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OBJECTIVE: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI). However, when primary PCI is not available in a timely fashion, fibrinolysis and early transfer for routine PCI is recommended. Prince Edward Island (PEI) is the only province in Canada without a PCI facility, and distances to the nearest PCI-capable facilities are between 290 and 374 kilometers. This results in prolonged out-of-hospital time for critically ill patients. We sought to characterize and quantify paramedic interventions and adverse patient events during prolonged ground transport to PCI facilities post-fibrinolysis. METHODS: We performed a retrospective chart review of patients presenting to any of four emergency departments (ED) on PEI during the calendar years 2016 and 2017. We identified patients through administrative discharge data and cross referenced with emergent out-of-province ambulance transfers. All included patients were managed as STEMIs in the EDs and subsequently transferred (primary PCI, pharmacoinvasive) directly from the EDs to PCI facilities. We excluded patients having STEMIs on inpatient wards and those transported by other means. We reviewed electronic and paper ED charts plus paper EMS records. We performed summary statistics. RESULTS: We identified 149 patients meeting inclusion criteria. Most patients were males (77.9%), mean age 62.1 (SD 13.8) years. The mean transport interval was 202 (SD 29.0) minutes. Thirty-two adverse events occurred during 24 transports (16.1%). There was one death, and four patients required diversion to non-PCI facilities. Hypotension was the most common adverse event (n = 13, 8.7%), and fluid bolus (n = 11, 7.4%) was the most common intervention. Three (2.0%) patients required electrical therapy. Nitrates (n = 65, 43.6%) and opioid analgesics (n = 51, 34.2%) were the most common drugs administered during transport. CONCLUSION: In a setting where primary PCI is not feasible due to distance, a pharmacoinvasive model of STEMI care is associated with a 16.1% proportion of adverse events. Crew configuration including ALS clinicians is the key in managing these events.
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Serviços Médicos de Emergência , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Paramédico , Estudos RetrospectivosRESUMO
BACKGROUND: Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15-25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9-1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival. METHODS: In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9-1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation. DISCUSSION: The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more. TRIAL REGISTRATION: Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059 .
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Ambulâncias , Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Telecomunicações , Canadá , Reanimação Cardiopulmonar/educação , Morte Súbita Cardíaca , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Qualidade de Vida , Análise de SobrevidaRESUMO
INTRODUCTION: The scene-size-up is a crucial first step in the response to a mass casualty incident (MCI). Unmanned aerial vehicles (UAV) may potentially enhance the scene-size-up with real-time visual feedback during chaotic, evolving or inaccessible events. We performed this study to test the feasibility of paramedics using UAV video from a simulated MCI to identify scene hazards, initiate patient triage, and designate key operational locations. METHODS: We simulated an MCI, including 15 patients plus 4 hazards, on a college campus. A UAV surveyed the scene, capturing video of all patients, hazards, surrounding buildings and streets. We invited attendees of a provincial paramedic meeting to participate. Participants received a lecture on Sort-Assess-Lifesaving Interventions-Treatment/Transport (SALT) Triage and MCI scene management principles. Next, they watched the UAV video footage. We directed participants to sort patients according to SALT Triage Step One, identify injuries, and to localize the patients within the campus. Additionally, we asked them to select a start point for SALT Triage Step Two, identify and locate hazards, and designate locations for an Incident Command Post, Treatment Area, Transport Area and Access/Egress routes. The primary outcome was the number of correctly allocated triage scores. RESULTS: Ninety-six individuals participated. Mean age was 35 years (SD 11); 46% (44) were female and 49% (47) were Primary Care Paramedics. Most participants (79; 82%) correctly sorted at least 12 of 15 patients. Increased age was associated with decreased triage accuracy [-0.04(-0.07, -0.01); p = 0.031]. Fifty-two (54%) correctly localized 12 or more patients to a 27 × 20m grid area. Advanced paramedic certification, and local residency were associated with improved patient localization [2.47(0.23,4.72); p = 0.031], [3.36(1.10,5.61); p = 0.004]. The majority of participants (70; 81%) chose an acceptable location to start SALT Triage Step Two and 75 (78%) identified at least 3 of 4 hazards. Approximately half (53; 56%) of participants appropriately designated 4 or more of 5 key operational areas. CONCLUSION: This study demonstrates the ability of UAV technology to remotely facilitate the scene size-up in an MCI. Additional research is required to further investigate optimal strategies to deploy UAVs in this context.
