Medical Care in a Police Intervention with Conducted Electrical Weapons: Zaragoza (Spain) Fire Department Protocol.

In the last decade, conducted electrical weapons (CEWs) have become a new tool for law enforcement agencies as an alternative to firearms. They provide security in the intervention for both the police and the citizen and try to cause the least possible harm to the subject to immobilize.The health care providers who perform in joint actions with the police in which CEWs are used should be aware of how they work, risk groups, as well as the most frequent clinical effects associated with the application of electrical discharge, and the complications that can be produced according to the area of impact of the electrodes.For this purpose, the current medical literature was reviewed by consulting the main health care sciences database (PubMed) to determine the medical measures to be taken before, during, and after the use of these weapons. Also presented and shared is the Zaragoza (Spain) Fire Department protocol.

Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors.

OBJECTIVE: To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data recorded in the nationwide Spanish OHCA Registry (OHSCAR). MATERIAL AND METHODS: We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome. Inclusion criteria were: age 16-60 years, witnessed OHCA, no return of spontaneous circulation (ROSC) and time interval <15min between OHCA occurrence and CPR initiation. RESULTS: Of a total 8789 cases, 3290 met the age criteria; of these, CPR was not witnessed in 745 cases. Among the remaining 2545 patients, 141 were included in uncontrolled donation after cardiac death (uDCD) programs, 902 arrived at the hospital with ROSC, 64 arrived with ongoing CPR and 15 cases were lost to follow-up. Of the remaining 1423 without ROSC, CPR initiation time was not recorded in 454 cases and 398 did not meet the time criteria <15min between OHCA and CPR initiation. Finally, 571 met all the criteria and could have been potential donors. There were significant differences in the actual donors percentage from potential donors percentage between provinces with and without donor programs (141/322=43.8% versus 0/390=0%), but there were no differences in ROSC between the two types of provinces (418/1320=31.7% versus 652/1970=33.4%). CONCLUSIONS: Many potential donors are missed in current clinical practice. uDCD programs are few and underused even in a country with high rates of organ transplantation.

[New medical approach to out-of-hospital treatment of psychomotor agitation in psychiatric patients: a report of 14 cases]. / Nuevo abordaje farmacológico en la agitación psicomotriz en pacientes psiquiátricos tratados en el medio extrahospitalario. A propósito de 14 casos.

OBJECTIVES: This case series explored the usefulness of an inhaled dose of 9.1 mg of loxapine administered outside the hospital to treat psychomotor agitation related to schizophrenia, bipolar disorder, or schizoaffective disorder. The Clinical Global Impression Scale and the Positive and Negative Syndrome Scale (excitement component) were used to assess the effects of treatment in 14 patients. The treatment was useful in 12 patients, who showed significant improvement (P<.001) after inhalation. We conclude that inhaled loxapine is useful for treating out-of-hospital psychomotor agitation related to a psychiatric disorder. Mechanical restraint and parenteral medication can be avoided after use of this drug. Loxapine treatment shortens the agitation episode and attenuates the impact on the patient, facilitating ambulance transfer.

OBJETIVO: El presente artículo evalúa la utilidad de la dosis de 9,1 mg de loxapina inhalada, administrada en el medio extrahospitalario, en el tratamiento de la agitación psicomotriz asociada a esquizofrenia, trastorno bipolar y trastorno esquizoafectivo. Se emplearon la Escala de Impresión Clínica Global y la Escala de Síntomas Positivos y Negativos - Componente de Excitación. Se atendieron un total de catorce pacientes. En doce de ellos el tratamiento se mostró útil, con una diferencia significativa entre los momentos previos y posteriores al tratamiento (p < 0,001). Se concluye que la loxapina inhalada es una opción útil en el medio extrahospitalario para el control de la agitación psicomotriz de causa psiquiátrica. Evita la contención mecánica y la necesidad de terapia farmacológica por vía parenteral. El tratamiento permite acortar la duración del episodio y atenuar su repercusión en el paciente, sin producir sedación y facilitando su traslado en ambulancia.

Inhaled Loxapine for the Treatment of Psychiatric Agitation in the Prehospital Setting: A Case Series.

Rapid and effective control of agitated patients is crucial for ensuring their safety and proper management. We present a case series of 12 agitated psychiatric patients who were suitable for treatment with inhaled loxapine in the prehospital emergency setting. Two refused its administration and two required additional treatment. Loxapine was effective within 2-10 minutes, with no adverse effects or sedation. In our experience the use of inhaled loxapine enabled rapid and non-coercive control of agitation in most psychiatric patients, allowing us to avoid mechanical restraint and injectable drugs, and facilitating the transportation and transfer of the patients.