc/hr the maximal temperature of 448 was reached at 21 minutes. At 30 minutes the temperature was 43.28. The maximal temperature of the 500 cc/hr infusion was 37.98 at 9 minutes and the temperature at 30 minutes was 32.28. The maximal temperature at the bolus infusion rate was 22.48 at 9 minutes and the liter was infused in 10 minutes with a final temperature of 22.18. In the second trial at 100 cc/hr the maximal temperature was 40.18, and it was reached at 21 minutes. At 30 minutes the temperature was 38.48. The maximal temperature of the 500 cc/hr infusion was 35.68 at 18 minutes and the temperature at 30 minutes was 33.98. The maximal temperature at the bolus infusion rate was 30.68 at 10 minutes and the liter was infused in 13 minutes with a final temperature of 30.38. Conclusion: An improvised, commercially available, portable heat exchanger will warm IV fluids at the time of infusion. 50 WEAPONS
MASS DESTRUCTION PREPAREDNESS AND REXIV PAN-AMERICAN GAMES, SANTO DOMINGO 2003 Amado A. Baez, Matthew D. Sztajnkrycer, Humberto H. Perez-Compres, Ediza M. Giraldez, Mayo Graduate School of Medicine OF
SPONSE FOR THE
Objective: From August 11 to 17, 2003, Santo Domingo, Dominican Republic, hosted the XIV Pan-American Games. With the participation of 42 nations, and the presence of nearly 10,000 athletes, trainers, and foreign dignitaries, the event is considered the fourth most important athletic competition in the world. Methods: Under the aegis of the Security Directorate, and with support from national and international security agencies, a Weapons of Mass Destruction (WMD) unit was developed and deployed for the games. Results: The Unit command structure utilized the standard military command format of S1-S5 codes, designating Personnel, Intelligence, Planning-Operations, Logistics, and Communication Officers, respectively. For operational support two strike teams (Alpha and Bravo) were active at any given time, each team consisting of 5 members (team leader, field physician, explosive ordinance officer, and two tactical officers). One civilian and two military hospitals were the designated receiving centers for the event. With the assistance of the WMD unit, ED staff were trained in WMDevent management and decontamination procedures. An initial 40-hour instructor ‘‘train-the-trainer’’ program was created, directed towards 100 military officers, who subsequently trained the more than 500 WMD first responders. An encrypted Web-based program was developed to assist in bioterrorism epidemiological surveillance, recording patient demographics and assessing chief complaints against those expected from CDC Category A bioterrorism agents. To complement standard chemical and biological detection kits, live animals were used as biological monitoring stations. Indigenous fish were employed to monitor the water supply, while small birds were strategically placed throughout the locale, under constant video surveillance. Technicians from the Dominican Nuclear and Atomic Affairs Commission performed radiation monitoring in the Pan-American Village as well the Olympic Stadium during the opening and closing ceremony of the Games. Conclusion: In part due to the extensive pre-planning and development of the WMD unit, the games were uneventful and a true success.
51 AN EMS TRANSFER AUTHORIZATION CENTRE IN RESPONSE TO TORONTO SARS OUTBREAK Bruce Farr, Michael Neill, John Loch, Russell D. MacDonald, Bruce Sawadsky, Chris Mazza, Karim Daya, Chris Olynyk, Sandra Chad, Toronto EMS THE
Objective: To describe the rapid development and implementation of an innovative EMS command, control, and tracking system to mitigate the risk of iatrogenic spread of SARS amongst health care facilities, health care workers, and patients in Ontario, Canada, due to interfacility patient transfers. Methods: A working group of stakeholders in health care and transport medicine developed and implemented a medically-based command and control centre for all interfacility (including acute and long-term care) patient transfers in Ontario, Canada. Development and implementation took place in three distinct but overlapping phases: needs assessment, design and implementation, and expansion and ongoing operations. Results: The needs assessment, design, and implementation were completed in less than 48 hours using existing EMS infrastructure and
NAEMSP ANNUAL MEETING ABSTRACTS
all simulated ambulance patients, there were no significant differences for 4 out of the 6 vehicles. For the two vehicles that demonstrated a difference, EMTs showed greater accuracy than EMT-Ps for one of the two. Preliminary analysis revealed a tendency for underestimation to exceed the overestimation. For all vehicles, 17 estimates (of a possible 270) were correct or within one pound of the actual weight. SPSS was used to analyze the data. Pearson’s correlation, t tests, and chi-square were used. Number of years of experience was associated with the highest degree of accuracy, followed by age. There were no significant differences in the level of training. When the level of training was controlled, the association of experience and age with accuracy remained. Conclusion: There is no difference in the accuracy of weight estimation of adult patients in the prehospital setting with respect to level of training. 