RESUMEN
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014. Inclusion criteria included all patients over 18 years of age with bleeding of supposedly abdominal and/or pelvic and/or junctional origin, uncontrolled haemorrhagic shock or cardiac arrest with attempted resuscitation. RESULTS: During this study period, a total of 1159 patients with trauma (3.2%) would have been eligible to undergo REBOA. Death on scene rate was 83.8% (n=31) and six patients had a beating heart when they arrived at the hospital. Ten out of the 37 patients had spontaneous circulatory activity. Among them, four people died on the scene or during transport. Thirty-six out of 37 patients were intubated, one benefited from the use of a haemostatic dressing and one benefited from a tourniquet. CONCLUSIONS: REBOA can be seen as an effective non-surgical solution to ensure complete haemostasis during the prehospital setting. When comparing the high mortality rate following haemorrhage with the REBOA's rare side effects, the risk-benefit balance is positive. Given that 3% of all patients with trauma based on this study would have been eligible for REBOA, we believe that this intervention should be available in the prehospital setting. The results of this study will be used: educational models for REBOA balloon placement using training manikins, with an ultimate aim to undertake a prospective feasibility study in the prehospital setting.
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Oclusión con Balón/estadística & datos numéricos , Servicios Médicos de Urgencia , Bomberos , Traumatismo Múltiple , Accidentes/mortalidad , Adulto , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/mortalidad , Traumatismo Múltiple/terapia , Paris/epidemiología , Resucitación/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Each year, the French Special Weapons And Tactics team, Groupe d'Intervention de la Gendarmerie Nationale, recruits new members through a physically demanding 8-week selection process. The goal of this study is to estimate the incidence and the causes for temporary or final interruptions during this process for medical reasons. SUBJECTS, MATERIAL AND METHODS: All of the candidates for the November 2015 selection process were included in this prospective study. The number and reasons for temporary or final interruptions were documented by military general practitioners. RESULTS: The applicants were 48 law enforcement professionals (2 women, mean age 29.4â years, range 22-35). In 14 cases, a temporary interruption was required and in five cases the selection process prematurely ended. Fifty-two per cent of the temporary interruptions were due to sprains, tendinopathies, fractures or muscle tears, 11% were due to burns, wounds or subcutaneous bruises, 16% were due to cranial trauma and 21% were due to medical causes. DISCUSSION: The high prevalence of minor traumatology that we observed is similar to the ones observed in other cohorts describing initial training for military personnel in the conventional forces. However, the presence of other pathologies in our study, such as cranial trauma or medical causes, is due to the specificity of this internship selection granting access to an elite unit.
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Policia/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Adulto , Quemaduras/epidemiología , Traumatismos Craneocerebrales/epidemiología , Femenino , Fracturas Óseas/epidemiología , Francia/epidemiología , Humanos , Aplicación de la Ley , Masculino , Policia/educación , Prevalencia , Esguinces y Distensiones/epidemiología , Tendinopatía/epidemiología , Terrorismo , Adulto JovenRESUMEN
BACKGROUND: The resuscitative endovascular balloon occlusion of the aorta (REBOA) technique controls abdominal, pelvic, junctional, and postpartum hemorrhage via aortic endoclamping. There are no protocols or clear indications guiding REBOA use in a two-tiered prehospital emergency medical system, as found in France. We conducted a Delphi study to clarify the indications and contraindications for REBOA application in such a system. METHODS: We performed a Delphi study in three rounds with an international group of doctors with REBOA expertise and clinical experience (members of the EndoVascular and Trauma Management Society). Based on the consensus answers, complemented by existing data in the literature, we developed a protocol for REBOA use in a medicalized prehospital setting. RESULTS: We identified 10 questions that were not answered in the literature and submitted them to 21 experts. Over three rounds, consensus was reached on these 10 questions. The most important ones were "In your opinion, in a hemorrhagic patient, vascularly well-filled and whose hemodynamics remain unstable with 3mg/h of norepinephrine, should we inflate a REBOA to prevent the patient's death and get them to the operating room alive?" and "In the case of REBOA placement (zone I) in the prehospital setting, would you agree that the maximum occlusion duration is approximately 30 minutes, with a partial or intermittent occlusion when possible?" CONCLUSION: We propose a protocol for REBOA use in a medicalized prehospital setting. This protocol clarifies that hemorrhagic shock, despite a noradrenaline (also known as norepinephrine) dose of 0.6µg/kg/min, is considered too serious for the patient to be transported to the trauma center without REBOA. Moreover, it clarifies that a zone 1 REBOA should be inflated for maximum 30 minutes and with a partial occlusion strategy, if possible. This protocol should be updated based on feedback following the establishment of prehospital REBOA and large randomized studies.
