Michael F. Boyle

Surgical cricothyrotomy performed by air ambulance flight nurses: A 5-year experience

Limited information exists in the current medical literature regarding the performance of surgical cricothyrotomy by flight nurse personnel. We undertook a retrospective review of all flight records from our regional air ambulance service. The flight team transported 2,188 patients during this time; 69 patients required surgical cricothyrotomy for airway access. In all cases, the procedure was performed by a flight nurse working under a predefined airway protocol. Indications for the procedure were predominantly for maxillofacial trauma. A secure airway was established in 98.5% of the cases (68/69). Acute complications involved hemorrhage (3) and placement (3) with a complication rate of 8.7%. We conclude that surgical cricothyrotomy can be performed by well-trained flight nurses with a high success rate and an acceptable complication rate.

Physician Integration into Mass Gathering Medical Care: The United States Air Show

INTRODUCTION Limited information exists concerning physician staffing at mass gathering events. METHODS A retrospective review of the preparation, planning, and provision of medical care for the United States Air Show was performed. Patient encounters from the air show for the years 1981-1991 also were evaluated. RESULTS The frequency rate of overall encounters was 8.45 patients/10,000 spectators and hospital transport rate was 0.6/10,000 spectators. The majority of complaints were related to heat or minor injuries. During this period, emergency physicians played a vital role in both medical planning and on-site staffing. Emergency medicine residents also participated. A small patient population received direct benefit from on-site physician intervention. CONCLUSION The on-site emergency physician is of benefit in event preplanning and reducing the burden on the EMS system during mass gathering events.

A proposed model for a residency experience in mass gathering medicine: The United States air show

STUDY OBJECTIVE Mass gathering medicine is an increasingly important responsibility for emergency physicians. A formal experience in mass gathering medicine can introduce emergency medicine residents to this aspect of community medicine. DESIGN Educational model based on field experience and retrospective chart review from 1981 through 1991. SETTING The US Air Show is a summer event that attracts an average of 223,000 spectators annually. Medical care is provided by physicians, nurses, and technicians operating within an organized system of care. Emergency medicine resident physicians (first-, second-, and third-year) evaluate and treat patients appropriate for the residents level of responsibility. Residents provide immediate medical control and are integrated into the event disaster plan. On-site attending physician supervision is available at all times. Didactic instruction and event orientation are integrated into the residency curriculum. Residents participate in the planning stages of the event. RESULTS During the study period, 2,091 patients were seen. The most common presenting problems were heat illness (28%), blisters and scrapes (25%), headaches (23%), fractures and lacerations (9%), and eye injuries (5%). One hundred forty-eight patients (7%) required transportation to the hospital. Approximately 16 residents participate each year and treat an average of 13.7 patients during their four-hour shift. A resident training model for a mass gathering experience is proposed to include adequate crowd size to generate useful patient volumes; a regularly scheduled event; organized medical and disaster preparations meeting local or published standards; didactic instruction on history, principles, and current issues; on-site attending supervision; degree of responsibility appropriate for training level; participation in planning and organizing the event; and postevent debriefing. CONCLUSION A residency experience and training program in mass gathering medicine can introduce the principles of planning and providing care for crowds attending large public events.

Objectives to direct the training of emergency medicine residents on off-service rotations: Emergency medical services

Emergency Medical Services are an area of special interest in emergency medicine. Many emergency physicians are called upon to direct, train, or manage emergency medical services. Residents training in emergency medicine have a need for a defined curriculum in emergency medical services. Residency training should provide a basic foundation in EMS including on- and off-line medical control, medicolegal aspects, communications, disaster management, and EMS history, structure, and function. The resident must gain experience through on-scene observation, EMT/Paramedic education, medical direction, and quality assurance activities. This paper is one in a continuing series of goals and objectives to direct resident training in off-service rotations. Specific resources, learning objectives, and experiences are suggested.

NECROTIZING MYOSITIS AND TOXIC STREP SYNDROME IN A PEDIATRIC PATIENT

Group A beta hemolytic streptococcus (GABHS) is a common pathogen in infections of skin, soft tissue structures, and muscle. Most infections, when recognized and treated appropriately, result in a benign course. The development of more virulent forms of this organism have resulted in severe life-threatening infections. The following case of an immunocompetent host with necrotizing myositis and septic shock emphasizes the potential morbidity of GABHS infection. The spectrum of soft tissue and muscle infections is reviewed. The pathophysiology and emergency management of septic shock from GABHS is discussed.

Objectives to direct the training of emergency medicine residents on off-service rotations: Electrocardiology

This is a continuing series of objectives to direct resident training in emergency medicine. Electrocardiography may not receive individual attention in many training programs. However, the importance, omnipresence, and medicolegal potential of electrocardiography in the practice of emergency medicine suggests its individual attention. Contents and specific learning objectives are presented to provide guidelines for resident mastery, following the format presented by preceding subjects.

Objectives to direct the training of emergency medicine residents on off-service rotations; radiologic imaging 1: Plain films

Interpretation of radiologic images is an essential skill for the emergency physician. This is the first of two sets of objectives for an off-service rotation in radiology. It covers the interpretation of plain films. The second series will address commonly used, but more sophisticated, imaging modalities including the use of contrast materials, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. This set of objectives may be used to guide a one-month radiology rotation or serve as part of a teaching program integrated with didactic training and emergency department experience.

Surgical cricothyrotomy performed by air ambulance flight nurses: A five year experience

Limited information exists in the current medical literature regarding the performance of surgical cricothyrotomy by flight nurse personnel. We undertook a retrospective review of all flight records from our regional air ambulance service. The flight team transported 2,188 patients during this time; 69 patients required surgical cricothyrotomy for airway access. In all cases, the procedure was performed by a flight nurse working under a predefined airway protocol. Indications for the procedure were predominantly for maxillofacial trauma. A secure airway was established in 98.5% of the cases (68/69). Acute complications involved hemorrhage (3) and placement (3) with a complication rate of 8.7%. We conclude that surgical cricothyrotomy can be performed by well-trained flight nurses with a high success rate and an acceptable complication rate.