Skip header and navigation

Refine By

8 records – page 1 of 1.

Are needle decompressions for tension pneumothoraces being performed appropriately for appropriate indications?

https://arctichealth.org/en/permalink/ahliterature156844
Source
Am J Emerg Med. 2008 Jun;26(5):597-602
Publication Type
Article
Date
Jun-2008

Can a single primary care paramedic configuration safely transport low-acuity patients in air ambulances?

https://arctichealth.org/en/permalink/ahliterature286059
Source
CJEM. 2017 Sep 22;:1-9
Publication Type
Article
Date
Sep-22-2017
Author
Homer Tien
Bruce Sawadsky
Michael Lewell
Sean Moore
Michael Peddle
Alun Ackery
Brodie Nolan
Russell D MacDonald
Source
CJEM. 2017 Sep 22;:1-9
Date
Sep-22-2017
Language
English
Publication Type
Article
Abstract
To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances.
We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario's Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls. Our primary outcome was clinical deterioration during transport. We then asked a panel to analyze each case of deterioration to determine if a dual-PCP configuration might have reasonably prevented the deterioration or have better treated the deterioration, compared to a single-PCP configuration.
In one year, contract carriers moved 3264 patients, who met inclusion criteria. 85% were from Northern Ontario. There were 21 cases of medical deterioration (0.6%±0.26%). Paper charts were found for 20 of these cases. Most were self-limited cases of pain or nausea. A small number of cases (n=5) were cardiorespiratory decompensation. There was 100% consensus amongst the panel that all cases of clinical deterioration were not related to team size. There was also 100% consensus that a dual-PCP team would not have been better able to deal with the deterioration, compared to a single-PCP crew.
We found that using a single-PCP configuration for transporting low acuity patients is safe. This finding is particularly important for rural areas where air ambulance is the only means for accessibility to care and where staffing issues are magnified.
PubMed ID
28934993 View in PubMed
Less detail

Can a single primary care paramedic configuration safely transport low-acuity patients in air ambulances?

https://arctichealth.org/en/permalink/ahliterature303243
Source
CJEM. 2018 03; 20(2):247-255
Publication Type
Journal Article
Date
03-2018
Author
Homer Tien
Bruce Sawadsky
Michael Lewell
Sean Moore
Michael Peddle
Alun Ackery
Brodie Nolan
Russell D MacDonald
Author Affiliation
*Ornge,Mississauga,ON.
Source
CJEM. 2018 03; 20(2):247-255
Date
03-2018
Language
English
Publication Type
Journal Article
Keywords
Air Ambulances - standards
Emergencies
Emergency Medical Technicians - standards
Emergency Service, Hospital - statistics & numerical data
Female
Health Services Needs and Demand - organization & administration
Humans
Male
Middle Aged
Ontario
Retrospective Studies
Transportation of Patients - organization & administration
Abstract
To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances.
We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario's Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls. Our primary outcome was clinical deterioration during transport. We then asked a panel to analyze each case of deterioration to determine if a dual-PCP configuration might have reasonably prevented the deterioration or have better treated the deterioration, compared to a single-PCP configuration.
In one year, contract carriers moved 3264 patients, who met inclusion criteria. 85% were from Northern Ontario. There were 21 cases of medical deterioration (0.6%±0.26%). Paper charts were found for 20 of these cases. Most were self-limited cases of pain or nausea. A small number of cases (n=5) were cardiorespiratory decompensation. There was 100% consensus amongst the panel that all cases of clinical deterioration were not related to team size. There was also 100% consensus that a dual-PCP team would not have been better able to deal with the deterioration, compared to a single-PCP crew.
We found that using a single-PCP configuration for transporting low acuity patients is safe. This finding is particularly important for rural areas where air ambulance is the only means for accessibility to care and where staffing issues are magnified.
PubMed ID
28934993 View in PubMed
Less detail

Care of the Injured Patients at Nursing Stations and during Air Medical Transport.

