In the prehospital setting, many providers advocate for video laryngoscopy as the initial method of intubation to improve the likelihood of a successful first attempt. However, bright ambient light can worsen visualization of the video laryngoscope liquid crystal display (LCD).

A patient involved in a motor vehicle accident was evaluated by an Emergency Medical Services (EMS) crew. Initial endotracheal intubation attempt using video laryngoscopy was aborted after the patient desaturated. The primary reason for the failure was poor visualization of the video laryngoscope LCD, despite attempts to block direct sunlight. Debriefing revealed that the intubating provider was wearing polarized sunglasses.

Because LCDs emit polarized light, use of polarized sunglasses may cause the display to appear dark. Thus, the purpose of this Case Report is to raise awareness of a potential safety issue that is likely under-recognized by prehospital providers but can be easily avoided.

SmithAJ, JackimczykK, HorwoodB, ChristensonD. Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital IntubationPrehosp Disaster Med. 2019;34(1):104–107.

The 2022 Russian invasion of Ukraine exacts a heavy death toll throughout Ukraine. Morbidity and mortality of warfighters and vulnerable civilian communities are inversely proportional to quality access to a viable medical evacuation chain. The military inspector is one option to fill the gap in prehospital medicine to reduce morbidity and mortality by providing damage control resuscitation/surgery (DCR/DCS).

Qualitative and quantitative methodologies are applied. Qualitatively describing the medical evacuation of Shane, providing death estimates of the point of injury to receipt of DCR/DCS. Provide interoperable care across the military-civilian and humanitarian sectors. Describe the standardized and consistent evacuation chains across the entire battlefront from the point of injury to the Role 1/Role 2 echelons of care.

The medical evacuation chain for this current iteration of Russian violence is currently inadequate, not standardized, not well integrated at the military-civilian interface. Preventable morbidity and mortality from conventional Russian weapon systems have increased.

Armed Forces of Ukraine to engage with NATO and EU colleagues to acquire the methodology and practical applications to reduce preventable morbidity and mortality. Standardized approaches to the concept of damage control resuscitation and damage control surgery to the paradigm of tactical combat casualty care can help reduce morbidity and mortality. The Ukraine crisis and Russian war is killing people in Ukraine, prehospital medicine must address and focus on reducing preventable causes of morbidity and mortality.

There is no widely-recommended standardized and valid measurement tool for evaluating the disaster preparedness of nurses. This study aims to assess the psychometric properties of scales developed or adapted to evaluate the sudden-impact natural disaster preparedness of nurses.

This study is a systematic literature review for the psychometric properties of disaster preparedness tools. Studies published from 2010 through June 2021 were identified from a systematic search of five databases, including Web of Science, PubMed, CINAHL, Scopus, and ProQuest. The Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used for the systematic review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for reporting. The World Health Organization’s (WHO) report on the Development of a Disaster Preparedness Tool Kit for Nursing and Midwifery was used to evaluate scale contents.

Six articles were identified that met the inclusion criteria. The scales generally had a multi-dimensional structure and used Likert scoring with internal consistency coefficients ranging from 0.785 to 0.97. All scales were rated sufficient in content validity, structural validity, and cross-cultural validity. One scale was rated sufficient in criterion validity while the others were rated indeterminate. One scale was rated insufficient in reliability and internal consistency while the others were rated sufficient.

The findings suggest improving the psychometric properties of scales of nurses’ disaster preparedness according to COSMIN, expanding their content scope, and developing new scales. The study will provide beneficial data to users and researchers regarding the need for a comprehensive assessment tool in determining the disaster preparedness of nurses.

Tropical cyclones are a recurrent, lethal hazard. Climate change, demographic, and development trends contribute to increasing hazards and vulnerability. This mapping review of articles on tropical cyclone mortality assesses geographic publication patterns, research gaps, and priorities for investigation to inform evidence-based risk reduction.

A mapping review of published scientific articles on tropical cyclone-related mortality indexed in PubMed and EMBASE (English) and SINOMED and CNKI (Chinese), focusing on research approach, location, and storm information, was conducted. Results were compared with data on historical tropical cyclone disasters.

