Prehospital Procedures Before Emergency Department Thoracotomy: “Scoop and Run” Saves Lives

Seamon, Mark J.; Fisher, Carol A.; Gaughan, John; Lloyd, M. G.; Bradley, Kevin M.; Santora, Thomas A.; Pathak, Abhijit; Goldberg, Amy J.

doi:10.1097/ta.0b013e31806842a1

Cited by 144 publications

(102 citation statements)

References 31 publications

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“…24 Studies also have shown that in cases of penetrating trauma, decreased time to definitive care is associated with improved survival outcomes. [25][26][27] Conclusions The current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current TCCC/C-TECC tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training is more likely to save victims rather than law enforcement personnel.…”

Section: Limitationsmentioning

confidence: 99%

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Stiles

Cook²,

Sztajnkrycer³

2017

Prehosp. Disaster med.

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IntroductionBased upon military experience, law enforcement has developed guidelines for medical care during high-threat conditions. The purpose of the current study was to provide a descriptive analysis of reported outcomes of law enforcement medical interventions.MethodsThis was a descriptive analysis of a convenience sample of cases submitted to the Wisconsin Tactical Medicine Initiative (Wisconsin USA), after the provision of successful patient care, between January 2010 and December 2015. The study was reviewed by the Mayo Foundation Institutional Review Board (Rochester, Minnesota USA) and deemed exempt.ResultsNineteen agencies submitted information during the study period. Of the 56 episodes of care reported, four (7.1%) cases involved care provided to injured officers while 52 (92.9%) involved care to injured civilians, including suspects. In at least two cases, on-going threats existed during the provision of medical care to an injured civilian. Law enforcement rendered care prior to Emergency Medical Services (EMS) arrival in all but two cases.ConclusionsThe current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current Tactical Combat Casualty Care (TCCC)/ Committee on Tactical Emergency Casualty Care (C-TECC) tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training appears more likely to save victims rather than law enforcement personnel.StilesCM, CookC, SztajnkrycerMD. A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the State of Wisconsin, 2010-2015. Prehosp Disaster Med. 2017;32(3):284–288.

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Section: Limitationsmentioning

confidence: 99%

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Stiles

Cook²,

Sztajnkrycer³

2017

Prehosp. Disaster med.

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“…Appeared a likely source of this increased risk of indirect central neurologic injury. CSI iatrogenia may have facilitated indirect neurologic injury by negatively impacting the "ischemic penumbra" [2][3][4][5][6]15,[22][23][24]27,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…The rapid mortality associated with vascular and airway injuries emphasizes the importance of immediately treating these lifethreatening injuries before addressing concerns about cervical spine instability [5,[17][18][19][20][21][22]. Transport delays for CSI vary from an average of 8-30 mins [23,24].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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“…Es claro que tiempos largos y la inadecuada reanimación prehospitalaria (reanimación agresiva con cristaloides) se asocia a peores resultados e impacto negativo en la sobrevida. 29 En el presente estudio debemos considerar varias limitaciones. Es un estudio retrospectivo de una única institución, donde la mayoría de los pacientes corresponden a los alrededores de una de las localidades con los índices más altos de violencia en Bogotá.…”

Section: Análisis De Asociación Con La Mortalidad Hospitalariaunclassified

Mortalidad Por Trauma Cardiaco Penetrante en Bogota, Colombia: Análisis de Factores Asociados

Isaza‐Restrepo¹,

Bolívar-Sáenz²,

Tarazona³

et al. 2012

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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RESUMENAntecedentes: La mayoría de las series de pacientes con heridas de corazón publicadas en la literatura son exclusivamente descriptivas y no sufi cientemente grandes para obtener conclusiones estadísticas. La prevalencia de agresiones en la población civil de algunos sectores de las ciudades Colombianas es elevada.Materiales y métodos: Para estudiar la probabilidad de mortalidad en los pacientes que ingresan a salas de cirugía con heridas de corazón se realiza un estudio de casos y controles anidado en la cohorte histórica de 240 pacientes admitidos a salas de cirugía del Hospital Occidente de Kennedy con diagnóstico de herida penetrante de corazón, Entre enero de 1999 y Octubre de 2009. Resultados:La mortalidad global fue de 15% (n = 36): 52.9% (9/17) para los pacientes con herida por arma de fuego y 12.1% (27/223) para los pacientes con herida por arma cortopunzante. Los valores del OR permitieron establecer que las lesiones con arma de fuego, el estado hemodinámico, el grado de la herida, las lesiones concomitantes en tórax y/o abdomen y el requerimiento de una toracotomía resucitativa se asocian con mayor probabilidad de muerte. Los resultados del análisis multivariado muestran que los únicos factores que de forma conjunta se asocian con la mortalidad son la lesión con arma de fuego (OR 22.7; IC 95% 4.6-112.9), y el estado hemodinámico (fatal: OR 11.4; IC 95% 1.6-82.0, agónico: 12.8; IC 3.4-48.5, shock profundo: 10.35; IC 2.9-36.4). Conclusiones:El trauma cardiaco penetrante en nuestra serie fue causado principalmente por heridas de arma cortopunzante, con una sobrevida similar a otros estudios con este mecanismo predominante. Nuestros resultados están de acuerdo con los parámetros de riesgo de mortalidad previamente propuestos en la literatura y en nuestros pacientes el compromiso del estado hemodinámico al ingreso a cirugia y las lesiones ocasionadas por arma de fuego, demostraron ser predictores signifi cativos de la mortalidad. La presencia de taponamiento cardiaco no tuvo un efecto protector.Palabras clave: Trauma cardíaco penetrante, Arma cortopunzante, Trauma en Colombia. ABSTRACTBackground: Most studies reported in literature of patients with heart injuries are merely descriptive and not large enough to obtain statistical conclusions. The prevalence of attacks on civilians in some sectors of Colombian cities is high.

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Prehospital Procedures Before Emergency Department Thoracotomy: “Scoop and Run” Saves Lives

Abstract: The performance of prehospital procedures in critical, penetrating trauma victims had a negative impact on survival after EDT in our study population. Paramedics should adhere to a minimal or "scoop and run" approach to prehospital transportation in this setting.

Cited by 144 publications

References 31 publications

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Mortalidad Por Trauma Cardiaco Penetrante en Bogota, Colombia: Análisis de Factores Asociados

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