49 USE OF AN IMPROVISED PORTABLE REUSABLE HEAT EXCHANGER FOR WARMING IV FLUIDS Richard B. Schwartz, Douglas Olson, Brad Z. Reynolds, Medical College of Georgia Objective: In military and wilderness settings, warming IV fluids can be very difficult. We proposed that IV fluids could be warmed sufficiently (at the time of use) by an improvised heat exchanger. Methods: The heat pack is made from a solution of sodium acetate in a sealed flexible plastic cover. When activated the heat pack becomes a semi-solid and warms to a temperature of approximately 548C. We wrapped this heat pack with IV extension tubing of various lengths and placed it in an insulated bag to create the heat exchanger. Liter bags of normal saline and the heat packs were cooled overnight in a refrigerated room to a temperature of 7.58C. Length of IV extension tubing and the flow rate were both varied. Trials were run to determine the ideal length of tubing to achieve optimal fluid temperature at variable flow rates. Results: Two trials were run, the first with 5.5 meters of extension tubing and the second with 11 meters of extension tubing. In each trial normal saline was infused at 100 cc/hr, 500 cc/hr, and at bolus rate. In the first trial at 100 cc/hr the maximal temperature of 448 was reached at 21 minutes. At 30 minutes the temperature was 43.28. The maximal temperature of the 500 cc/hr infusion was 37.98 at 9 minutes and the temperature at 30 minutes was 32.28. The maximal temperature at the bolus infusion rate was 22.48 at 9 minutes and the liter was infused in 10 minutes with a final temperature of 22.18. In the second trial at 100 cc/hr the maximal temperature was 40.18, and it was reached at 21 minutes. At 30 minutes the temperature was 38.48. The maximal temperature of the 500 cc/hr infusion was 35.68 at 18 minutes and the temperature at 30 minutes was 33.98. The maximal temperature at the bolus infusion rate was 30.68 at 10 minutes and the liter was infused in 13 minutes with a final temperature of 30.38. Conclusion: An improvised, commercially available, portable heat exchanger will warm IV fluids at the time of infusion. 50 WEAPONS
MASS DESTRUCTION PREPAREDNESS AND REXIV PAN-AMERICAN GAMES, SANTO DOMINGO 2003 Amado A. Baez, Matthew D. Sztajnkrycer, Humberto H. Perez-Compres, Ediza M. Giraldez, Mayo Graduate School of Medicine OF
SPONSE FOR THE
Objective: From August 11 to 17, 2003, Santo Domingo, Dominican Republic, hosted the XIV Pan-American Games. With the participation of 42 nations, and the presence of nearly 10,000 athletes, trainers, and foreign dignitaries, the event is considered the fourth most important athletic competition in the world. Methods: Under the aegis of the Security Directorate, and with support from national and international security agencies, a Weapons of Mass Destruction (WMD) unit was developed and deployed for the games. Results: The Unit command structure utilized the standard military command format of S1-S5 codes, designating Personnel, Intelligence, Planning-Operations, Logistics, and Communication Officers, respectively. For operational support two strike teams (Alpha and Bravo) were active at any given time, each team consisting of 5 members (team leader, field physician, explosive ordinance officer, and two tactical officers). One civilian and two military hospitals were the designated receiving centers for the event. With the assistance of the WMD unit, ED staff were trained in WMDevent management and decontamination procedures. An initial 40-hour instructor ‘‘train-the-trainer’’ program was created, directed towards 100 military officers, who subsequently trained the more than 500 WMD first responders. An encrypted Web-based program was developed to assist in bioterrorism epidemiological surveillance, recording patient demographics and assessing chief complaints against those expected from CDC Category A bioterrorism agents. To complement standard chemical and biological detection kits, live animals were used as biological monitoring stations. Indigenous fish were employed to monitor the water supply, while small birds were strategically placed throughout the locale, under constant video surveillance. Technicians from the Dominican Nuclear and Atomic Affairs Commission performed radiation monitoring in the Pan-American Village as well the Olympic Stadium during the opening and closing ceremony of the Games. Conclusion: In part due to the extensive pre-planning and development of the WMD unit, the games were uneventful and a true success.
51 AN EMS TRANSFER AUTHORIZATION CENTRE IN RESPONSE TO TORONTO SARS OUTBREAK Bruce Farr, Michael Neill, John Loch, Russell D. MacDonald, Bruce Sawadsky, Chris Mazza, Karim Daya, Chris Olynyk, Sandra Chad, Toronto EMS THE
Objective: To describe the rapid development and implementation of an innovative EMS command, control, and tracking system to mitigate the risk of iatrogenic spread of SARS amongst health care facilities, health care workers, and patients in Ontario, Canada, due to interfacility patient transfers. Methods: A working group of stakeholders in health care and transport medicine developed and implemented a medically-based command and control centre for all interfacility (including acute and long-term care) patient transfers in Ontario, Canada. Development and implementation took place in three distinct but overlapping phases: needs assessment, design and implementation, and expansion and ongoing operations. Results: The needs assessment, design, and implementation were completed in less than 48 hours using existing EMS infrastructure and