A total of 150 articles were included, 116 in English and 34 in Chinese. Nine cyclones accounted for 61% of specific event analyses. The United States (US) reported 0.76% of fatalities but was studied in 51% of articles, 96% in English and four percent in Chinese. Asian nations reported 90.4% of fatalities but were studied in 39% of articles, 50% in English and 50% in Chinese. Within the US, New York, New Jersey, and Pennsylvania experienced 4.59% of US tropical cyclones but were studied in 24% of US articles. Of the 12 articles where data were collected beyond six months from impact, 11 focused on storms in the US. Climate change was mentioned in eight percent of article abstracts.

Regions that have historically experienced high mortality from tropical cyclones have not been studied as extensively as some regions with lower mortality impacts. Long-term mortality and the implications of climate change have not been extensively studied nor discussed in most settings. Research in highly impacted settings should be prioritized.

Events, specifically those where excessive alcohol consumption is common, pose a risk to increase alcohol-related presentations to emergency departments (EDs). Limited evidence exists that synthesizes the impact from events on alcohol-related presentations to EDs.

This integrative review aimed to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs.

An integrative literature review methodology was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Information sources used to identify studies were MEDLINE, CINAHL, and EMBASE, last searched May 26, 2021.

In total, 23 articles describing 46 events met criteria for inclusion. There was a noted increase in alcohol-related presentations to EDs from 27 events, decrease from eight events, and no change from 25 events. Public holidays, music festivals, and sporting events resulted in the majority of increased alcohol-related presentations to EDs. Few articles focused on ED length-of-stay (LOS), treatment, and disposition.

An increase in the consumption of alcohol from holiday, social, and sporting events pose the risk for an influx of presentations to EDs and as a result may negatively impact departmental flow. Further research examining health service outcomes is required that considers the impact of events from a local, national, and global perspective.

Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon’s Information Theory to triage.

Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon’s entropy evaluates the degree of informational confusion quantitatively and improves primary triage.

The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 – all 32 patients in the triage area at commencement of triage; Case 2 – 16 randomly imported patients to join 16 post-triage patients; Case 3 – eight patients imported randomly and another eight grouped separately; Case 4 – 16 patients grouped separately; Case 5 – random placement of all 32 post-triage patients; Case 6 – isolation of eight patients of minor priority level; Case 7 – division of all patients into two groups of 16; and Case 8 – separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A – triage conducted in random manner; and System B – triage arranged into four categories).

In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3.00 bits/symbol as maximal value when the probability of each category was 1/8, whereas the values in System B showed a linear decrease from 2.00 to 0.00 bits/symbol.

Informational confusion in a primary triage area measured using Shannon’s entropy revealed that random triage using a low-visibility tag might increase the degree of confusion. Methods for reducing entropy, such as enhancement of triage colors, may contribute to minimizing informational confusion.

AjimiY, SasakiM, UchidaY, KanekoI, NakaharaS, SakamotoT. Primary Triage in a Mass-casualty Event Possesses a Risk of Increasing Informational Confusion: A Simulation Study Using Shannon’s Entropy. Prehosp Disaster Med. 2016;31(5):498–504.

The study describes the implementation of a prehospital treatment algorithm that included intravenous (IV) bolus (IVB) nitroglycerin (NTG) followed by maintenance infusion for the treatment of acute pulmonary edema (APE) in a single, high-volume Emergency Medical Services (EMS) system.

This is a retrospective chart review of patients who received IVB NTG for APE in a large EMS system in Minnesota and Wisconsin (USA). Inclusion criteria for treatment included a diagnosis of APE, systolic blood pressure ≥120mmHg, and oxygen saturation (SpO2) ≤93% following 800mcg of sublingual NTG. Patients received a 400mcg IVB of NTG, repeated every two minutes as needed, and subsequent infusion at 80mcg/min for transport times ≥10 minutes.

Forty-four patients were treated with IVB NTG. The median total bolus dose was 400mcg. Twenty patients were treated with NTG infusion following IVB NTG. The median infusion rate was 80mcg/min. For all patients, the initial median blood pressure was 191/113mmHg. Five minutes following IVB NTG, it was 160/94mmHg, and on arrival to the emergency department (ED) it was 152/90mmHg. Five minutes after the initial dose of IVB NTG, median SpO2 increased to 92% from an initial reading of 88% and was 94% at hospital arrival. One episode of transient hypotension occurred during EMS transport.

Patients treated with IVB NTG for APE had reduction in blood pressure and improvement in SpO2 compared to their original presentation. Prehospital treatment of APE with IVB appears to be feasible and safe. A randomized trial is needed to confirm these findings.