In a review of 45,284 patients with penetrating trauma, those with spinal immobilization before transport (4.3 percent) “were twice as likely to die, even when controlling for other patient and injury characteristics,” Elliot R. Haut, M.D., from Johns Hopkins Hospital and Johns Hopkins University School of Medicine in Baltimore told Research Monitor. Haut’s team used the National Trauma Data Bank to compare age, gender, ethnicity, mechanism of injury (gunshot or stab), injury severity, insurance status, patient vitals, multiple EMS treatments and death rates for penetrating trauma patients immobilized or not prior to EMS transport. Overall, nearly 15 percent of immobilized patients died, compared with just more than 7 percent of those not immobilized.
Haut said less than one in 1,000 of these patients may have benefited from spinal immobilization, but “for every 66 patients immobilized, there was one additional death.” The investigators suggest modification of current EMS protocols to permit selective spinal immobilization in cases of penetrating injury. — Trauma 68(1):115–121, January 2010.
PAD + EMS increases survival
Public AED application plus EMS care seems to be a lifesaving combination for many OOHCA patients, notes Thomas D. Rea, M.D., and colleagues at the University of Washington in Seattle. In collaboration with Seattle’s King County Emergency Medical Services, Rea’s team analyzed 10,332 EMS-treated OOHCA cases that occurred from 1999 through 2006 in the Seattle region. They report:• Over eight years, public AED locations increased from 119 to 1,739, and PAD increased from 0.6 to 2.4 percent of all cardiac arrests.
• 91 percent of PAD cases (143 of 157) were unconscious at EMS arrival; 27 percent had spontaneous pulse; about 75 and 46 percent, respectively, required CPR and defibrillation from EMS; 76 percent (120 of 157) had spontaneous pulse at the end of EMS care.
• EMS treatment included intravenous access (98 percent), intubation (85 percent) and medications (57 percent).
• 70 PAD-treated patients survived to hospital discharge, 68 with normal or mildly impaired neurological function.
These observations highlight how multiple factors can impact patient outcomes. Early recognition and EMS activation, plus bystander CPR and AED application, are important. Still, “EMS must continue active resuscitation for the large majority of patients,” Rea told Research Monitor. — Resuscitation 81(2):163–167, February 2010.
No risk from flame retardant in firefighter gear
In response to October 2008 reports of elevated levels of the flame retardant antimony trioxide in the hair of about 30 firefighters—results that led to workers’ compensation claims—Marie A. de Perio, M.D., and colleagues at the Hazard Evaluations and Technical Assistance Branch of CDC/NIOSH in Cincinnati initiated an antimony-related health hazard evaluation. The team tested antimony concentrations in individual urine samples. (Hair tests, they note, cannot reliably distinguish between internal and external exposure, are unreliable for testing heavy metals in the body and frequently produce different results from different laboratories.)
The urine tests from two groups of firefighters—24 not wearing antimony-containing firefighting pants for two weeks and 42 who wore antimony-treated pants regularly for about four years overall—showed antimony concentrations generally below or within the normal range found in the general population, regardless of which pants were worn. The CDC investigators write that the antimony-treated fabric in the National Fire Protection Association-compliant fabric “was not associated with elevated levels of urinary antimony.” — Morbidity and Mortality Weekly Report 58(46):1300–1303, Nov. 27, 2009; Journal of Occupational and Environmental Medicine 52(1):81–84, January 2010.
EMS health and wellness research
Hearing problems were reported by 1,024 NREMT-certified EMS professionals surveyed for a 2007 LEADS study, led by EMS Research Fellow Antonio R. Fernandez, M.S., NREMT-P, at NREMT in Columbus, Ohio. Notably:• 153 (15 percent), average age of 39 years, reported a hearing problem during the previous 12 months. Of these, 114 rated their hearing as fair or poor.
• Minority ethnicity and working in large communities seemed most related to increased odds for hearing problems after factoring for demographics, estimated lifetime noise exposures and overall work-related characteristics.
• 158 respondents (67 percent) said hearing protection did not hinder communication with patients or co-workers. Still, only 213 (21 percent of the total) used some type of hearing protection—head phones, foam ear plugs or another device—while working their EMS job.
Further investigations that measure actual hearing thresholds over time, and characteristics of large vs. small communities, are needed to clarify hearing problems in EMS workers. — American Journal of Industrial Medicine, online in advance of print Dec. 16, 2009.
Back pain was reported by 930 NREMT-certified EMS professionals (about 64 percent male) in a LEADS study led by Jonathan R. Studnek, Ph.D., at The Center for Prehospital Medicine, Carolinas Medical Center in Charlotte, N.C. (Studnek led the study during his NREMT research fellow stint.) Notably:
• Of the 55 percent (511 individuals) who reported back problems in previous LEADS surveys, 329 reported recent pain; 182 did not.By comparison, of the 419 who had not previously reported back problems, 141 had recent pain; 278 did not.
• Past back problems or fair/poor health (noted in about 11 percent of those surveyed) seemed associated with two- to three-times greater odds for recent back pain after accounting for multiple individual and job factors.
• About half (470/930) noted back or leg pain on one or more days over a two-week period during the previous year.
These findings indicate a large number of EMS workers experience back problems. Further investigations need to examine causes. — American Journal of Industrial Medicine 52(1):12–22, January 2010.
A study of most-common injuries in EMS personnel and firefighters, led by Audrey A. Reichard, MPH, of the CDC/NIOSH Division of Safety Research in Morgantown, W.Va., found:
• In 21,900 EMS workers, 41 percent had sprains/strains. The neck/back was most often injured (29 percent).
• Among 37,300 firefighters, 33 percent had sprains/strains, with legs and feet (24 percent) and the neck/back (18 percent) most injured.
• Contusions/abrasions; lacerations; punctures; blood/body fluid, pathogen, or chemical exposures; or other unspecified pain—mostly to extremities—were less common.
These findings come from limited emergency responder work data recorded in the National Electronic Injury Surveillance System and treated in hospitals in 2000 and 2001. In their report, Reichard’s team calls for “new and enhanced research and prevention efforts” among all emergency responder occupations. — American Journal of Industrial Medicine 53(1):1–11, January 2010.
