To determine the duration and obstacles to prolonged on-scene cardiopulmonary resuscitation (CPR), and establish how long a pair of emergency medical technicians (EMTs) can provide high-quality CPR.Intermediate-level EMTs in Gyeonggi-do Province, Republic of Korea completed a survey regarding on-scene CPR. EMTs undergoing routine training took part in a simulation using mannequins. Parameters including compression depth, total number and rate of compressions; occurrence of incorrect hand position and incomplete chest recoil were collected over 16 2-min cycles of CPR (32 min total), with EMTs working in pairs.The simulation study included 43 EMTs. The median duration of on-scene CPR was 3.7 min. Fear of decrease in performance was the main obstacle to continued CPR (n = 188/254 [74.0%]). Standards for high-quality CPR were met at each of the 16 steps of the simulation. Compression rate increased significantly with time. There were no significant changes in any other parameter.Pairs of EMTs maintained high-quality CPR for 16 cycles (32 min) with no decrease in performance. Our findings could provide evidence to recommend guidelines for duration of on-scene CPR for cardiac arrest, particularly in countries where the level and number of ambulance crews are limited.
Many disasters have occurred around the world and have caused sizable damage. A disaster, called a mass casualty incident (MCI), generates a large number of casualties that overwhelm the capacity of local medical resources, and the disaster responses to the MCI requires many interactions among the disaster responders. To evaluate the efficiency of the disaster responses against MCIs, this paper proposes an agent-based model describing the cooperations among the responders during the overall process in the disaster responses from transporting patients to their definitive care. In particular, the proposed model includes geospatial details, such as the road network and the location of hospitals around the disaster scene, and medical information, such as the distribution of medical resources and transporting units, in the region of interest to discover the key factors of the disaster response system that customized to the target region. The case study in this paper presents that the proposed approach was applied to describe a disaster response system and illustrates how the additional details are utilized to analyze the disaster response system. We expect that the proposed method can provide comprehensive insights to a disaster response system of interest, and it can be used as groundwork for improving the disaster response system.
As the number of people living in high-rise buildings increases, so does the incidence of cardiac arrest in these locations. Changes in cardiac arrest location affect the recognition of patients and emergency medical service (EMS) activation and response. This study aimed to compare the EMS response times and probability of a neurologically favorable discharge among patients who suffered an out-of-hospital cardiac arrest (OHCA) event while on a high or low floor at home or in a public place. This retrospective analysis was based on Smart Advanced Life Support registry data from January 2016 to December 2017. We included patients older than 18 years who suffered an OHCA due to medical causes. A high floor was defined as ≥3rd floor above ground. We compared the probability of a neurologically favorable discharge according to floor level and location (home vs. public place) of the OHCA event. Of the 6,335 included OHCA cases, 4,154 (65.6%) events occurred in homes. Rapid call-to-scene times were reported for high-floor events in both homes and public places. A longer call-to-patient time was observed for home events. The probability of a neurologically favorable discharge after a high-floor OHCA was significantly lower than that after a low-floor OHCA if the event occurred in a public place (adjusted odds ratio (aOR), 0.58; 95% confidence intervals (CI), 0.37-0.89) but was higher if the event occurred at home (aOR, 1.40; 95% CI, 0.96-2.03). Both the EMS response times to OHCA events in high-rise buildings and the probability of a neurologically favorable discharge differed between homes and public places. The results suggest that the prognosis of an OHCA patient is more likely to be affected by the building structure and use rather than the floor height.
Neuron-specific enolase (NSE) is released into serum when nerve cells are damaged, and the levels thereof are used to determine neurological prognosis in patients who have suffered cardiac arrest or stroke. Delayed neuropsychiatric sequelae (DNS), a major complication of carbon monoxide poisoning (COP), can be caused by inflammatory response which is a mechanism of neuronal injury in cardiac arrest and stroke. NSE is known as a predictor of neurological prognosis in ischemic brain injury after cardiac arrest, and it is also reported as a predictor of DNS in acute COP. When serum NSE is measured serially in cardiac arrest patients, the best time to predict neurological prognosis is known at 48-72 h, but there are no studies analyzing serial serum NSE in acute COP. Thus, we explored whether serum NSE levels measured three times at 24 h intervals after COP predicted the development of DNS.This prospective observational study was conducted on patients treated for COP from May 2018 to April 2020 in a tertiary care hospital in Korea. Neuron-specific enolase levels were assessed 24, 48, and 72 h after presentation at hospital. We used logistic regression to explore the association between NSE levels and DNS development.The NSE level was highest at 48 h, and the difference between the DNS group and the non-DNS group was greatest on the same time point. On multivariable logistic regression analysis, the NSE level at 48 h of >20.98 ng/mL (odds ratio [OR], 3.570; 95% confidence interval [CI], 1.412-9.026; P = .007) and the initial Glasgow Coma Scale (GCS) score of <9 (OR, 4.559; 95% CI, 1.658-0.12.540; P = .003) was statistically significant for DNS development.Early identification of those who will experience DNS in acute COP patients is clinically important for deciding treatment. In this study, we revealed that NSE level of >20.98 ng/mL at 48 h time point can be used as an independent predictor of DNS (OR, 3.570; 95% CI, 1.412-9.026; P = .007; AUC, 0.648).
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