Bharath Chakravarthy

Guidelines for Field Triage of Injured Patients: In conjunction with the Morbidity and Mortality Weekly Report published by the Center for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.

Simulation in Medical School Education: Review for Emergency Medicine

Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

The Relationship of Pedestrian Injuries to Socioeconomic Characteristics in a Large Southern California County

Objectives: The goal of this study is to explore the relationship between pedestrian injuries and socioeconomic characteristics. Methods: Pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS), which is assembled from police crash reports by the California Highway Patrol Information Services Unit. Four thousand crashes were identified and geocoded within the census tracts in a county population of 2,846,289 over a 5-year period. Population and population characteristics for census tracts were obtained from the 2000 U.S. Census. Results: The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 8.7 percent of residents with low income and averaged 11 per 100,000 pedestrian crashes annually. One fourth of the census tracts had more than 32.2 percent of residents with low income and an average of 44 pedestrian crashes per 100,000 annually. Negative binomial regression showed that with each 1 percent increase in the percentage of residents with low income was associated with a 2.8 percent increase in pedestrian crashes. The percentage of residents age 14 years or less, adult residents who had not completed high school, residents who spoke English less than “very well” and spoke another language at home, and the population density were each associated with a higher frequency of pedestrian crashes. However, when low income was added to these 4 regression models, the relationship between low income and pedestrian crashes increased. Conclusions: Our study showed that pedestrian crashes are 4 times more frequent in poor neighborhoods and that neither age of the population, education, English language fluency, nor population density explained the effect of poverty.

Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse

The Center for Disease Control and Prevention (CDC) has published significant data and trends related to opioid prescription pain relievers (OPR). In 2008, 20,044 deaths were attributed to prescription drug overdose of which 14,800 (73.8%) were due to OPR, an amount greater than the number of overdose deaths from heroin and cocaine combined. The majority of these deaths were unintentional. Between 1999–2008, overdose deaths from OPR increased almost four-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Most significant to emergency physicians is the estimate that 39% of all opioids prescribed, administered or continued come from the emergency department (ED). We present findings from the CDC’s Morbidity and Mortality Weekly Report (MMWR) with commentary on current recommendations and policies for curtailing the OPR epidemic.1

Pediatric pedestrian injuries: emergency care considerations

Pedestrian traffic injuries are a growing public health threat worldwide. The global economic burden of motor vehicle collisions and pedestrian injuries approximates

Guidelines for Field Triage of Injuried Patients - eScholarship

500 billion. In the United States, the number of pedestrian fatalities increased from 4675 in 2004 to 4881 in 2005. In addition nearly 60,000 injuries occurred during the same year. Injury patterns vary depending on the age, sex, and socioeconomic status of the individual. Children comprise one of the most vulnerable populations in pedestrian traffic injuries. Pedestrian injury remains the second leading cause of unintentional injury-related death among children aged 5 to 14 years. The burden of injury, upon the individual, families, and society, is frequently overwhelming. From recent data, pedestrian injuries and deaths are increasing in the United States and the World, and they require particular attention by emergency care providers and policy makers.

Assessment of Alcohol Use Patterns Among Spanish-Speaking Patients

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.

Comparison of the visual function index to the snellen visual acuity test in predicting older adult self-restricted driving

ABSTRACT Objective: The objective of this study was to assess drinking patterns of Spanish-speaking patients using a bilingual computerized alcohol screening and brief intervention (CASI) tablet computer equipped with the Alcohol Use Disorders Identification Test (AUDIT). Methods: This retrospective study was conducted in a tertiary university hospital emergency department (ED) between 2006 and 2010. Data from 1816 Spanish-speaking ED patients were analyzed using descriptive statistics, the chi-square test for independence, and the Kruskal-Wallis rank sum test for comparisons using quantitative variables. Results: Overall, 15% of Spanish-speaking patients were at-risk drinkers, and 5% had an AUDIT score consistent with alcohol dependency (≥20). A higher percentage of Spanish-speaking males than females were at-risk drinkers or likely dependent. Spanish-speaking males exhibited higher frequency of drinking days per week and higher number of drinks per day compared with females. Among older patients, nondrinking behavior increased and at-risk drinkers decreased. The majority of males and females were ready to change their behavior after the CASI intervention; 61% and 69%, respectively, scored 8–10. Conclusions: This study indicated that CASI was an effective tool for detecting at-risk and likely dependent drinking behavior in Spanish-speaking ED patients. The majority of patients were ready to change their drinking behavior. More alcohol screening and brief intervention tools should be tested and become readily accessible for Spanish-speaking patients.

Polysubstance Abuse: Alcohol, Opioids and Benzodiazepines Require Coordinated Engagement by Society, Patients, and Physicians

Objective: In this observational study, a modified version of the Visual Function Index (VF-14) and the Snellen Visual Acuity Test were compared in how well they correlated with self-restricted driving habits in older adults. The VF-14 was originally designed to assess vision in cataract patients; however, in this study, a modified version (mVF-14) was evaluated as a tool for predicting self-restricted driving in older drivers. Methods: During a 3-month period, 151 drivers over the age of 65 were screened at the local senior center. In addition to the Snellen Visual Acuity Test and mVF-14, each participant was given a questionnaire about their driving habits, previously used in self-restriction studies. Results: Out of 151 total participants, 134 were included and 7 nondrivers and 10 subjects who did not complete all questionnaires were excluded. One hundred one participants exhibited normal visual acuity of 20/40 or better (75%), and 110 scored over 90 on the mVF-14 (82%). Spearmans rank sum correlation coefficient was used to analyze the data and showed significant negative correlation of the mVF-14 and Snellen with self-restricted driving. Individuals with normal vision (20/40 or better on the Snellen eye test) had both high and low mVF-14 scores. Conclusions: The study shows that poor vision, as indicated by the Snellen scale and low mVF-14 scores, correlates to self-imposed driving limitations. The mVF-14 showed further distinctions of self-restriction between individuals in the same Snellen Visual Acuity category. Therefore, using the mVF-14 in addition to the Snellen Visual Acuity Test can be helpful to further differentiate visual ability within older drivers who appear to have normal vision.

A geographic analysis of collisions involving child pedestrians in a large southern California county

The Centers for Disease Control and Prevention (CDC) has published significant data trends related to substance abuse involving opioid pain relievers (OPR), benzodiazepines and alcohol in the United States. The CDC describes opioid misuse and abuse as an epidemic, with the use of OPR surpassing that of illicit drugs. Alcohol has also been a persistent problem and is associated with a number of emergency department visits and deaths independent of other substances. The use of these drugs in combination creates an additive effect with increased central nervous system suppression and a heightened risk of an overdose. We present a summary of the findings from the Morbidity and Mortality Weekly Report (MMWR) with commentary on strategies to combat prescription drug and alcohol abuse.