Medical Care During Mountain Rescue in King County, Washington, from 2004 to 2017.

INTRODUCTION: Seattle Mountain Rescue (SMR) is a nonprofit, volunteer organization that provides mountain rescue services in King County, Washington. This study analyzed the medical care provided by SMR over 14 y to understand the challenges in patient care in the region and to perform data collection and monitoring. METHODS: A retrospective review of mission reports submitted from 2004 to 2017 was conducted. Date, location, demographics, activity, callout reason, chief complaint, treatments provided, extraction means, and helicopter utilization were analyzed. Data are presented as mean±SD, with range as appropriate, unless otherwise noted. Linear regression was used to estimate changes in mission volume over time. RESULTS: There were 552 missions involving 756 subjects during the study period. Mission totals increased by 4 (95% CI 2-6, P<0.001) per year. Four locations accounted for 38% of mission volume. Subject age was 36±18 y, and 59% of subjects were male. The most common activity leading to rescue was hiking (80%). Injuries or illness precipitated 58% of callouts, whereas lost, stranded, or overdue subjects comprised 40%. For subjects requiring medical treatment, 81% involved a traumatic injury, 64% were packaged in a litter, and 35% required splinting. CONCLUSIONS: The frequency of mountain rescue missions in King County, Washington, has increased in the past 14 y, with traumatic injuries most frequently requiring medical care. Missing data were common in most categories, and nonstandardized reports challenged research efforts. This study provides a baseline for future research and data collection and adds to the literature regarding the medical care provided during mountain rescue incidents.

Airway Management Practice in Adults With an Unstable Cervical Spine: The Harborview Medical Center Experience.

BACKGROUND: Airway management in the presence of acute cervical spine injury (CSI) is challenging. Because it limits cervical spine motion during tracheal intubation and allows for neurological examination after the procedure, awake fiberoptic bronchoscopy (FOB) has traditionally been recommended. However, with the widespread availability of video laryngoscopy (VL), its use has declined dramatically. Our aim was to describe the frequency of airway management techniques used in patients with CSI at our level I trauma center and report the incidence of neurological injury attributable to airway management. METHODS: Adults presenting to the operating room with CSI without a tracheal tube in situ between September 2010 and June 2017 were included. All patients were intubated in the presence of manual-in-line stabilization, a hard cervical collar, or surgical traction. Worsening neurological status was defined as new motor or sensory deficits on postoperative examination. RESULTS: Two hundred fifty-two patients were included, of which 76 (30.2%) had preexisting neurological deficits. VL was the most frequent initial airway management technique used (49.6%). Asleep FOB was commonly performed alone (30.6%) or in conjunction with VL (13.5%). Awake FOB was rarely performed (2.3%), as was direct laryngoscopy (2.8%). All techniques were associated with high first-attempt success rates, and no cases of neurological injury attributable to airway management technique were identified. CONCLUSIONS: Among patients with acute CSI at a high-volume academic trauma center, VL was the most commonly used initial intubation technique. Awake FOB and direct laryngoscopy were performed infrequently. No cases of neurological deterioration secondary to airway management occurred with any method. Assuming care is taken to limit neck movement, providers should use the intubation technique with which they have the most comfort and skill.

Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest.

AIMS: Although the intraosseous (IO) route is increasingly used for vascular access in out-of-hospital cardiac arrest (OHCA), little is known about its comparative effectiveness relative to intravenous (IV) access. We evaluated clinical outcomes following OHCA comparing drug administration via IO versus IV routes. METHODS: This retrospective cohort study evaluated Emergency Medical Services (EMS)-treated adults with atraumatic OHCA in a large metropolitan EMS system between 9/1/2012-12/31/2014. Access was classified as IO or IV based on the route of first EMS drug administration. Study endpoints were survival to hospital discharge, return of spontaneous circulation (ROSC) and survival to hospital admission. RESULTS: Among 2164 adults with OHCA, 1800 met eligibility criteria, 1525 of whom were treated via IV and 275 principally via tibial-IO routes. Compared to IV, IO-treated patients were younger, more often women, had unwitnessed OHCA, a non-cardiac aetiology, and presented with non-shockable rhythms. IO versus IV-treated patients were less likely to survive to hospital discharge (14.9% vs 22.8%, p=0.003), achieve ROSC (43.6% vs 55.5%, p<0.001) or be hospitalized (38.5% vs 50.0% p<0.001). In multivariable adjusted analyses, IO treatment was not associated with survival to discharge (odds ratio (OR) (95% confidence interval) 0.81 (0.55, 1.21), p=0.31), but was associated with a lower likelihood of ROSC (OR=0.67 (0.50, 0.88), p=0.004) and survival to hospitalization (OR=0.68 (0.51, 0.91), p=0.009). CONCLUSION: Though not independently associated with survival to discharge, principally tibial IO versus IV treatment was associated with a lower likelihood of ROSC and hospitalization. How routes of vascular access influence clinical outcomes after OHCA merits additional study.