The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with 'Smart' triage than with 'SALT' triage.

IntroductionIn the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.ResultsProtocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.ConclusionProtocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

The SALT mass casualty triage system can be applied quickly in the field and appears to be safe, as measured by a low undertriage rate. There was, however, significant overtriage. Further refinement is needed, and effect on patient outcomes needs to be evaluated.

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The objective of this study was to assess differences in menopausal symptoms between postmenopausal (PM) Hispanic (H) and PM Caucasian (C) women. This was a prospective survey. Data from a convenience sample of 404 PM women (50% H, 50% C) were evaluated. Comparing H with C women, statistically significant differences (P < 0.05) in symptoms were noted with mood changes (76% H, 54% C), a decrease in energy (56% H, 36% C), palpitations (54% H, 26% C), breast tenderness (39% H, 28% C), memory loss (34% H, 22% C), and vaginal dryness (34% H, 44% C). When controlling for education and income, there were differences in mood changes, a decrease in energy and palpitations between the groups. Consistent with previous data, hot flashes (80% H, 75% C) and night sweats (67% H, 64% C) were the most common symptoms in the PM C women, and there were no significant differences compared with PM H women. Symptoms reported by PM C women in this sample are consistent with rates in the literature, but PM H women reported several symptoms at a higher rate. These differences remain when socioeconomic factors are considered, suggesting ethnicity may be an independent variable in menopausal symptomatology.

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