Scholarly activity is a required component of any fellowship. As an accredited subspecialty of emergency medicine, the practice of emergency medical services has much to contribute to the existing body of literature. On a regular basis, prehospital providers render life saving treatment, convey patients to definitive care, and interface with a wide variety of clinical and public health professionals. Fellows are expected to critically analyze EMS research and complete a manuscript or abstract suitable for publication in a peer reviewed journal. This page highlights publications from Allegheny Health Network's EMS faculty and identifies "hot topics" in the field of emergency medical services.
- FitzGibbon KM, Nable JV, Ayd B, Lawner BJ, Comer AC, Lichenstein R, Levy MJ, Seaman KG, Bussey I. Mass gathering medical care in eletronic dance music festivals. Prehosp Disaster Med. 2017 Oct;32(5):563-567
- Bouland AJ, Halliday MH, Comer AC, Levy MJ, Seaman KG, Lawner BJ. Evaluating barriers to bystander CPR among laypersons before and after compression only CPR training. Prehosp Emerg Care. 2017 Sep-Oct;21(5):662-669
- Jones J, Lawner B. Prehospital sepsis care. Emerg Med Clin North Am. 2017. Feb;35(1):175-183
- Millin MG, Comer AC, Nable JV, Johnston PV, Lawner BJ, Woltman N, Levy MJ, Seaman KG, Hirshon JM. Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: a systematic review and meta analysis. Resuscitation. 2016 Nov;108:54-60
- Halliday MH, Bouland AJ, Lawner BJ, Comer AC, Ramos DC, Fletcher M. The medical duty officer: An attempt to mitigate the ambulance at hospital interval. West J Emerg Med. 2016 Sep;17(5):662-8
HOT TOPICS IN PREHOSPITAL CARE AND EMERGENCY MEDICINE
1. Police transport of penetrating trauma victims
2. Tranexamic acid (TXA) in prehospital care
- Recent literature suggests that GSW victims may benefit from rapid transport by police
- Philadelphia, PA, has operationalized an EMS protocol that endorses police transport of GSW victims to one of 5 area trauma centers
- Band, et al (2011). Injury adjusted mortality of victims transported by police following penetrating trauma. Acad Emerg Med.
- Wandling, et al (2016). Police transport versus ground EMS: A trauma system level evaluation of prehospital care policies and their effect on clinical outcomes. J Trauma Acute Care Surg
- Band, et al (2014). Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med
2. Tranexamic acid (TXA) in prehospital care
- Several RCTs suggest that TXA can reduce mortality and morbidity in trauma
- TXA works to "stabilize" clots by preventing the breakdown of fibrin- it is an amino acid that is an "anti-fibrinolytic"
- Patients who are likely to benefit from TXA are those who (1) have a high shock index and (2) are in hemorrhagic shock
- However, patients who have sufficient amounts of clotting factors available may NOT benefit from TXA. The "TEG" test and other assessments of clotting function are used in the hospital setting to determine which patients are likely to benefit most from TXA
- In general, hemorrhaging and hypotensive patients in the prehospital setting are likely candidates for TXA administration
- Support for TXA comes from two recent trials, the MATTERs trial and the CRASH-2 trial
- The CRASH (Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage) trial was published in the LANCET. It enrolled prehospital patients in a double blind, randomized fashion. Patients received either TXA or placebo which was given within 8 hours of presentation. A four week follow up was conducted, and TXA was linked to an absolute mortality reduction. Benefits were proportional to timely administration, and the risk of complications rose if TXA was administered > 4 hours from the time of injury
- Full text of the CRASH-2 trial published in Lancet
- The MATTERS (Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study was a retrospective trial published in JAMA Surgery in 2012. It was not a randomized trial but an observational study of patients who received TXA at a military base. Patients of all ages were included in the analysis, and those patients who underwent transfusion were included in the analysis.
- TXA was administered at the discretion of the treating surgeon. Benefits of TXA were attributed to the sickest cohort of patients, specifically those requiring massive transfusion.
- Criticisms of the trial included a low number of enrolled patients (TXA group included 293) and the fact that the trial was conducted at one isolated military hospital
- MATTERs study full text here