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Aeronaves/instrumentação , Incidentes com Feridos em Massa , Observação/métodos , Adulto , Serviços Médicos de Emergência , Auxiliares de Emergência/educação , Estudos de Viabilidade , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Triagem , Adulto JovemRESUMO
OBJECTIVES: Disaster medicine teaching is an important, and understudied, component of EM residency training programs. Little is known about disaster medicine training in Canadian EM programs, particularly within the 1-year EM enhanced skills programs. The purpose of this study is to (1) understand which disaster medicine topics are currently taught in EM enhanced skills programs and (2) establish a list of the highest priority disaster medicine teaching topics for those programs. METHODS: We distributed an eight-question survey to all 31 EM enhanced skills site directors across Canada by email. Questions on the survey asked which of 39 disaster medicine subtopics were (1) currently taught and (2) should be taught to EM enhanced skills residents. RESULTS: Of 31 invited participants, 16 completed the study (52% response rate). The most taught topic was introduction to disaster medicine/nomenclature (13/16 programs), while 11/16 programs currently teach decontamination indications and issues, personal protective equipment, prehospital disaster management, and trauma mass casualty incidents. Topics reported high or essential priority for teaching included introduction to disaster medicine/nomenclature (12/16 programs), decontamination indications and issues, personal protective equipment, and prehospital disaster management (11/16 programs). CONCLUSIONS: This study identified disaster medicine topics currently taught at Canadian EM enhanced skills programs, along with recommending a list of priority teaching topics. These findings can inform future disaster medicine content in EM training program curricula.
RéSUMé: OBJECTIFS: L'enseignement de la médecine de catastrophe est une composante importante et peu étudiée des programmes de résidence en MU. On sait peu de choses sur la formation à la médecine de catastrophe dans les programmes canadiens de MU, en particulier dans les programmes d'un an visant à améliorer les compétences en MU. L'objectif de cette étude est de 1) comprendre quels sujets relatifs à la médecine de catastrophe sont actuellement enseignés dans les programmes d'amélioration des compétences en MU et 2) d'établir une liste des sujets d'enseignement de la médecine de catastrophe les plus prioritaires pour ces programmes. MéTHODES: Nous avons distribué par courriel un questionnaire de huit questions aux 31 directeurs de sites d'amélioration des compétences en MU au Canada. Les questions de l'enquête portaient sur les 39 sous-thèmes de la médecine de catastrophe qui 1) sont actuellement enseignés et 2) devraient être enseignés aux résidents ayant des compétences renforcées en MU. RéSULTATS: Sur les 31 participants invités, 16 ont terminé l'étude (taux de réponse de 52 %). Le sujet le plus enseigné était l'introduction à la médecine de catastrophe/la nomenclature (13/16 programmes), tandis que 11/16 programmes enseignent actuellement les indications et les problèmes de décontamination, l'équipement de protection individuelle, la gestion préhospitalière des catastrophes et les traumatismes liés aux incidents de masse. Les sujets considérés comme prioritaires ou essentiels pour l'enseignement comprenaient l'introduction à la médecine de catastrophe/la nomenclature (12/16 programmes), les indications et les problèmes de décontamination, l'équipement de protection individuelle et la gestion préhospitalière des catastrophes (11/16 programmes). CONCLUSIONS: Cette étude a permis d'identifier les sujets relatifs à la médecine de catastrophe actuellement enseignés dans les programmes canadiens d'amélioration des compétences en MU, et de recommander une liste de sujets d'enseignement prioritaires. Ces résultats peuvent éclairer le contenu futur de la médecine de catastrophe dans les programmes de formation en médecine d'urgence.
