Remote Scene Size-up Using an Unmanned Aerial Vehicle in a Simulated Mass Casualty Incident.

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.

A Randomized Comparison of Clothing Removal Techniques in a Simulated Trauma Patient Exposure.

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.

Cut and rip and cut alone techniques versus usual practice in the removal of trauma patient clothing.

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.