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Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España

domingo, 25 de octubre de 2015

"When ambulances crash". Infographic / The National Highway Traffic Safety Administration and Ground Ambulance Crashes. 2014

Infographic: When ambulances crash

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NHTSA reviewed 10 years of data on ambulance crashes to understand patient and provider safety

WASHINGTON — The National Highway Traffic Safety Administration used 10 years of data to understand patient and provider safety in EMS-involved collisions. This infographic illustrates their findings.
The National Highway Traffic Safety Administration and Ground Ambulance Crashes. 2014

sábado, 24 de octubre de 2015

A qué distancia vemos un coche si lleva las luces encendidas. DGT España

A qué distancia vemos un coche si lleva las luces encendidas
Está demostrado que los coches que circulan con luces encendidas –sean de cruce o DRL– son percibidos mucho mejor por los demás usuarios. Un estudio realizado para la DGT en 2007 por el Departamento de Seguridad Pasiva del IDIADA demostró que, incluso en las mejores condiciones de visibilidad (al mediodía, en una carretera mixta, rodeada de vegetación y cielo a partes iguales), un vehículo con luces se detecta más de 100 metros antes que un vehículo de color negro y sin luces. Incluso en peores condiciones, el coche con luces encendidas se ve antes (a 240 m) que otros sin luces de color blanco (90 m), gris (100 m) o negro (30 m).

lunes, 19 de octubre de 2015

Mobile phones should be used to speed help to cardiac arrest victims, guidelines say By AMERICAN HEART ASSOCIATION NEWS

Mobile phones should be used to speed help to cardiac arrest victims, guidelines say

Go to the NEW CPR guidelines 2015-2020

New resuscitation guidelines update CPR chest pushes

Attempts to revive people who have stopped breathing date back centuries. But it was in the late 1950s and early 1960s that modern CPR developed.
1740 - Paris Academy of Sciences recommends mouth-to-mouth resuscitation for drowning victims.
1891 - Dr. Friedrich Maass performs the first documented chest compressions on a patient.

1903 - Dr. George Crile reports the first successful use of external chest compressions to revive a patient.
1956   - Dr. James Elam and Dr. Peter Safar develop the modern technique of mouth-to-mouth resuscitation.
1958 - Work begins on the Resusci Anne manikin, developed by toy company owner Asmund Laerdal, Dr. Peter Safar and Dr. Bjorn Lind. The training aid is introduced in 1960.
1960 - Dr. James Jude (from left), Dr. William Kouwenhoven and G. Guy Knickerbocker publish a paper in the Journal of the American Medical Association on “closed-chest cardiac massage,” which evolved into cardiopulmonary resuscitation, or CPR.
1963 - The American Heart Association formally endorses CPR.
1966 - The first CPR guidelines are published by the National Academy of Sciences–National Research Council.

1972 - The world’s first mass CPR training program begins in Seattle, certifying more than 100,000 people in the first two years.

1981 - 911 operators in King County, Washington, begin giving CPR instructions over the phone — a practice that is now recommended nationwide.
1983 - The AHA convenes a national conference to develop CPR guidelines for children and infants.
1990s - Public Access Defibrillation programs begin placing automated external defibrillators, or AEDs, in public places and provide training to the public.
2005 - The AHA develops the Family & Friends CPR Anytime Kit, allowing anyone to learn CPR in 20 minutes.
2008 - The AHA introduces Hands-Only CPR.
2015 - Through a network of about 400,000 instructors and 4,000 training centers worldwide, the AHA trains more than 17 million people in CPR each year.
Twenty-seven states now require hands-on, guidelines-based CPR training for high school graduation. Each year, more than 1.6 million public high school graduates will have been trained in CPR.
Sources: American Heart Association, Journal of the American Medical Association, Laerdal Medical

