Jeff T. Grange

Violence against emergency medical services personnel

Background. Emergency medical services (EMS) providers may be exposed to violent behavior while performing their routine duties. Objectives. To determine the prevalence of violence against EMS providers in the prehospital setting and to determine factors associated with such violence. Methods. Consecutive medical calls for EMS agencies in a southern California metropolitan area were prospectively analyzed for one month. Following each call, prehospital personnel recorded information about any episodes of violence (verbal or physical) during the run as well as variables felt to be associated with these behaviors. Results. There were 4,102 cases available for analysis. Overall, some sort of violence occurred in 8.5% (349/4,102) of patient encounters. Of this reported violence, 52.7% (184/349) was directed against prehospital care providers, while 47.3% (165/349) was directed against others. The prevalence of violence directed against prehospital care personnel was therefore 4.5% (184/4,102). Patients accounted for most (89.7%; 165/184) of this violent behavior. The type of violence varied, with 20.7% (38/184) being verbal only, 48.9% (90/184) being physical, and 30.4% (56/184) constituting both verbal and physical attacks. Male sex, patient age, and hour of the day were significantly associated with episodes of violence. Logistic regression analysis provided odds ratios (ORs) with confidence intervals (CIs) for factors that were predictive of violent behavior. These included police presence (OR 2.8; 95% CI 1.8–4.4), apparent presence of gang members (OR 2.9; 95% CI 1.6–5.3), perceived psychiatric disorder (OR 5.9; 95% CI 3.5–9.9), and perceived presence of alcohol or drug use (OR 7.0; 95% CI 4.4–11.2). Conclusion. Emergency medical services providers in some areas are at substantial risk for encountering violence in the prehospital setting. Certain situational factors may be used to predict the risk of encountering violence. Training, protocols, and protective gear for dealing with violent situations should be encouraged for all prehospital personnel.

On-site physicians reduce ambulance transports at mass gatherings.

Objectives. To prospectively determine if on-site physicians at a mass gathering reduced the number of ambulance transports to local medical facilities. The authors also wished to determine the level of care provider (emergency medical technician, EMT-P, registered nurse, or medical doctor) required to treat and disposition each patient. Methods. This study determined whether each patient presenting to on-site first aid stations at California Speedway during a large motorsports event would require ambulance transport to the hospital per the local emergency medical services (EMS) protocols. Whether the on-site physician prevented certain ambulance transports also was determined. Additionally, the minimum level of provider that could treat and disposition each patient was determined. Results. On-site physicians significantly reduced (p < 0.001) the number of ambulance transports at this mass gathering. Ambulance transports to local hospitals were reduced by 89% (from 116 to 13). Fifty-two percent of the patients were able to be treated and dispositioned (cardiac arrests, minor first aid, etc.) by a paramedic. Registered nurses were able to treat and disposition another 39% of the patients with pre-established protocols written by the track medical director. These patients had abrasions requiring tetanus shots, mild to moderate heat exhaustion that resolved with intravenous hydration, and other minor complaints. Finally, about 9% of the patients required physician-level care (suturing, prescriptions, etc.) to treat and disposition them. Conclusion. On-site physician-level medical care at large mass gatherings significantly reduces the number of patients requiring transport to hospitals, thus reducing the impact on the local EMS system and surrounding medical facilities.

The California 500: Medical care at a NASCAR Winston Cup race

Background. Stock car racing is Americas fastest-growing professional sport. With more than 5.5 million paid admittances and another 148 million watching the 34-race NASCAR Winston Cup series on television, emergency physicians are increasingly called upon to organize medical support for such events. Currently, little reliable information is available to assist in determining what specific personnel and equipment are necessary to optimally support a race event. Objective. To characterize the spectrum of presenting injuries and illnesses at a NASCAR Winston Cup event. Methods. This study was a retrospective review of all patients presenting to nine on-site first aid stations from June 19 to 22, 1997, for the inaugural California 500 race weekend at California Speedway in Fontana, California. Staffing of the nine first aid stations was provided by 20 paramedics, 25 emergency nurses, five emergency physicians, nine advanced life support (ALS) ambulances with two crew members each, and a medically configured helicopter with flight crew. Results. Of the 923 patients seen, 38 were drivers/crew, 230 were track employees, and 644 were spectators. One hundred thirty-six of the patients were treated in the two infield facilities, while 787 were treated in the grandstand first aid stations. Patients seen per hour peaked just before the start of the race at 73 patients seen. Of the ten patients transported to the hospital, three required admission. No deaths occurred. Conclusion. These data may assist individuals planning medical support for large motorsports venues.

Street bikes versus dirt bikes: a comparison of injuries among motorcyclists presenting to a regional trauma center.

BACKGROUND This study sought to compare the spectrum of injuries and outcomes between off-road and on-road motorcyclists. METHODS Demographic information, accident location, helmet use, anatomic injuries, physiologic data, length of stay, transfusions, operations, Injury Severity Scores, and determination of death were abstracted for a consecutive cohort of patients over a 5-year period. RESULTS There were no significant differences between off-road motorcyclists (n = 376) and on-road motorcyclists (n = 371) in terms of helmet use, loss of consciousness, initial systolic blood pressure, initial Glasgow Coma Scale, initial Revised Trauma Score, or hand, wrist, forearm, arm, clavicle, foot, ankle, femur, pelvis, spinal, or head injuries. On-road motorcyclists were significantly more likely, however, to require transfusions (p < 0.025); sustain blunt chest, abdominal, or skin trauma; or die (p < 0.05). CONCLUSIONS On-road motorcyclists are more likely to sustain blunt abdominal trauma, blunt chest trauma, skin trauma, and death than off-road motorcyclists.

The games: what can the sports medicine community learn from raves?

Electronic dance music festivals, also known as raves, are increasing in popularity. Despite the occasional tragedy in the lay press regarding medical incidents at raves, such events are relatively safe when compared to other mass gatherings. While the medical usage rates are lower than rock concerts and marathons, there are many similarities to both types of events with regard to the types of injuries and medical complaints. This article may assist in planning medical support for raves in the future.