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Medicina de Desastres , Medicina de Emergência , Internato e Residência , Humanos , Medicina de Desastres/educação , Canadá , Currículo , Medicina de Emergência/educaçãoRESUMO
Introduction Trauma shears are commonly used by emergency medical services (EMS) providers to remove clothing from patients and expose underlying traumatic injuries. Other tools exist that may be more effective, but they are largely untested. This study compared the use of trauma shears versus two cutting hooks in removing clothing from a simulated trauma patient. Methods We recruited 18 paramedic students to participate in a cross-over study designed to remove clothing from a wholly dressed full-body training mannequin using trauma shears (with the cut-and-rip (CAR) technique) and two cutting hooks (S-Cut QE (ES Equipment AB, Nol, Sweden) and the Talon Rescue Emergency Clothing Knife (TRECK+, Talon Rescue, Farmington, CT, USA)). We determined the order of the tools using a three-by-three Latin square and randomized participants equally between possible orders to minimize carryover effects. We recorded times for total clothing removal and the removal of clothing from the upper and lower body, respectively. We employed a mixed-effects analysis of variance (ANOVA) to determine any differences between tools. Results Removal time was significantly faster with the S-Cut QE compared to the CAR technique and TRECK+ (mean 78 seconds, 95% confidence interval (CI) 52-103 vs. 142 seconds, 95% CI 117-167, vs. 209 seconds, 95% CI 184-235, p<0.001). The S-Cut QE was significantly faster than the CAR technique and TRECK+ for upper body clothing removal (mean 47 seconds, 95% CI 30-64 vs. 92 seconds, 95% CI 75-109, vs. 131 seconds, 95% CI 115-148, p<0.001) and the S-Cut QE and CAR were significantly faster than TRECK+ for lower body clothing removal (mean 25 seconds, 95% CI 11-38 and 44 seconds, 95% CI 31-58 vs. 71 seconds, 95% CI 58-85, p<0.001). Most (78%) participants preferred the S-Cut QE over other tools. Conclusion The S-Cut QE removed clothing from a simulated trauma patient faster than both the CAR and TRECK+. Emergency medical services (EMS) agencies should consider adding a cutting hook to their standard trauma kit.
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Paramedicine as a profession is continually evolving in clinical practice, responsibilities, and workload. Changes over time in both population demographics and distribution have altered the demand for, and availability of, prehospital emergency medical services (EMS). These factors may also affect scheduling policies in many EMS organizations. However, there is little evidence that suggests optimal shift scheduling patterns to reduce adverse health events such as increased stress or fatigue in prehospital emergency health care providers. Our objective was to describe associations between variations in shift scheduling patterns and EMS provider health outcomes, such as fatigue, stress, sleep quality, and general mental and physiological health. We also sought to identify knowledge gaps. We performed searches of PubMed, CINAHL, Embase, and Cochrane databases for primary studies, systematic reviews, and meta-analyses published between January 2000 and December 2020. Studies reporting measurable health care outcomes in prehospital personnel with defined shift schedule patterns in land-based ambulance systems were included. Our search strategy yielded 188 studies, of which 11 met eligibility criteria (eight cross-sectional surveys, one single case report, one retrospective cohort study, one prospective cohort study, and one systematic review), with one additional study found through reference list screening, leaving 12 studies for review. All publications contained a description of shift schedule characteristics and shared similar outcomes of interest, although there was variation in comparators and assessment of outcomes. Most studies showed high rates of fatigue, stress, mental health concerns, and negative general health outcomes in paramedic shift worker populations. The case study reported improved fatigue, alertness, and sleep quality levels following a switch from a 24-hour shift pattern to an eight-hour shift. We did not complete an in-depth risk of bias assessment for any of the studies. Melnyk evidence ratings varied from IV to VI, indicating a low quality of evidence evaluating the impacts of shift schedule patterns in paramedics, with the retrospective cohort study design, ranked as IV, systematic review as a V, and prospective cohort study, case report and surveys ranked as VI. The low quality and quantity of evidence indicate the need for further research to definitively assess relationships between specific schedule patterns and health outcomes.
