Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 23

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
wearing protective equipment including a helmet, wrist guards, and
knee pads. His vital signs were unremarkable. On physical exam, he
had limited range of motion of the left shoulder secondary to pain;
left-sided chest pain on inspiration; and diffuse abdominal pain,
greatest in the left upper quadrant with volunlary guarding. An
abdominal CT demonstrated a grade 2 splenic laceration with free
fluid in the peritoneal cavity. His initial hematocrit was 35.7%. He
was admitted to the Regional Pediatric Trauma Center where he
remained hospitalized for 6 days. His hematocrit stabilized at 21%.
Conclusion: Studies have emphasized the value of protective gear
in reducing the incidence of injuries. It is unlikely that current
recommended protective gear, including helmet, wrist guards, and
elbow and knee pads, would have prevented the abdominal injury
in this patient. We hope that this case increases the awareness of
non-extremity and non-head injuries with this sport. While protec-
tive gear is one means by which the common injuries may be
prevented, other injury prevention measures, e.g., environmental
modifications like supervised parks and improved product design
to decrease speed or to enhance the ability to stop, need to be
implemented to improve the likelihood that a wider variety of and
more serious injuries can be prevented.
P 20 - Injury Prevention
What about high speed and an aggressive style of driving
during emergency medical services-interventions?
De Graeve K, Deroo K, Buylaert WA, Calle PA
Ghent University Hospital, Belgium
Objective: As high speed and an aggressive style of driving are
major risk factors for serious traffic accidents, frontline emergency
medical services (EMS)-vehicles have an increased collision risk.
Consequently, attention should be paid to the risk taking behaviour
of EMS-drivers. The aim of this study was to analyze the impact of
the installation of a “black box” in a mobile intensive care unit
(MlCU)-vehicle.
Methods: On May 30,2000, a Fleetlogger® data recording system
(VDO Kienzle) was installed in a Volvo break V70. The two main
recorded items were: maximum speed and harsh brake (i.e.
difference of speed, sampled at half seconds intervals, greater than
11 km/h). In November 2000 the professional MlCU-drivers were
given well-defined guidelines (i.e. maximum speed of 140 km/h on
highways, attention to speed limits on secondary roads and avoi-
dance of an aggressive style of driving). Furthermore, a monitoring
system was installed. Data from three periods were analyzed: (1)
October 2000, (2) December 2000, and (3) January 2001.
Results: For MlCU-runs (partly) via highways, the maximum speed
(mean + S.D.) decreased significantly from 167 + 18 km/h (range:
139-204 km/h) in period 1 (n=17) to 152 + 14 km/h (range: 116-173
km/h) in period 2 (n=51) and 143 + 12 kni/h (range: 104-168 km/h)
in period 3 (n=84; Mann-Whitney U-test for period 1 versus period
3: p < 0.0001). With regard to harsh brakes in these MlCU-runs, a
25% reduction was found: from 5.61 brakes/10 km in period 1 to
4.75 brakes/10 km in period 2 and 4.22 brakes/10 km in period 3.
For MlCU-runs exclusively via secondary roads, the maximum
speed also decreased significantly: from 121 + 29 km/h (range: 73-
187 km/h) in period 1 (n=56), to 109 + 23 km/h (range: 66-159 km/h)
in period 2 (n=107) and 108 + 15 km/h (range: 75-154 km/h) in
period 3 (n=133; p= 0.004). In these MlCU-runs, a 42% reduction
of harsh braking events was found: from 18.25 brakes/10 km in
period 1, to 13.85 brakes/10 km in period 2 and 10.51 brakes/10 km
in period 3.
Conclusion: Our data suggest thal “black boxes”, combined with
well-defined guidelines and a close monitoring system, are a good
tool to modify the risk taking behaviour of EMS-drivers, although
some high values of the maximum speed reveal that the results are
still not optimal. Obviously, additional measures (e.g. EMS-driver
education programmes, scrutinized use of lights and siren, guide-
lines for citizens on how to clear a lane, national standards for safe
EMS-operations, ...) are needed to ensure the best possible com-
promise between safety for all road users and a timely delivery of
appropriate care to all patients.
P 21 - Cardiovascular Emergencies
Should hospitals provide automated external defibrillators in
non-clinical areas?
Wright KD
John Radcliffe Hospital, Oxford, UK
Introduction: All hospitals in the United Kingdom who receive
acute admissions have a dedicated cardiac arrest response team.
This team is composed normally of an anaesthetist, the medical
registrar and senior house officer on call, the senior nurse, an
operating department assistant and often the resuscitation officer.
Usually the team is called to ward areas or other clinical areas for
the sudden collapse of an inpatient. Occasionally the team will be
called to a non-clinical area. Under these circumstances the team
will often arrive and be without significant resuscitation equipment.
If this has to be brought from a nearby ward area then valuable time
is lost. Alternatively the patient may be scooped and run to the
Emergency Department in an untidy exercise. The question we are
asking is: Is there a need for a portable resuscitation pack and
lightweight defibrillator for response to medical emergencies in
non-clinical areas of the hospital?
Method: A retrospective analysis of all cardiac arrest audit forms
was conducted. This was used to assess the location and type of
cardiac arrest. Resuscitation officers and medical staff were
questioned about arrest calls in non-clinical areas to trace those
without audit forms. Data were analysed to establish the incidence
of cardiac arrest in a non-clinical area. Non-clinical areas were
defined as foyer areas, basements, laboratory areas and waiting
areas without formal resuscitation equipment.
Results: The results are shown below. The study period was August
1999 until August 2001.
Total cardiac arrests Non-clinical area arrests
Wycombe General 304 2
Wexham Park 360 6
Condusion: There is an incidence of cardiac arrest in areas without
resuscitation equipment. In order to provide an acceptable level of
treatment such as prompt airway care and rapid defibrillation a
portable response pack and lightweight defibrillator should be
dispatched to cardiac arrest calls.
Læknablaðið/Fylgirit 45 2002/88 23