Walt A. Stoy

Comparison of the Ferno Scoop Stretcher with the Long Backboard for Spinal Immobilization

Objectives. Spinal immobilization is essential in reducing risk of further spinal injuries in trauma patients. The authors compared the traditional long backboard (LBB) with the Ferno Scoop Stretcher (FSS) (Model 65-EXL). They hypothesized no difference in movement during application andimmobilization between the FSS andthe LBB. Methods. Thirty-one adult subjects had electromagnetic sensors secured over the nasion (forehead) andthe C3 andT12 spinous processes andwere placed in a rigid cervical collar, with movement recorded by a goniometer (a motion analysis system). Subjects were tested on both the FSS andthe LBB. The sagittal flexion, lateral flexion, andaxial rotation were recorded during each of four phases: 1) baseline, 2) application (logroll onto the LBB or placement of the FSS around the patient), 3) secured logroll, and4) lifting. Comfort andperceived security also were assessed on a visual analog scale. Results. There was approximately 6–8 degrees greater motion in the sagittal, lateral, andaxial planes during the application of the LBB compared with the FSS (both p < 0.001). No difference was found during a secured logroll maneuver. The FSS induced more sagittal flexion during the lift than the LBB (p < 0.001). The FSS demonstrated superior comfort andperceived security. Conclusion. The FSS caused significantly less movement on application andincreased comfort levels. Decreased movement using the FSS may reduce the risk of further spinal cord injury.

Physician Medical Direction andClinical Performance at an Established Emergency Medical Services System

Objective. Few developed emergency medical services (EMS) systems operate without dedicated medical direction. We describe the experience of Hamad Medical Corporation (HMC) EMS, which in 2007 first engaged an EMS medical director to develop andimplement medical direction andquality assurance programs. We report subsequent changes to system performance over time. Methods. Over one year, changes to the services clinical infrastructure were made: Policies were revised, paramedic scopes of practice were adjusted, evidence-based clinical protocols were developed, andskills maintenance andeducation programs were implemented. Credentialing, physician chart auditing, clinical remediation, andonline medical command/hospital notification systems were introduced. Results. Following these interventions, we report associated improvements to key indicators: Chart reviews revealed significant improvements in clinical quality. A comparison of pre- andpost-intervention audited charts reveals a decrease in cases requiring remediation (11% to 5%, odds ratio [OR] 0.43 [95% confidence interval (CI) 0.20–0.85], p = 0.01). The proportion of charts rated as clinically acceptable rose from 48% to 84% (OR 6 [95% CI 3.9–9.1], p < 0.001). The proportion of misplaced endotracheal tubes fell (3.8% baseline to 0.6%, OR 0.16 [95% CI 0.004–1.06], (exact) p = 0.05), corresponding to improved adherence to an airway placement policy mandating use of airway confirmation devices andsecuring devices (0.7% compliance to 98%, OR 714 [95% CI 64–29,334], (exact) p < 0.001). Intravenous catheter insertion in unstable cases increased from 67% of cases to 92% (OR 1.31 [95% CI 1.09–1.71], p = 0.004). EMS administration of aspirin to patients with suspected ischemic chest pain improved from 2% to 77% (OR 178 [95% CI 35–1,604], p < 0.001). Conclusions. We suggest that implementation of a physician medical direction is associated with improved clinical indicators andoverall quality of care at an established EMS system

Using Interactive Videodisc to Test Advanced Airway Management Skills

PURPOSE To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration. METHODS The study was a nonrandomized, nonequivalent comparison group design of a convenience sample of 86 American Heart Association (AHA), advanced cardiac life support (ACLS) students, who obtained instruction in airway management by the interactive videodisc (IVD) learning system (n = 41), or by the traditional method of demonstration/return demonstration (n = 45). The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal (ET) intubation and esophageal obturator airway (EOA) insertion. RESULTS No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated. However, initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect (p = 0.004) compared to ACLS students learning by the traditional method. This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification. In a post-test satisfaction questionnaire, 34 IVD students reported satisfaction with learning airway management using this instructional method, but also expressed a preference to have an ACLS instructor available. CONCLUSION This study highlights the role of IVD in teaching the complex skills of advanced airway management.

Evaluation of a New Device for Simultaneous Compressions and Ventilations

The resuscitator bag has been considered the standard for prehospital, ventilatory managment. Recently, the Berg Resuscitation Apparatus (BRA) was developed as an alternative. Two devices were compared for their ability to deliver adequate tidal volumes and efficacy during simulated, single-rescuer CPR In the first phase, emergency care providers ventilated a test lung using a resuscitator bag, BRA, and demand valve. No significant differences between methods were found. During the second phase of the study, subjects performed single-rescuer CPR on a resuscitation mannikin for two minutes, using the bag-valve-mask and the BRA with a mask. The BRA delivered a volume of 0.81±0.26 liters compared to 0.35±0.19 liters using the resuscitator bag. The BRA allows ventilation to be performed as does the traditional equipment. When used in single rescuer CPR, it appears to provide a substantial increase in the tidal volumes delivered.

EMT training for medical students

Dr. John Lumpkin (University of Chicago): The subject of integrating EMT training into the medical school curriculum has recently become controversial. How much education in EMS is necessary for the average medical student? Could EMS education somehow effect the way that they as graduate physicians interact with the EMS system? Many of us are familiar with the incident that occurred about two years ago at the American College of Gastroenterologists in Palm Springs, California. A paramedic was managing a patient in cardiac arrest via radio communication with the base station. The gastroenterologists wanted to help, but the paramedic saw them as interfering and refused to allow their involvement. The result was that some of the gastroenterologists were removed from the scene by the police, who were more afraid of the paramedic than the strangers. Another subject involves the expectations that society holds for the medical student. In many ways, for instance, the medical student is expected by family and friends to be a practitioner of medicine from the day he/she is accepted into a graduate program. Yet, the student generally has none of the practical skills necessary. Is it reasonable or appropriate within the medical school curriculum to teach the medical student how to handle these situations prior to graduation from medical school? Dr. Daniel Goodenberger (Georgetown University): Despite the fact that EMT courses at Georgetown have never been publicized, they have been going on for approximately 1.5 years. They were begun in 1968