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INTRODUCTION: The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the situational awareness of medical incident commanders' (ICs') scene assessment of mass gatherings. Mass gatherings occur frequently and the potential for injury at these events is considered higher than the general population. These events have generated mass-casualty incidents (MCIs) in the past. The aim of this study was to compare UAV technology to standard practice (SP) in scene assessment using paramedic students during a mass-gathering event (MGE). METHODS: This study was conducted in two phases. Phase One consisted of validation of the videos and accompanying data collection tool. Phase One was completed by 11 experienced paramedics from a provincial Emergency Medical Services (EMS) service. Phase Two was a randomized comparison with 47 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada) of the two scene assessment systems. For Phase Two, the paramedic students were randomized into a UAV or a SP group. The data collection tool consisted of two board categories: primary importance with 20 variables and secondary importance with 25 variables. After a brief narrative, participants were either shown UAV footage or the ground footage depending on their study group. After completion of the videos, study participants completed the data collection tool. RESULTS: The Phase One validation showed good consensus in answers to most questions (average 79%; range 55%-100%). For Phase Two, a Fisher's exact test was used to compare each variable from the UAV and SP groups using a P value of .05. Phase Two demonstrated a significant difference between the SP and UAV groups in four of 20 primary variables. Additionally, significant differences were found for seven out of 25 secondary variables. CONCLUSION: This study demonstrated the accurate, safe, and feasible use of a UAV as a tool for scene assessment by paramedic students at an MGE. No observed statistical difference was noted in a majority of both primary and secondary variables using a UAV for scene assessment versus SP.
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Auxiliares de Emergência , Incidentes com Feridos em Massa , Pessoal Técnico de Saúde , Humanos , Estudantes , TecnologiaRESUMO
INTRODUCTION: The interpretation of electrocardiograms (ECGs) is an essential competency in modern paramedicine. Although educational guidelines for paramedic ECG interpretation exist, they are broad, not evidence-based, and lack prioritization in a prehospital clinical context. We conducted this study to gain consensus among stakeholders (EMS physicians, paramedic educators, and paramedic clinicians) regarding which ECG diagnoses or findings are most important for a practising advanced care paramedic to know. Methods: This study was an internet-based Delphi survey. We purposefully sampled participants in pairs (physician/paramedic) from all 10 Canadian provinces. Individuals rated a previously developed comprehensive list of emergency ECG diagnoses or findings on the importance of paramedic recognition and impact on prehospital care using a 4-point Likert scale. The consensus was achieved with a minimum of 75% agreement on Likert rating for a single diagnosis or finding during survey rounds one to three. When consensus was not reached, stability was defined as a shift of individual ratings between rounds of 20% or less. RESULTS: All 20 participants completed the first and second rounds of the survey, and 17 (85%) completed three rounds. Overall, 32 (26.4%) of 121 potentially important ECG diagnoses or findings reached consensus, 2 (1.7%) reached stability and 87 (71.9%) reached neither consensus nor stability. Twenty-one (17.4%) diagnoses or findings were considered "Very Important", six (4.9%) "Important", and five (4.1%) "Minimally Important". In the first round of the survey, the mean rating of the importance of a paramedic knowing a specific ECG diagnosis or finding was lower in the physician group than the paramedic group on 85 (72%) of 118 initial diagnoses or findings. CONCLUSION: We have created a list of ECG diagnoses or findings prioritized for the prehospital context that may assist paramedic educators in focusing on educational interventions. Many ECG diagnoses or findings failed to reach consensus or stability, demonstrating potential disagreement regarding clinical expectations for ECG knowledge among paramedics or physicians.
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A 16-month-old presents to the emergency department (ED) after a fall while running at home. Her mother noted some blood in the child's mouth and believed there was a tear in the skin above the front teeth.
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Serviço Hospitalar de Emergência , Boca/lesões , Traumatismos Dentários , Feminino , Humanos , Lactente , DenteRESUMO
A 65-year-old female smoker complains of dizziness and mild headache. While at the local pharmacy buying acetaminophen, she decides to check her blood pressure to see if it could be "causing her symptoms." Her initial measurement is 220/96 mm Hg. In consultation with the on-duty pharmacist she is instructed to immediately attend the emergency department (ED) for management of her hypertension.