https://arctichealth.org/en/permalink/ahliterature291708
Source
Air Med J. 2018 May - Jun; 37(3):161-164
Publication Type
Journal Article
Author
Brodie Nolan
Alun Ackery
Sol Mamakwa
Shari Glenn
David VanderBurgh
Aaron Orkin
Michael Kirlew
Evelyn Dell
Homer Tien
Author Affiliation
Ornge Air Ambulance, 5310 Explorer Drive, Mississauga, Ontario, L5W 5H8, Canada.
Source
Air Med J. 2018 May - Jun; 37(3):161-164
Language
English
Publication Type
Journal Article
Abstract
Nursing stations are the only access point into the health care system for some communities and have limited capabilities and resources. We describe characteristics of patients injured in Northern Ontario who present to nursing stations and require transport by air ambulance. Secondary objectives are to compare interventions performed at nursing stations with those performed by flight paramedics and to identify systemic gaps in trauma care.
A retrospective cohort study was performed of all injured patients transported by air ambulance from April 1, 2014, to March 31, 2015.
A total of 125 injured patients were transported from nursing stations. Blunt trauma accounted for 82.5% of injuries, and alcohol intoxication was suspected in 41.6% of patients. The most frequently performed interventions were intravenous fluids and analgesia. Paramedics administered oxygen 62.4% of the time, whereas nursing stations only applied in 8.8% of cases. Flight paramedics were the only providers to intubate and administer tranexamic acid, mannitol, or vasopressors.
Care for patients at nursing stations may be improved by updating the drug formulary based on gap analyses. Further research should examine the role of telemedicine support for nursing station staff and the use of point-of-care devices to screen for traumatic intracranial hemorrhage.
PubMed ID
29735227 View in PubMed
Less detail

Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma.

https://arctichealth.org/en/permalink/ahliterature137759
Source
Can J Surg. 2011 Feb;54(1):9-16
Publication Type
Article
Date
Feb-2011
Author
David Gomez
Barbara Haas
Najma Ahmed
Homer Tien
Avery Nathens
Author Affiliation
Division of Trauma, Department of Surgery at St. Michael's Hospital, 30 Bond Street, Toronto, Ontario. gomezjaramid@smh.toronto.on.ca
Source
Can J Surg. 2011 Feb;54(1):9-16
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Communication
Cross-Sectional Studies
Disaster Planning - organization & administration
Emergency Medical Services - organization & administration
Emergency Service, Hospital - utilization
Female
Humans
Interprofessional Relations
Male
Mass Casualty Incidents
Needs Assessment
Ontario
Physician Executives - organization & administration
Program Evaluation
Total Quality Management
Trauma Centers - organization & administration
Abstract
Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs.
We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where preparedness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses.
Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs.
The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI.
Notes
Cites: N Engl J Med. 2007 Dec 27;357(26):2723-718160694
Cites: J Am Coll Surg. 2007 Oct;205(4):612-617903738
Cites: Chest. 2008 May;133(5 Suppl):8S-17S18460503
Cites: J Trauma. 2002 Aug;53(2):201-1212169923
Cites: J Trauma. 2003 Jan;54(1):147-54; discussion 154-512544910
Cites: Surg Clin North Am. 1991 Apr;71(2):257-662003249
Cites: J Trauma. 2005 Mar;58(3):487-9115761341
Cites: J Health Adm Educ. 2006 Spring;23(2):169-8016700442
Cites: J Trauma. 2006 Oct;61(4):943-817033566
Cites: J Trauma. 2006 Oct;61(4):949-5317033567
Cites: Lancet. 2006 Dec 23;368(9554):2219-2517189033
Cites: Prehosp Disaster Med. 2006 Sep-Oct;21(5):340-417297905
Cites: Arch Surg. 2007 Feb;142(2):203-517309974
Cites: J Trauma. 2007 Aug;63(2):253-717693820
Cites: Adv Data. 2007 Jul 24;(390):1-1017702147
Cites: Adv Data. 2007 Aug 20;(391):1-1317874715
Comment In: Can J Surg. 2011 Feb;54(1):7-821251426
PubMed ID
21251427 View in PubMed
Less detail