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Dolor en el Pecho/etiología , Vasos Coronarios/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/diagnóstico , Vasos Coronarios/lesiones , Vasos Coronarios/fisiopatología , Electrocardiografía/métodos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/fisiopatologíaAsunto(s)
Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Fracturas Óseas/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Accidentes por Caídas , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that uses internal clamping of the aorta to control abdominal, pelvic, or junctional bleeding. We created a course to train military physicians in both civilian prehospital use and battlefield use. To determine the effectiveness of this training, we conducted REBOA training for French military emergency physicians. METHODS: We trained 15 military physicians, organizing the training as follows: a half-day of theoretical training, a half-day of training on mannequins, a half-day on human corpses, and a half-day on a living pig. The primary endpoint was the success rate after training. We defined success as the balloon being inflated in zone 1 of a PryTime mannequin. The secondary endpoints were the progression of each trainee during the training, the difference between the median completion duration before and after training, the median post-training duration, and the median duration for the placement of the sheath introducer before and after training. RESULTS: Fourteen of the physicians (93%) correctly placed the balloon in the mannequin at the end of the training period. During the training, the success rate increased from 73% to 93% (p = .33). The median time for REBOA after training was only 222 seconds (interquartile range [IQR] 194-278), significantly faster than before training (330 seconds, IQR 260-360.5; p = .0033). We also found significantly faster sheath introducer placement (148 seconds, IQR 126-203 versus 145 seconds, IQR 115.5 - 192.5; p = .426). CONCLUSION: The training can be performed successfully and paves the way for the use of REBOA by emergency physicians in austere conditions.
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Oclusión con Balón , Procedimientos Endovasculares , Médicos , Choque Hemorrágico , Animales , Aorta , Constricción , Humanos , Resucitación , Choque Hemorrágico/terapia , PorcinosRESUMEN
AIM: The detection of cardiac arrests by dispatchers allows telephone-assisted cardiopulmonary resuscitation (t-CPR) and improves Out-of-Hospital Cardiac Arrest (OHCA) survival. To enhance the OHCA detection rate, in 2012, the Paris Fire Brigade dispatch center created an original technique called "Hand On Belly" (HoB). The new algorithm that resulted has become a central point in a broader program for dispatch-assisted cardiac arrests. METHODS: This is a repeated cross-sectional study with retrospective data of four 15-day call samples recorded from 2012 to 2018. We included all calls from OHCAs cared for by Basic Life Support (BLS) teams and excluded calls where the dispatcher was not in contact directly with a witness. The primary endpoint was the successful detection of an OHCA by the dispatcher; the secondary endpoints were successful t-CPR and measurements of the different time intervals related to the call. Logistic regressions were performed to assess parameters associated with detecting OHCAs and initiating t-CPR. RESULTS: From 2012 to 2018, among the detectable OCHAs, the proportion correctly identified increased from 54% to 93%; the rate of t-CPRs from 51% to 84%. OHCA detection and t-CPR initiation were both associated with HoB breathing assessments (adjustedOR: 89, 95%CI: 31-299, and adjustedOR: 11.2, 95%CI: 1.4-149, respectively). Over the study period, the times to answering calls and the time to sending BLS teams were shorter than those recommended by international guidelines; however, the times to OHCA recognition and starting t-CPR delivery were longer. CONCLUSIONS: The HoB effectively facilitated OHCA detection in our system, which has achieved very high performance levels.