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Hipertensão , Acetaminofen , Idoso , Serviço Hospitalar de Emergência , Feminino , Cefaleia , Humanos , Hipertensão/diagnóstico , FarmacêuticosRESUMO
IntroductionThe proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the way medical incident commanders (ICs) respond to mass-casualty incidents (MCIs) in triaging victims. The aim of this study was to compare UAV technology to standard practice (SP) in triaging casualties at an MCI. METHODS: A randomized comparison study was conducted with 40 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada). Using a simulated motor vehicle collision (MVC) with moulaged casualties, iterations of 20 students were used for both a day and a night trial. Students were randomized to a UAV or a SP group. After a brief narrative, participants either entered the study environment or used UAV technology where total time to triage completion, GREEN casualty evacuation, time on scene, triage order, and accuracy were recorded. RESULTS: A statistical difference in the time to completion of 3.63 minutes (95% CI, 2.45 min-4.85 min; P=.002) during the day iteration and a difference of 3.49 minutes (95% CI, 2.08 min-6.06 min; P=.002) for the night trial with UAV groups was noted. There was no difference found in time to GREEN casualty evacuation, time on scene, or triage order. One-hundred-percent accuracy was noted between both groups. CONCLUSION: This study demonstrated the feasibility of using a UAV at an MCI. A non-clinical significant difference was noted in total time to completion between both groups. There was no increase in time on scene by using the UAV while demonstrating the feasibility of remotely triaging GREEN casualties prior to first responder arrival.Jain T, Sibley A, Stryhn H, Hubloue I.Comparison of unmanned aerial vehicle technologyassisted triage versus standard practice in triaging casualties by paramedic students in a mass-casualty incident scenario. Prehosp Disaster Med. 2018;33(4):375-380.
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Pessoal Técnico de Saúde/educação , Incidentes com Feridos em Massa , Triagem/métodos , Simulação por Computador , Serviços Médicos de Emergência , HumanosRESUMO
IntroductionThe proliferation of unmanned aerial vehicles (UAV) has the potential to change the situational awareness of incident commanders allowing greater scene safety. The aim of this study was to compare UAV technology to standard practice (SP) in hazard identification during a simulated multi-vehicle motor collision (MVC) in terms of time to identification, accuracy and the order of hazard identification. METHODS: A prospective observational cohort study was conducted with 21 students randomized into UAV or SP group, based on a MVC with 7 hazards. The UAV group remained at the UAV ground station while the SP group approached the scene. After identifying hazards the time and order was recorded. RESULTS: The mean time (SD, range) to identify the hazards were 3 minutes 41 seconds (1 minute 37 seconds, 1 minute 48 seconds-6 minutes 51 seconds) and 2 minutes 43 seconds (55 seconds, 1 minute 43 seconds-4 minutes 38 seconds) in UAV and SP groups corresponding to a mean difference of 58 seconds (P=0.11). A non-parametric permutation test showed a significant (P=0.04) difference in identification order. CONCLUSION: Both groups had 100% accuracy in hazard identification with no statistical difference in time for hazard identification. A difference was found in the identification order of hazards. (Disaster Med Public Health Preparedness. 2018;12:631-634).