Epidemiologic features of medical emergencies in remote First Nations in northern Ontario: a cross-sectional descriptive study using air ambulance transport data.

https://arctichealth.org/en/permalink/ahliterature305896
Source
CMAJ Open. 2020 Apr-Jun; 8(2):E400-E406
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Author
David VanderBurgh
David W Savage
Sacha Dubois
Natalie Binguis
Sadie Maxwell
Natalie Bocking
Terri Farrell
Homer Tien
Stephen D Ritchie
Aaron Orkin
Author Affiliation
Section of Emergency Medicine (VanderBurgh, Savage), Division of Clinical Sciences and Human Sciences Division (Dubois), Northern Ontario School of Medicine; Centre for Applied Health Research (Dubois), St. Joseph's Care Group; School of Nursing (Dubois), Faculty of Health and Behavioural Sciences, Lakehead University; Nishnawbe Aski Nation (Binguis), Thunder Bay, Ont.; Windigo First Nations Council (Maxwell); Sioux Lookout First Nations Health Authority (Bocking, Farrell), Sioux Lookout, Ont.; Division of General Surgery (Tien), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; School of Human Kinetics (Ritchie), Faculty of Health and Centre for Rural and Northern Health Research (Ritchie), Laurentian University, Sudbury, Ont.; Department of Family and Community Medicine (Orkin), University of Toronto; Department of Emergency Medicine (Orkin), St. Joseph's Health Centre and Humber River Hospital, Toronto, Ont.
Source
CMAJ Open. 2020 Apr-Jun; 8(2):E400-E406
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Air Ambulances - statistics & numerical data
Child
Child, Preschool
Cross-Sectional Studies
Emergencies - epidemiology
Emergency Medical Services - statistics & numerical data
Emergency Service, Hospital - statistics & numerical data
Female
Geography, Medical
Humans
Incidence
Infant
Male
Middle Aged
Ontario - epidemiology
Population Surveillance
Rural Health Services - statistics & numerical data
Transportation of Patients - statistics & numerical data
Young Adult
Abstract
For about 25 000 Ontarians living in remote northern First Nations communities, seeing a doctor in an emergency department requires flying in an airplane or helicopter. This study describes the demographic and epidemiologic characteristics of patients transported from these communities to access hospital-based emergency medical care.
In this cross-sectional descriptive study, we examined primary medical data on patient transportation from Ornge, the provincial medical air ambulance service provider, for 26 remote Nishnawbe Aski Nation communities in northern Ontario from 2012 to 2016. We described these transports using univariate descriptive statistics.
Over the 5-year study period, 10 538 patients (mean 2107.6 per year) were transported by Ornge from the 26 communities. Transport incidence ranged from 9.2 to 9.5 per 100 on-reserve population per year. Women aged 65 years or more had the highest transport incidence (25.9 per 100). Girls aged 5-9 years had the lowest mean incidence (2.1 per 100). Gastrointestinal issues accounted for 13.3% of transfers. Neurologic issues, respiratory issues and trauma each accounted for about 11% of transfers, and cardiac issues for 9.6%. Patients with obstetric issues accounted for 7.6% of transfers per year, and toxicologic emergencies for 7.5%.
This study provides the epidemiologic foundation to improve emergency care and emergency transport from remote First Nation communities in Ontario.
PubMed ID
32447282 View in PubMed
Less detail

Pulmonary emboli after blunt trauma: timing, clinical characteristics and natural history.

