Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams

Dutch, Martin; Austin, Kristy

doi:10.1017/s1049023x12000994

Cited by 22 publications

(20 citation statements)

References 11 publications

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“…Cooling measures, IV fluids, and symptomatic support including benzodiazepines are treatments that may be indicated for agitated delirium or seizures in this setting. 74 , 75 …”

Section: Methodsmentioning

confidence: 99%

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

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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 an acute change in mental status 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 altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.ResultsProtocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.ConclusionProtocols for patients with AMS 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.

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“…Cooling measures, IV fluids, and symptomatic support including benzodiazepines are treatments that may be indicated for agitated delirium or seizures in this setting. 74 , 75 …”

Section: Methodsmentioning

confidence: 99%

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

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“…A decreased number of transfers to hospital is well-associated with the provision of on-site medical care by Emergency Medical Services (EMS) and personnel in the field. [10][11][12] And while the science of MG medicine is fast evolving, literature on models predicting patient encounters is scarce, 9 and except for Belgium's Red Cross Flanders' (Flanders, Belgium) Medical Triage and Registration Informatics System (MedTRIS), 13 minimum data sets (MDS) for research and evaluation of MGs are lacking. Models most cited in MG literature are the models of Arbon 5,14 and Hartman.…”

Section: Introductionmentioning

confidence: 99%

The Development of PRIMA - A Belgian Prediction Model for Patient Encounters at Mass Gatherings

Spaepen

Haenen

Hubloue

2020

Prehosp. Disaster med.

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Introduction: Mass gatherings (MGs) grow in frequency around the world. With the intrinsic potential for significant health risks for all involved, MGs pose a challenge for those responsible for the provision of on-site medical care. Belgian law obliges local governments to identify and analyze the risks involving a MG. Though medical risk factors are long known, all too often, resourcing for in-event health services is based on anecdotal and previous experiences. Problem: Despite the fast-evolving science on MGs, the lack of reliable tools – based on empirical and analytical approaches – to predict patient presentation rates (PPRs) at MGs remains. Methods: A two-step method was followed to develop, update, and support a Plan Risk Manifestation (PRIMA) program. First, a continuous systematic literature review was conducted. Once developed, the model was run using data obtained from Belgian Federal Public Service (FPS; Brussels, Belgium) Health, Food Chain Safety, and Environment (HFCSE); event organizers; and municipalities. Results: In total, 231 studies and documents were included to form the program. With the data provided, three variables were computed to run the calculation model to predict the PPR. Three medical risk axes were defined for this model: (1) isolation risk; (2) population risk; and (3) risk at illness. A combined dataset was derived from the prediction of the PRIMA program combined with the actual data obtained after the MG. This proved a solid basis for the calculation model of the PRIMA program. Conclusion: Despite that validation is needed, the PRIMA program and its prediction model for PPRs at MGs carries the promise of a general, applicable prediction and risk analysis tool for a multitude of events.

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“…Health care professionals involved in the provision of on-site care at large music festivals and EDMEs experience first-hand the range of clinical presentations at these events, and researchers are just beginning to document the illness/injury burden and case-mix associated with this category of event 3 5 , 7 , 8 , 10 - 12 , 49 , 50 Because of risk profile of EDMEs, on-site medical care is sometimes provided and various authors have argued that health services should be on site; 51 however, little is known about the impact of different models of on-site care, ranging from first aid (FA) only to higher level of care (HLC) multidisciplinary teams, which may include advanced care paramedics, nurses, psychiatric nurses, drug counselors, nurse practitioners, physicians, and others.…”

Section: Introductionmentioning

confidence: 99%

Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event

Lund

Turris

2015

Prehosp. Disaster med.

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Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams

Cited by 22 publications

References 11 publications

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

The Development of PRIMA - A Belgian Prediction Model for Patient Encounters at Mass Gatherings

Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event

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