The introduction of public access defibrillation to a university community: the University of Virginia public access defibrillation program.

The use of the automatic external defibrillator (AED) can significantly reduce the time to defibrillation in patients with sudden cardiac death. This early defibrillation via the AED can also improve patient outcome, including survival and neurologic status among survivors. We undertook the addition of a public access defibrillation program at a large mid-Atlantic university. In our design of the system, we found little useful information to guide us in the development and construction our system. This article is a review of the process of public access defibrillation AED system development such that other medical and academic leaders at similar institutions can more easily develop such systems.

Emergent precordial percussion revisited--pacing the heart in asystole.

Precordial percussion is a technique by which a manual force is applied repeatedly to the chest of a patient experiencing an unstable bradycardic or asystolic rhythm. The force is used not to defibrillate the myocardium as is the case with the "precordial thump" in pulseless ventricular tachycardia/ventricular fibrillation but rather to initiate a current through the myocardium in the form of an essentially mechanically paced beat. In this review, we discuss the physiology and utility of precordial percussion, or precordial thump, in the emergency setting as a very temporary bridge to more effective and permanent pacing techniques.

The impact of warm weather on mass event medical need: a review of the literature.

Over the last 20 years, interest in medical need at mass events has increased. Many studies have been published identifying the characteristics of such events that significantly impact the number of patients who seek care. Investigators agree that weather is one of the most important variables. We performed a literature search using several biomedical databases (MEDLINE via PubMed, the Cochrane database, BMJ's Clinical Evidence compendium, and Google Scholar) for articles addressing the effect of weather on medical need at mass events. This search resulted in 8 focused articles and several other resources from the reference sections of these publications. We found that the early literature is composed of case reports and predominantly subjective observations concerning the impact of weather on medical need. Most investigators agree upon a positive relationship between heat/humidity and the frequency of patient presentation. More recent authors make attempts at quantifying the relationship and propose prediction models for patient volume and medical personnel requirements. We present an ancestral review of these studies, discuss their results collectively, and propose a simplified algorithm for predicting patient volume at mass events. This review is intended for event planners and mass event emergency medical personnel for planning future events. We also hope to stimulate further study to develop and verify prediction models.

Predicting resource use at mass gatherings using a simplified stratification scoring model.

INTRODUCTION: Mass gathering events require varying types and amounts of medical resources to deal with patient presentations. The needs of various events have so far been difficult to predict with precision, yet likely are impacted by several factors which may be used in a predictive fashion. HYPOTHESIS: Medical needs at mass gathering events can be predicted based on a combination of weather, number in attendance, presence of alcohol, demographic of the participants in attendance, and crowd intentions. Furthermore, each of these factors can be assigned a score and events can be stratified based on that score. METHODS: Fifty-five mass gathering events of varying type occurring in proximity to a large mid-Atlantic university were analyzed retrospectively. Based on a scoring system using the factors described, the events were categorized as "minor," "intermediate," or "major." The actual medical needs at each event were then analyzed. RESULTS: Twelve events were classified a priori as "minor," 20 events were classified as "intermediate," and 23 received a classification of "major." These events had averages of 2.3, 6.3, and 71 total contacts, respectively. These trends were consistent for minor encounters, major encounters, and transports. The classification system correctly predicted the resource demand for the 3 classes of events. CONCLUSION: A classification system that stratifies events based on weather, number in attendance, presence of alcohol, demographic in attendance, and crowd intentions can effectively predict medical needs at mass gatherings. This system is most accurate in the description of minor- and intermediate-type events; major events were less well described by this classification system.

The impact of the code drugs: cardioactive medications in cardiac arrest resuscitation.

The goal of treating patients who present with cardiac arrest is to intervene as quickly as possible to affect the best possible outcome. The mainstays of these interventions, including early activation of the emergency response team, early initiation of cardiopulmonary resuscitation, and early defibrillation, are essential components with demonstrated positive impact on resuscitation outcomes. Conversely, the use of the code drugs as a component of advanced life support has not benefited these patients to the same extent as the basic interventions in a general. Although short-term outcomes are improved as a function of these medications, the final outcome has not been altered significantly in most instances.