Cities nationwide should consider using mobile phones and apps to connect people in cardiac arrest with nearby CPR-trained rescuers, say new guidelines from the American Heart Association.
The guidelines, published Thursday in Circulation, claim that such community programs could increase bystander CPR, which, depending on the community, is performed in 10 percent to 65 percent of the roughly 326,000 cardiac arrests that happen outside the hospital each year.
Accessing people through a mobile network can get help to the scene faster, said Raina Merchant, M.D., director of the Social Media and Health Innovation Lab at Penn Medicine.
“While emergency system personnel are on their way, bystanders can come by and start helping out,” said Merchant, an assistant professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine who was not involved in writing the new guidelines.
About 90 percent of American adults have cellphones and two out of three have smartphones, according to the Pew Research Center.
The new recommendation is largely based on a Swedish study that tested a mobile alert system in Stockholm. The study, published in June in The New England Journal of Medicine, found that bystander CPR was initiated in 62 percent of cardiac arrests among the group who received cellphone alerts. In the group that did not receive alerts, CPR was performed 48 percent of the time.
“There’s a lot of work that needs to be done about how to best optimize these programs,” said Merchant. “Simply having the program doesn’t ensure that people will use it.”
About 1,400 U.S. communities are implementing a CPR mobile alert program developed by the nonprofit PulsePoint Foundation, said president Richard Price. When a cardiac arrest happens, 911 dispatch centers alert responders within a quarter mile of the patient.
Potential responders register through a free mobile app, which alerts them when an emergency occurs, maps directions and reminds them how to give chest compressions. After the emergency, the system sends the local EMS agency a detailed report about the incident and surveys responders about their actions.
“By directly alerting those who are qualified and nearby, maybe in the business next door or on the floor above, PulsePoint is able to put the right people in the right place at the right time,” Price said.
Annual costs to implement the system range from $8,000 a year for communities with up to 300,000 residents to $28,000 a year for populations of 1.5 million or more, according to Price.
Communities already using the alert programs will aid in research about why people respond and how to get them to respond, said Merchant.
In addition to summoning rescuers, cellphones also allow people at the scene of a cardiac emergency to get CPR instructions from 911 dispatchers without leaving the victim’s side. Dispatchers should be trained to help callers recognize cardiac arrest quickly and walk them through chest compressions, the guidelines say.
The AHA recommends that anyone who sees a teenager or adult suddenly collapse call 911 and push hard and fast on the center of the chest, a technique known as Hands-Only CPR.

The AHA guidelines have been updated every five years through a complex process involving more than 250 international experts from the AHA and six other resuscitation councils that form the International Liaison Committee on Resuscitation.
At an AHA-hosted ILCOR conference in early 2015, seven expert panels discussed, debated and reached consensus on hundreds of resuscitation topics, based on research published since the 2010 guidelines.
The AHA used that scientific consensus to create the CPR and Emergency Cardiovascular Care guidelines: “how-to” manuals that translate the science into practice. They are used to train millions of potential rescuers and are integrated into state and local emergency medical services protocols.
“CPR saves lives. That’s the big take-home from the guidelines. A lot of the science that works continues to work,” said Merchant.
“We need more people to do CPR,” she said. “Some will be through mobile, some will be through dispatchers … some will be remembering from a training class. [Mobile] is one part of the solution, but not the only piece.”

domingo, 11 de octubre de 2015

Nuevas recomendaciones para el control de Hemorragias Masivas, Consenso de Hartford III. Lugar Ateneo de Cadiz 26 Oct 2015

Nuevas recomendaciones para el control de Hemorragias Masivas, Consenso de Hartford III.
Lugar Ateneo de Cadiz 26 Oct 2015

La conferencia está dirigida a médicos, enfermeros, técnicos en emergencias, personal de Fuerzas Armadas y Cuerpos Policiales, bomberos, voluntarios y personal técnico de Cruz Roja y/o Protección Civil, socorristas; es decir, cualquier persona relacionada con la asistencia prehospitalaria de emergencias.

