Fires may be dangerous, but a study of 650 firefighters, paramedics, engineers, inspectors and battalion chiefs from the Tucson Fire Department found most injuries occurred during mandatory, on-the-job exercise.
Researchers from the University of Arizona and Johns Hopkins University analyzed data from the department’s work-related injury database from 2004 to 2009 and found a total of nearly 18 injuries per 100 firefighters annually. Almost 33 percent of injuries occurred during mandatory workouts; transporting patients resulted in almost 17 percent; training drills accounted for just over 11 percent; and fireground operations accounted for about 10 percent.
The vast majority of injuries (96 percent) weren’t serious, mostly sprains and strains, though fire-related injuries tended to be more serious. More than half of the injuries (56 percent) occurred during the beginning of 24-hour shifts, while patient transport injuries produced the largest proportion of lost-time injuries (60 percent). The authors note that of the 902 injuries identified, 45 percent were repeat injuries, which suggests that even minor injuries “when evaluated over the span of a career ... [have] the potential to accumulate and result in some loss of function towards the end of one’s career,” the researchers wrote.
“While most studies indicate the need for improved fitness ... to carry out response activities, efforts should also be concentrated on providing these men and women with improved resources and structure to maintain fitness levels and training-based skills without exposing themselves to injury in those processes,” the authors wrote. The study was published online Nov. 23, 2011, in the journal Injury Prevention.
Shift Work May Up Women’s Odds of Diabetes
Women who work the night shift have a “modestly” higher risk of gaining weight and developing type 2 diabetes, a new study finds. Researchers from Harvard School of Public Health followed 177,000 women who took part in the Nurses’ Health Study I and II. Women were asked how long they worked rotating night shifts, defined as working at least three nights a month in addition to working days and evening shifts.
The longer women worked rotating night shifts, the higher their odds of developing diabetes. Compared to women who reported no rotating shift work, women who worked that schedule for three to nine years were at a 20 percent increased risk of developing diabetes. Women who did 20 years or more of shift work had a 58 percent increased risk. When researchers took into account body mass index (high BMIs are a known risk factor for diabetes), women who worked rotating night shifts were still at increased risk.
The stury was published in the Dec. 6, 2011, issue of PLoS Medicine.
Overdoses of Four Common Meds Sending Seniors to the ED
Two diabetes medications and two blood-thinning agents account for two-thirds of unintentional overdoses that cause seniors to seek emergency care, according to a study in the Nov. 24, 2011, issue of the New England Journal of Medicine.
Researchers from the Centers for Disease Control and Prevention looked at cases of drug-related events that occurred among people aged 65 and older from 2007 to 2009; the data were taken from a nationally representative database. Warfarin was to blame in about one-third (33 percent) of overdoses; 13 percent were due to oral anti-platelet medications; and another 28 percent were due to diabetes meds, including insulin and oral hypoglycemic agents.
Many of the reactions that sent older Americans to EDs were serious. About two-thirds involved changes in mental status such as confusion, loss of consciousness or seizures. “Improving the safe use of the handful of drugs most implicated in emergency hospitalizations has the greatest potential to reduce the most emergency hospitalizations among older Americans,” lead study author Daniel Budnitz, M.D., director of the CDC’s medication safety program, said in a statement.
Prehospital Thrombolytics May Be Key to Improving STEMI Outcomes
Less than 10 percent of ST-segment elevation myocardial infarction (STEMI) patients who need to be transferred from a community hospital to a facility that can perform percutaneous coronary intervention (PCI) are discharged within the recommended 30 minutes, new research shows. The study, published in the Nov. 28, 2011, issue of the Archives of Internal Medicine by researchers at Yale University and colleagues, found that door-in to door-out time was an hour or more for more than half of patients and 90 minutes or longer for 31 percent. Prior research shows that patients have a 56 percent higher risk of dying in the hospital when door-in to door-out times exceed 30 minutes.
Using data on nearly 14,000 patients from more than 1,000 hospitals gathered by the Centers for Medicare and Medicaid Services, the researchers found a median door-in to door-out time of more than one hour, while just 9.7 percent of the hospitals had a median time of 30 minutes or less. Times were longer at hospitals that were small, rural and/or government owned and saw fewer STEMI patients.
Rather than continue to focus mostly on transferring patients more quickly, Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, and editor of the journal, said in an accompanying editorial that a change in tactics is needed. “[This study] makes it clear that there are immovable obstacles to shortening the time to transfer (TTT) to approach the national benchmark of 30 minutes. After years of well-intentioned arduous efforts to decrease TTT, it is time to consider other strategies,” she wrote.
The study suggests that more lives would be saved by giving thrombolytic therapy in the ambulance when patients can’t be taken straight to a primary PCI hospital. “Transfer should not be performed unless the patient is at high risk and there is reason to believe that with transfer the patient will receive primary PCI within 60 minutes,” Redberg concluded.