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Reanimación Cardiopulmonar , Asesoramiento a Distancia , Asesoramiento de Urgencias Médicas/métodos , Sistemas de Comunicación entre Servicios de Urgencia/organización & administración , Paro Cardíaco Extrahospitalario , Algoritmos , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/estadística & datos numéricos , Estudios Transversales , Asesoramiento a Distancia/instrumentación , Asesoramiento a Distancia/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Paris/epidemiología , Mejoramiento de la Calidad , Análisis de Supervivencia , Teléfono , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
Fainting on a plane is quite common, and stewards are used to taking care of things. Statistically, there is always a physician on board. This Letter to the Editor details a case report that deals with inappropriate pacemaker inhibition during a flight. Roche NC , Thabouillot O , Bouvier F , Paule P. Prepare for take-off: fasten your seatbelt and keep a magnet in your pocket!. Prehosp Disaster Med. 2018;33(1):114-115.
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Viaje en Avión , Falla de Equipo , Marcapaso Artificial/efectos adversos , Síncope/etiología , Humanos , Masculino , Seguridad del Paciente , Factores de Riesgo , Síncope/terapiaRESUMEN
A seven-month-old girl was referred to the emergency department (ED) after a general practitioner suspected Steven-Johnson syndrome. Actually, the diagnosis of bullous pemphigoid (BP) was made based on biopsies; BP is a rare, autoimmune skin disease involving the presence of blisters known as bullae. The child was efficiently treated with topical steroids. This case shows the importance of the ED physician's prior knowledge of BP so that a differential diagnosis with other autoimmune diseases (dermatosis, pemphigus) can be made.Thabouillot O, Le Coz J, Roche NC. Bullous pemphigoid in an infant: a case report. Prehosp Disaster Med. 2018;33(4):448-450.
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Penfigoide Ampolloso/diagnóstico , Biopsia , Diagnóstico Diferencial , Urgencias Médicas , Femenino , Humanos , Lactante , Penfigoide Ampolloso/patologíaRESUMEN
This is a case report of a 45-year-old man who reported complete amnesia during the very first kilometer of a 10-km run. He was wearing a heart rate monitor (HRM). The interrogation of his HRM watch showed 200 bpm tachycardia beginning in the first kilometer and increasing up to 220 bpm during the last kilometer. The patient was asked to wear a Holter-monitor (Holter Research Laboratory; Helena, Montana USA) electrocardiogram (ECG) while practicing a training session. This examination allowed for the diagnosis of an adrenergic paroxysmal atrial fibrillation (AF) with an impressive auriculo-ventricular conduction over 260 bpm. This case highlights that non-medical devices, such as connected watches, can be helpful to diagnose arrhythmias. Thabouillot O , Bostanci K , Bouvier F , Dumitrescu N , Stéfuriac M , Paule P , Roche NC . Syncope during competitive events: interrogating heart rate monitor watches may be useful! Prehosp Disaster Med. 2017;32(6):691-693.
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Fibrilación Atrial/diagnóstico , Carrera , Síncope/diagnóstico , Fibrilación Atrial/etiología , Fibrilación Atrial/prevención & control , Diagnóstico Diferencial , Electrocardiografía Ambulatoria , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Síncope/etiología , Síncope/prevención & controlRESUMEN
This is a report of a fortunate story of an unusual AK-47 bullet trajectory which took place during the Paris (France) attack of November 13th, 2015. A young man, trying to protect his girlfriend, interfered between her and a shooter. He had been wounded in the posterior compartment of the thigh. The bullet penetrated him and, instead of exiting, rebound against his Smartphone, which was in the front pocket of his pants. Thanks to that, the missile bullet did not injure his girlfriend but ended its trajectory in the fat tissue of his thigh. Thabouillot O , Perrier P , Roche NC , Agard D , Barbier O , Martin G , Viant E , Leclere JB . A fortunate story of an unusual AK-47 bullet trajectory: always keep a Smartphone in your pocket. Prehosp Disaster Med, 2016;31(3):343-345.