Se tratarán las recomendaciones para el control de hemorragias con potencial de comprometer la vida del accidentado, según las directrices sacadas del consenso de Hartford III. Qué, Por qué y Cómo del abordaje agresivo de una hemorragia masiva de origen traumático.

La duración es de alrededor de una hora, la entrada es libre hasta cubrir aforo (80 personas). Se ruega confirmar asistencia siempre que sea posible. Fecha confirmada, lunes 26 de octubre de 2015 a las 20:00h.

domingo, 4 de octubre de 2015

Glucagón para rescate rápido de la hipoglucemia en "Spray Nasal"

Glucagón Spray Nasal para Hipoglucemia

24 de septiembre de 2015 17:57
Es más cómodo que una inyección y es seguro y eficaz, también en niños y adolescentes.
Locemia Solutions ha diseñado un dispositivo de un solo uso para la administración nasal de glucagón en pacientes diabéticos que sufren una hipoglucemia severa. La usabilidad del dispositivo ha sido evaluada en un ensayo en el que 16 miembros del personal sanitario fueron entrenados para administrar glucagón, por vía nasal o mediante inyección, a un maniquí. La totalidad de los participantes logró administrar la dosis nasal completa, mientras que sólo 8 lo consiguieron utilizando la inyección.
En un ensayo separado con 15 voluntarios sin entrenamiento alguno, ninguno consiguió administrar la dosis completa mediante inyección y sólo 3 consiguieron inyectar una dosis incompleta. En contraste, 14 voluntarios lograron administrar la dosis completa con el dispositivo nasal. Joel Zonszein, médico en el Albert Einstein College of Medicine de Nueva York, indica que, en la práctica clínica diaria, la dificultad de inyectar glucagón es frecuente, incluso entre el personal entrenado, por lo que valora positivamente el polvo nasal como opción para mejorar el resultado del tratamiento.
Los datos de usabilidad se añaden a los de ensayos de fase III previos, los cuales han demostrado que el glucagón en polvo nasal en adultos es tan eficaz en la reversión de la hipoglucemia como el glucagón inyectado. Otros estudios, presentados en el congreso anual de American Diabetes Association, también han demostrado la eficacia y seguridad del dispositivo en niños y adolescentes. 
Mayoría de jóvenes tiene accidentes estando ebrios
"Rep. Dominicana 1er país del mundo en muertes por accidentes de trafico"
13-14 y 15 de Diciembre 2015
Santo Domingo, DN. Rep. Dominicana
La Vega, Rep. Dominicana
Comité de Trauma Colegio Dominicano de Cirujanos
Leer reportaje del Listin Diario en el enlace

viernes, 2 de octubre de 2015

Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads

Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads
Intubating a Patient Wearing a Helmet

 Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads
 By  , JEj

You’re detailed to the local high school football game; it’s the biggest game of the season. The event is a sellout in front of over 10,000 fans, and all four of the local news stations are filming. After the kickoff return, you notice officials and players from both teams waving to the sideline for the medical staff. You’re called onto the field; you have an unconscious patient lying on his side and an athletic trainer has control of the cervical spine (C-spine). What do you do next? Do you want to remove the helmet and shoulder pads or leave them place? Why? This definitely isn’t the time for on-the-job training.
Potential spinal injuries in football can quickly become a complicated treatment and transport problem if you’re not properly trained and prepared.
Football players and other athletes who wear shoulder pads and helmets will very rarely be found lying perfectly straight and in a supine position
We’re going to discuss how to properly immobilize and treat athletes with a helmet and shoulder pads in place and discuss situations when the equipment should be removed. It’s our hope this article will provide direction on how to treat these patients and how to train for an event before an incident occurs.

