Kathy J. Rinnert

Tactical emergency medical support

As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of death or grievous harm to law officers, bystanders, hostages, or perpetrators. Further, law enforcement agencies who attempt to apprehend dangerous, heavily armed criminals with a special operations team that lacks the expertise to treat the medical consequences that may arise from such a confrontation may be negligent of deliberate indifference. Meanwhile, evidence exists within the military, civilian law enforcement, and medical literature that on-scene TEMS serves to improve mission success and team safety and health, while decreasing morbidity and mortality in the event of an injury or illness suffered during operations. National professional organizations within law enforcement and emergency medicine have identified and support the fundamental need for mission safety and the development of a standard model to train and incorporate TEMS into law enforcement special operations. The overall objective of TEMS is to minimize the potential for injury and illness and to promote optimal medical care from the scene of operations to a definitive care facility. The design, staffing, and implementation of a TEMS program that maximally uses the community resources integrates previously disparate law enforcement, EMS, and emergency medical/trauma center functions to form a new continuum of care [55].

Altitude physiology and the stresses of flight

Associate Professor of Clinical Medicine, Section of Emergency Medicine, Department of Medicine, University of Chicago; Medical / Program Director, University of Chicago Aeromedical Network, University of Chicago Hospitals, Chicago, Ill. Chief Aeromedical Resident, University of Chicago Aeromedical Network; Senior Resident, Section of Emergency Medicine, Department of Medicine, University of Chicago Hospitals, Chicago, III.

The effectiveness of bystander CPR in an animal model

Several clinical studies have yielded conflicting results in examining the effectiveness of bystander CPR (BCPR). The purpose of this pilot study was to determine the effectiveness of BCPR in an animal model of cardiac arrest and resuscitation. Ten swine were instrumented for hemodynamic and regional blood flow measurements with tracer microspheres. After two minutes of ventricular fibrillation (VF), the animals received eight minutes of either BCPR (five) or no-bystander CPR (NBCPR; five). Defibrillation was then attempted in both groups. If unsuccessful, CPR was begun and epinephrine 0.02 mg/kg was administered. Defibrillation was attempted again three and one-half minutes after epinephrine administration. Regional myocardial and cerebral blood flows were measured 30 seconds and five and one-half minutes after initiation of BCPR and one minute after epinephrine administration. In the BCPR group, myocardial blood flow was initially 29.0 +/- 33.2 and decreased to 15.0 +/- 21.5 mL/min/100 g during the last two and one-half minutes of BCPR. Cortical cerebral blood flow was initially 2.0 +/- 2.8 and fell to 0.6 +/- 0.8 mL/min/100 g during the last two and one-half minutes of BCPR. There were no statistical differences in myocardial blood flow and cerebral blood flow between the initial or late stages of BCPR (P greater than .14). There were no statistical differences in myocardial blood flow and cerebral blood flow between BCPR and NBCPR groups after epinephrine administration (P greater than .09).(ABSTRACT TRUNCATED AT 250 WORDS)

The core content of emergency medical services medicine.

Abstract On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.

Development of an EMS curriculum.

Abstract Emergency medical services (EMS) became an American Board of Medical Specialties (ABMS) approved subspecialty of emergency medicine in September 2010. Achieving specialty or subspecialty recognition in an area of medical practice requires a unique body of knowledge, a scientific basis for the practice, a significant number of physicians who dedicate a portion of their practice to the area, and a sufficient number of fellowship programs. To prepare EMS fellows for successful completion of fellowship training, a lifetime of subspecialty practice, and certification examination, a formalized structured fellowship curriculum is necessary. A functional curriculum is one that takes the entire body of knowledge necessary to appropriately practice in the identified area and codifies it into a training blueprint to ensure that all of the items are covered over the prescribed training period. A curriculum can be as detailed as desired but typically all major headings and subheadings of the core content are identified and addressed. Common curricular components, specific to each area of the core content, include goals and objectives, implementation methods, evaluation, and outcomes assessment methods. Implementation methods can include simulation, observations, didactics, and experiential elements. Evaluation and outcomes assessment methods can include direct observation of patient assessment and treatment skills, structured patient simulations, 360° feedback, written and oral testing, and retrospective chart reviews. This paper describes a curriculum that is congruent with the current EMS core content, as well as providing a 12-month format to deploy the curriculum in an EMS fellowship program. Key words: curriculum; education; emergency medical services; fellowships and scholarships