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Desenho de Equipamento/normas , Incidentes com Feridos em Massa/estatística & dados numéricos , Tecnologia de Sensoriamento Remoto/normas , Triagem/normas , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Estudos de Coortes , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Estudos Prospectivos , Tecnologia de Sensoriamento Remoto/métodos , Ensino , Fatores de Tempo , Triagem/métodos , Triagem/estatística & dados numéricosRESUMO
IntroductionRapid exposure of a trauma patient is an essential component of the primary survey. No gold standard exists regarding the best technique to remove clothing from a trauma patient. The purpose of this study is to compare two techniques of clothing removal versus usual practice using standard trauma shears. METHODS: Advanced Care Paramedic (ACP) students were randomized to either the Cut and Rip (CAR) or Cut Alone (CAL) techniques to remove clothing from a standardized trauma mannequin. Practicing paramedics were recruited to remove clothing from the mannequin using Usual Practice (UP). Total time and time for removal of individual pieces of clothing was recorded. RESULTS: Twenty-four participants (8 per group) were recruited to participate. The student groups (CAR, CAL) were similar in mean age (29, 27), years of practice (1 student >5 years) and male gender (63, 43%). The UP group was older (mean 34), more experienced (63% practice >5 years), and had a higher level of training (63% ACP) but a similar percentage of males (63%). Removal time was significantly less in the CAR group compared to the CAL group (mean 104 seconds, 95% CI 88-120 vs. mean 136 seconds, 95% CI 119-154, p=0.02). Removal times in the UP group were not significantly different from the other groups (mean 124 seconds, 95% CI 108-140, p>0.05). CONCLUSION: The CAR technique is faster than both CAL and UP groups to remove clothing from a standard trauma mannequin.
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Vestuário , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência/educação , Manequins , Estudantes de Ciências da Saúde , Adulto , Pessoal Técnico de Saúde/educação , Análise de Variância , Feminino , Humanos , Masculino , Análise e Desempenho de Tarefas , Fatores de TempoRESUMO
Introduction Learners in the emergency department (ED) frequently encounter individuals who are homeless. We sought to evaluate the effect of an inner city emergency medicine rotation at the Royal Alexandra Hospital (RAH) on the attitudes of medical students and residents towards this population. Methods Data were collected both pre- and post-rotation using an electronic survey. Data collected included demographic information and as well as scores on the Health Professionals' Attitudes Towards the Homeless Inventory (HPATHI). Pre- and post-survey results were compared using Wilcoxon tests. Results Ninety-eight students completed the rotation. A total of 40 (41%) students completed both pre- and post-surveys. Demographic information was available for 66 respondents. Most participants were male (42 {64%}), single (47 {71%}), and 30 years of age or younger (59 {89%}). Most participants were of a Caucasian or East/South Asian background (61 {92%}) and grew up in an urban setting (51 {77%}). Overall, 43 (90%) participants saw at least one person who was homeless during their rotation. There was no significant difference between pre- and post-aggregate scores (z = -0.78, p = 0.44), or any of its three subscales (Personal Advocacy, Social Advocacy, and Cynicism). Conclusion First year residents and medical students are frequently exposed to patients who are homeless during an inner city ED rotation. Attitudes towards these patients did not significantly change following the rotation. Educational objectives should be set to improve attitudes of learners towards those with unstable housing throughout the ED rotation.
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BACKGROUND: Riding all-terrain vehicles (ATVs) is a popular recreational activity, with approximately 1.5 million users in Canada. Despite legislation aimed at reducing injury rates, ATV-related incidents remain a major cause of trauma and death. This paper reviews the epidemiology of major injury associated with ATV use in Nova Scotia. METHODS: The Nova Scotia Trauma Registry was used to identify all adults over age 15 who sustained major ATV-related trauma (Injury Severity Score [ISS] >/=12) within a 5-year period. Demographic variables, temporal statistics, alcohol use, helmet use, injury characteristics and injury outcome variables, including ISS, length of stay (LOS), Glasgow Coma Scale score and discharge status were evaluated. RESULTS: Twenty-five patients met the inclusion criteria. Most (92%) were males, and 64% were between 16 and 34 years of age. Most injuries occurred between 1300 hrs and 1900 hrs, 52% occurred on the weekend, and 40% occurred in the spring. The average ISS was 22.1, and injuries to the central nervous system comprised 39% of all major injuries. Alcohol was involved in up to 56% of all incidents, and only 4 patients (16%) were known to be wearing a helmet at the time of injury. Average hospital LOS was 21.6 days. INTERPRETATION: ATV-related incidents are a continuing source of major injury. This paper describes the epidemiology of ATV-related major trauma presenting to the sole tertiary care referral centre in one province. Information gained from this study should be used to influence ATV public education programs.