There are more benefits to leaving the shoulder pads and helmet in place than removing them.1,2 However, sometimes you may need to remove them. It’s important to note two things: First, if you’re going to remove one, you must remove both. Second, you need to be properly trained and need to practice the procedures for removing the helmet and shoulder pads.
Paul Sparling notes that in his 30-plus years working with the NFL, he’s never removed the helmet and shoulder pads from a player with any suspicion of a C-spine injury. It’s best to leave the equipment on the patient and transport them to the hospital (preferably a trauma center) where the patient has access to proper advanced medical care. If possible, a member of the team’s medical staff should accompany the patient.
A cross-table lateral C-spine X-ray should be performed to rule out fractures before making the decision to remove the helmet and shoulder pads. This also allows the patient to be in a more controlled environment so if a cervical fracture or dislocation/subluxation is found, the patient will have access to a full medical staff, including emergency medicine staff, orthopedic surgeons, neurosurgeons, anesthesiologists and respiratory staff, during the removal of the equipment in the event a problem occurs.
Immobilizing a Patient with a Helmet and Shoulder Pads
Begin taping the helmet to the backboard, again noting that the chin strap is left secured and in place on the helmet and patient.

Immobilizing a Patient with a Helmet and Shoulder Pads
Fill in void spaces between the helmet and shoulders using towels.

Immobilizing a Patient with a Helmet and Shoulder PadsThe patient is now secured to the backboard and ready for transfer. Manual C-spine should be held in place until the helmet is taped and secured. In addition, the patient’s torso should be strapped onto the board before proceeding to immobilize the head to the backboard, just as you would do in any other spinal immobilization procedure

Immobilizing a Patient with a Helmet and Shoulder Pads
Apply pads to the right and left side of the helmet to help secure it to the backboard. Note the chin strap has been left in place. This is vital to assure the head is secured properly.