Risk reduction for exposure to blood-borne pathogens in EMS

The Occupational Safety and Health Administration (OSHA) estimates that approximately 5.6 million workers are at risk for contact with blood and other specified body fluids during the performance of their work duties. Of these, 4.4 million are health care workers at risk of exposure to potentially infectious materials. These workers include nurses, physicians, dentists and dental workers, laboratory and blood bank technologists, emergency department personnel, orderlies, housekeeping personnel, and others. OSHA identifies an additional 1.2 million others, “whose job might require providing first-response medical care in which reasonable expectation of contact with blood or potentially infectious materials may occur.” The latter category includes personnel employed as law enforcement officers, fire suppression and rescue workers, correctional officers, paramedics, and emergency medical technicians (EMTs).

Catastrophic Anachronisms: The Past, Present and Future of Disaster Medicine

Disasters, particularly earthquakes, volcanoes, floods, war-related complications, famine and infectious epidemics, have been a part of recorded human experience. From Pompeii to the Johnston Flood and World War II and the Black Plague to the Spanish Influenza, there have been catastrophic occurrences that will not long be forgotten by either legend or history books. Nevertheless, those occurrences were relatively few and far-between before the mid-twentieth century. Indeed, the nature of disasters has changed since then. From terrorists taking advantage of ‘new technology’ to weather-related events that cause trillions of dollars worth of damages and economic loss, the world has evolved.

Local Perspectives on Bioterrorism

Learning objectives: 1. Identify the efforts being undertaken by the Parkland Health and Hospital System to prepare for bioterrorism. 2. Identify the efforts being undertaken by the Dallas–Fort Worth Hospital Council to prepare for bioterrorism. 3. Identify the efforts being undertaken by the emergency department at Baylor University Medical Center to prepare for bioterrorism. 4. Identify the efforts being undertaken by the Dallas County Medical Society to prepare for bioterrorism.

A review of infection control practices, risk reduction, and legislative regulations for blood-borne disease: Applications for emergency medical services

The National Association of EMS Physicians (NAEMSP) recognizes the potential for exposure to blood-borne diseases for those engaged in public safety occupations. Since a number of infections may be acquired via blood or body fluid exposure, observance of infection control practices, workplace activities, and worker education may mitigate such exposures and reduce the likelihood of occupationally acquired illness. This document reviews the current literature on infection control, risk reduction measures, and legislative concerns associated with blood-borne disease as they relate to emergency medical services (EMS).

53. A Descriptive Analysis of Air Medical Directors in the United States

Purpose : The practice of helicopter emergency medical services is variable in its mission profile, crew configuration, and transport capabilities. We sought to describe the characteristics of physician air medical directors in the United States. Methods : We surveyed medical directors concerning their education, training, transport experience, and roles/responsibilities in critical care air transport programs. Results : Two page surveys were mailed to 281 air medical services. Three programs merged or were dissolved. Data from 122/278 (43.9%) air medical directors were analyzed. One-hundred eleven respondents reported residency training in: Emergency Medicine (EM) 44 (39.6%), Internal Medicine (IM) 18 (16.2%), General Surgery (GS) 18 (16.2%), Family Practice (FP) 12 (10.8%), dual-trained (EM/IM, EM/FP, IM/FP) 11 (9.9%) and others 8 (7.2%). Medical directors’ roles/responsibilities consist, most frequently of: drafting protocols 108 (88.5%), QA/CQI activities 104 (85.3%), crew training 98 (80.3%), and administrative negotiations 95 (77.7%).