https://arctichealth.org/en/permalink/ahliterature133253
Source
Injury. 2012 Sep;43(9):1502-6
Publication Type
Article
Date
Sep-2012
Author
Fernando Spencer Netto
Homer Tien
Jeremy Ng
Sarah Ortega
Sandro Scarpelini
Sandro B Rizoli
William Geerts
Author Affiliation
Trauma Program, Department of Surgery of Sunnybrook Health Sciences Centre, University of Toronto, Canada. Fernando.Spencer@uhn.on.ca
Source
Injury. 2012 Sep;43(9):1502-6
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Anticoagulants - therapeutic use
Canada - epidemiology
Female
Humans
Incidental Findings
Male
Middle Aged
Physician's Practice Patterns
Pulmonary Embolism - epidemiology - radiography
Retrospective Studies
Risk factors
Tomography, X-Ray Computed
Venous Thromboembolism - epidemiology - radiography
Abstract
Venous thromboembolism (VTE) frequently complicates the recovery of trauma patients, and contributes to morbidity and mortality. Recent studies showed an increase in diagnosis of pulmonary embolism (PE) mainly in the early or immediate period after trauma. The clinical significance of those incidental PEs is unclear.
The study cohort included all blunt trauma patients who had a contrast-enhanced CT of the chest performed as part of their initial trauma assessment from January 1, 2005 to January 31, 2007 in a large academic Canadian trauma centre. Patients diagnosed with PE at any point during admission were identified using our institutional trauma registry. All chest CT scans and electronic charts were reviewed. Patients were classified according to time of PE detection (immediate, early or late) and symptoms (asymptomatic or symptomatic). The clinical characteristics and hospital course of the patients who were diagnosed with immediate PE were described.
1259 blunt trauma patients were reviewed. Six patients presented with immediate PE (0.5%); nine patients were found to have early PE (0.7%) and 13 had late PE (1.0%). All six of the patients with immediate PE were classified as asymptomatic. Five of the nine patients with early PE were symptomatic and all 13 patients who developed late PE were symptomatic. Amongst the six patients with immediate PE, five survived 24h hospitalisation. Four of them were managed with prophylactic low molecular weight heparin and no other thromboembolic events were observed during admission or after discharge.
The increased use of advanced CT technology in trauma patients has resulted in an increased diagnosis of incidental PEs that are asymptomatic. The clinical significance and management of these small, incidental PE are uncertain and further studies are needed to clarify the natural history of this controversial finding.
PubMed ID
21722897 View in PubMed
Less detail

Re-evaluating the field tourniquet for the Canadian Forces.

https://arctichealth.org/en/permalink/ahliterature113191
Source
Mil Med. 2013 Jun;178(6):669-75
Publication Type
Article
Date
Jun-2013
Author
Erin Savage
Dylan Pannell
Elspeth Payne
Terrance O'Leary
Homer Tien
Author Affiliation
Canadian Forces Health Services, 1745 Alta Vista Drive, Ottawa, Ontario, Canada.
Source
Mil Med. 2013 Jun;178(6):669-75
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Hemorrhage - therapy
Humans
Middle Aged
Military Medicine
Military Personnel
Outcome Assessment (Health Care)
Patient Simulation
Prospective Studies
Tourniquets
Young Adult
Abstract
To determine the best field tourniquet for Medical Technician (Med Tech) use in the Canadian Forces (CF).
We conducted a prospective controlled trial, comparing the efficacy and ease of applicability of 3 types of commercially available windlass tourniquets in 4 tactical situations on simulated patients. The primary outcome was time to tourniquet application with secondary outcomes including effectiveness and Med Tech satisfaction.
The overall finding of this study indicates that the Combat Application Tourniquet (C-A-T) was applied the fastest in each scenario and was also significantly the most effective in occluding distal blood flow. The survey results show that the 3 tourniquet types are similar in many of the measures of ease of learning and application, with the C-A-T scoring highest in self-application and the Special Operations Forces Tactical Tourniquet Wide having the lowest scores for both durability and effectiveness.
When tested on a group of CF Med Techs, the C-A-T remained the CF field tourniquet of choice, based on the assessed criteria. Although there is inherent bias in the approach of this study, it reflects the process required to determine if a new piece of kit is superior to what is already considered the standard to a trained and equipped military.
PubMed ID
23756075 View in PubMed
Less detail

8 records – page 1 of 1.