Firearm Acoustic Detection in Hartford, Connecticut: Outcomes of a Trauma Center - Law Enforcement Collaboration.

Introduction Firearm homicide is a leading cause of violence-related death in the United States.Unfortunately, more than 80% of illegal firearm discharges are never reported to police by traditional means.ShotSpotterTM (Newark, California) is an acoustic firearm event detection system that can localize gunfire, prompting police, and subsequent emergency medical services (EMS) presence. Previously reported healthcare effects of acoustic detection are speculative in nature. We sought to investigate Hartford, Connecticut's experience with ShotSpotter​​​​​​​TM given its smaller size and broad coverage.  Methods The three trauma centers in Hartford (two for adults and one for pediatric) collaborated with the Hartford Police to review outcomes of victims with acoustically detected gunshots and compare them to those who went undetected. We performed a retrospective review of patients who presented with gunshot wounds (GSW) over a 30-month period, from January 1, 2016 to June 30, 2018. Victim location and acoustic detection were reconciled by the police department and hospital staff independently. Patients were individually matched for location, prehospital response, treatment durations, and hospital outcomes. Results Of 387 GSW, 157 (40.6%) presented via EMS and were included in the sample. Of these, 89 correlated to a detection event (56.7%) and 68 had no correlating event (43.3%). These two groups had no difference in prehospital treatment times, scene and transport duration, and injury severity. Further, the need for surgery or transfusion, lengths of stay, and disposition, including mortality, did not differ. Conclusions Despite limited previous reports demonstrating conferred benefits to acoustic detection of gunshots, Hartford's experience showed no benefit. The potential for such systems to act as early warning systems is evident but may depend on a city's resources, geography, and technology.

Implementation of a community-based mature driver screening and referral program: A feasibility study.

We tested the feasibility of implementing a community mature driver screening and referral program utilizing the Roadwise Review screening instrument. We recruited a convenience sample of 151 mature drivers (age 65 and over) at six community senior centers in suburban Connecticut. A 30 item survey collected demographic information, driving history, and self-reported vision, physical fitness, and attention problems. Participants completed a 30min computer screening program that assessed 8 areas associated with driving ability. Referrals were provided to participants with identified impairments. A post survey measured program satisfaction; a two week follow-up determined intent to address impairments. Among the problems/issues reported: reading highway/street signs or seeing other vehicles at night (25%), trouble looking over shoulder when changing lanes (18%), avoidance of night driving (22%) or in unfamiliar places (31%). Screening found mild impairments in 86% of participants and 52% with serious impairments. Referrals were given to 75%; at follow-up, 74% reported intent to complete referrals. Most participants (94%) would recommend the program to family/friends. In conclusion, this study was feasible to implement and identified driving impairments among mature drivers. Most participants intended follow-up with driving recommendations and program satisfaction was high.

Epidemiology of trauma at a level 1 trauma center.

We reviewed trauma registry data (2004-06) from a Level 1 trauma center to describe the epidemiology of injury. There were 5,900 trauma patients. Most admissions were among white men, age 20-29 years (mean age = 48 years). Most admissions occurred in the summer, on Saturday and Sunday evenings. Blunt injuries (89%) and fractures (49%) predominated. Mean ISS = 9.7. ISS = 9-15 was highest among those 70+ years and lowest among patients 30-39 years (P < 0.01). Motor vehicle crashes and falls were the most common mechanism of injury. Violent assaults ranked highest in the injury prevention priority score. This research identified areas for further study and will help guide community injury prevention programs and policies.

Trauma intubations: can a protocol-driven approach be successful?

OBJECTIVE: To determine the success rate of a trauma airway protocol. METHODS: This was a prospective cohort study of trauma patients requiring intubation conducted for 24 months. The study facility is a Level I trauma center serving an urban population. The protocol suggests that the first two attempts at intubation be by the third-year emergency medicine resident, a hospital-wide stat overhead page for anesthesia occurs, which results in anesthesia (occasionally a resident only, but usually an attending) presence in the trauma room in 5 to 10 minutes. After each intubation, the emergency medicine resident or the attending physician completed a data collection form indicating the number of intubation attempts and result of each one, who performed each attempt, complications related to each attempt, and airway adjuncts used. RESULTS: Two hundred seventy-four patients were intubated during the study period by either emergency medicine physician or anesthesiologist with a success rate of 91.6% after the third attempt. The complication and cricothyrotomy rates were 9.8% and 2.6%, respectively. CONCLUSION: Our trauma airway protocol allows for the safe and effective management of the trauma airway.