A study in the October–December 2011 issue of Prehospital Emergency Care has found that EMS workers are at higher risk of on-the-job injuries than other workers. Analyzing data workplace injury reports from the Bureau of Labor Statistics and the National Electronic Injury Surveillance System, researchers from the National Institute for Occupational Safety and Health identified nearly 100,000 nonfatal injuries to EMTs and paramedics from 2003 to 2007 and 65 fatal injuries, or an average of 13 per year. Most fatalities were due to motor vehicle crashes (45 percent) and aircraft crashes (31 percent). About one-fourth of fatalities had other causes, including one in which an EMT was struck by another vehicle.
The fatality rate was 6.3 per 100,000 full-time workers compared to 4.0 for all workers. About 85 percent of the fatally injured were paid workers; the rest were volunteers.
Nonfatal injuries were primarily associated with overuse injuries (33 percent), with the most common diagnosis being sprains and strains (38 percent). About half of those occurred while moving a patient. The second most common cause of nonfatal injury was exposure to a harmful substance or environment (21 percent); about three-fourths of these cases involved exposure to body fluids or substances from another person, or exposure to a needle or syringe.
Emergency Treatment for Heart Attack Improving, but Delays Still Occur
ST-segment elevation myocardial infarction (STEMI) patients in need of emergency artery-opening procedures are getting that treatment faster than they once did, but delays are still common, particularly in transferring patients to hospitals equipped to perform the procedure.
According to a study published online Sept. 19, 2011, in Circulation: Journal of the American Heart Association, about one-quarter of the nation’s hospitals perform artery-opening angioplasty, also known as percutaneous coronary intervention (PCI). The rest typically refer and transfer patients to hospitals that have this capability.
Researchers from the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital examined six years of data from more than 2,000 STEMI patients transferred from 31 non-PCI hospitals in Minnesota and Wisconsin to the Minneapolis Heart Institute. Despite transports of as far as 210 miles, about 30 percent of patients were treated in the recommended 90 minutes or less, and 66 percent were treated in 120 minutes or less.
When delays occurred, they happened most often at the referring hospital, followed by the PCI center and during transport. The most common cause of delay at the referring hospital was due to waiting for transport (26 percent), followed by unexplained emergency department delays, inconclusive ECGs, diagnostic dilemmas and cardiac arrest.
“Standardizing transfer protocols, increasing the availability of transport vehicles, and implementing prehospital notification at referral hospitals may lead to earlier dispatching of transport services and improvements in treatment times,” the authors write.
A Gentler Way to Restore Heart Rhythm?
Researchers from Johns Hopkins say they may have come up with a less painful way to prevent cardiac arrest in people with implanted cardiac defibrillators.
Every year, more than 200,000 U.S. residents receive implanted cardiac defibrillators that deliver a high-voltage shock to the heart when in ventricular fibrillation. Those who’ve experienced the shock say it’s painful, and some studies suggest that the shock may damage heart muscle, according to the study, which is in the Sept. 28, 2011, issue of Science Translational Medicine.
The new, “proof of principal” research found that using lower-amplitude, high-frequency alternating current at 100–200 Hz stopped the dangerous arrhythmia, at least in cells in the lab. “The alternating current puts the disorganized, rapidly moving heart cells in a refractory state, like suspended animation. When we turn off the current, the cells immediately return to a normal state,” said senior study author Ronald Berger, M.D., Ph.D., a cardiac electrophysiologist at the Johns Hopkins Heart and Vascular Institute, in a university news release. “If further research confirms what we have learned so far, this could be less painful for a patient while achieving the same result.”
Hyperventilation Common During Pediatric Resuscitation
Hyperventilation during the resuscitation of infants and children appears to be common among pediatric residents, interns, respiratory therapists and nurses, a study in the Oct. 3, 2011, issue of Pediatrics finds.
Researchers from Children’s Hospital of Alabama and the University of Alabama at Birmingham videotaped and analyzed the rate of ventilation with a bag-valve mask during 72 unannounced simulated pediatric medical emergencies at a pediatric teaching hospital between 2004 and 2010. In every case, hospital staff overventilated the “patient,” doing an average of about 41 breaths per minute instead of the eight to 20 breaths recommended in the American Heart Association’s Pediatric Advanced Life Support (PALS) guidelines. (Rate per minute varies according to the child’s age.) Prior research shows that excessive ventilation increases pressure in the chest and decreases coronary perfusion and survival.
According to the study, the message of 2005 PALS guidelines, which emphasizes avoiding hyperventilation, doesn’t seem to be getting through, as there was no difference in hyperventilation rates during the period between 2004 and 2007 and after 2007, when hospital staff should have had plenty of time to learn the recommended technique. Because pediatric resuscitation happens so infrequently, researchers recommend more simulated cardiac arrest training to maintain skills.