Preoxygenate the patient if time allows. One study showed that use of oxygen by nasal cannula at 15 Lpm during intubation and insertion of a supraglottic airway (SGA) aid in the preoxygenation of the patient. Preoxygenation using a nasal cannula with bag-valve mask (BVM) ventilations also increases the oropharyngeal fraction of inspired oxygen (FiO2).2 (See photos below.)
Just as you would with any known/suspected C-spine injury, maintain continuous manual in-line cervical stabilization (which is superior to a C-collar) during the intubation procedure.2 If possible, place the patient in the reverse Trendelenburg position by elevating the head of the backboard 20 degrees during the intubation procedure. Once you’ve confirmed endotracheal (ET) tube placement, secure the ET tube before any patient movement. If there’s enough time to intubate the patient in the prehospital setting, then there’s enough time to secure the tube.
A frequently stated reason for accidental esophageal intubation is "the tube moved." The tube position should be rechecked after each patient movement (e.g., backboard to stretcher, stretcher to ambulance); end-tidal carbon dioxide (EtCO2) use provides continuous placement monitoring. Additionally, make sure you document the procedure on your patient record, including—but not limited to—the use of manual in-line immobilization during the procedure, how you secured the patient to the backboard, preoxygenation, the tube size and depth of insertion (the centimeter number on the tube at the lip line), the number of intubation attempts, any complications, and the method of confirmation of correct tube placement (e.g., esophageal intubation detector, auscultation, colorimetric CO2 detector or waveform capnography).
There are some incidents where you may need to remove the helmet and shoulder pads, such as when the face mask can’t be removed in a timely manner for airway control. However, keep in mind, it’s much more time consuming to remove both the helmet and shoulder pads correctly, and you’ll need at least 3–4 properly trained personnel to safely accomplish the task. Another example for helmet and shoulder pads removal is if the helmet isn’t a proper fit and is causing airway problems and/or immobilization problems; this would be more common in youth league football.
Intubating a Patient Wearing a Helmet
Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads
Intubating a Patient Wearing a Helmet
Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads
Intubating a Patient Wearing a Helmet
When removing the helmet and shoulder pads, one of the most difficult tasks is to maintain neutral C-spine alignment. The first step is to have someone maintain cervical immobilization at the head. Then, cut the jersey off and expose the front of the shoulder pads. Open the buckles or cut the straps on the shoulder pads to expose the chest and then open or cut the side straps (some manufacturers have a quickrelease strap on the upper-right side of the chest plate).
Next, have a second member place their arms up and under through the front of the shoulder pads and take control of the C-spine at the jaw. The member at the head will now remove the helmet while the second member maintains cervical immobilization and alignment. When the helmet is off, the first member will then pull the shoulder pads off above the shoulder and head. Next, apply a C-collar, immobilize the patient to the board and apply CID pads and straps.
There are a couple "levitation" techniques for removal of the helmet and shoulder pads, but they’re difficult and require 4–6 personnel and a lot of practice to perform efficiently (and they’re weight-dependent on the athlete). These techniques may work for younger athletes and players such as receivers and defensive backs, but would be extremely difficult to perform on a lineman weighing over 300 lbs.
Recently, the National Athletic Trainers Association (NATA) published a position paper titled, "Appropriate care of the spine injured athlete: Updated from 1998 document." The paper was followed by an addendum that essentially leaves it up to medical personnel to evaluate and assess each individual circumstance to determine if equipment should be removed before transport. This approach is consistent with what most athletic trainers have been doing for years. For example, prior to the addendum from NATA and during our recent Emergency Action Plan review at Paul Brown Stadium with paramedics, team physicians and certified athletic trainers, all agreed that the medical staff would continue to evaluate each situation on a case-by-case basis. The Cincinnati Bengals’ medical staff’s approach is essentially what the addendum now calls for.
Our position remains that except in extreme circumstances that require the equipment be removed to render care to the patient, the equipment should remain on because removing it on the field can take valuable time from ensuring the patient gets to a trauma center for appropriate care as quickly as possible. Additionally, the NATA statement specifically pointed out that there should be a minimum of three trained emergency care providers in order for equipment to be removed in advance of transport. In the vast majority of emergency sports injury situations that occur (youth football programs, junior high and some high school football programs), there may be one or two at the most who are trained and experienced to handle such equipment removal in the field. This would render a situation in which there isn’t sufficient staffing to remove the equipment in a timely or efficient manner.

Removing a Helmet and Shoulder Pads

The thirh caregiver will take control of the back, of the head as the helmet is removed by the second caregiver

Slide your arms between the chest and anterior shoulder pads and gain control of the C-spine on the anterior side of the head and jaw.

Remove the bilateral chin pads from the helmet. A tongue depressor works well for this.

Cut the chest straps on the anterior side on the shoulder pads

Begin removing the helmet, ensuring there’s good anterior C-spine control (arms will be between the chest and shoulder pads, and C-spine will be controlled holding the side of the head). With the chin pads removed, total contact is easily achieved.

Remove de Helmet chin strap 
Using a fourth caregiver, elevate the shoulders enough to slide the pads over the patient’s head.

After the pads are removed, lower the patient to the ground

Apply a C-Collar 
Fully immobilize the patient to the backboard with straps and head blocks.

The male patient is on his side and the athletic trainer has manual control of the C-spine. The patient appears to be breathing, but you want to do a better assessment. You place the backboard behind him and logroll him onto it. Your partner takes over control of the C-spine and asks the trainer to remove the face mask. As you’re working, the patient begins to regain consciousness and complains of numbness.
On further neurological exam, the patient has diminished hand grips bilaterally and has no noted plantar-flexion or dorsi-flexion to the lower extremities. Given this information, you decide the best choice for this patient would be to immobilize him with the helmet and shoulder pads in place. You continue to monitor the patient’s airway and vitals and start an IV according to protocol. You ready the patient for transport to a trauma center while your partner calls the receiving staff.
Ultimately, how you immobilize a patient with helmet and shoulder pads should be based on local protocols, and your department or organization’s medical director’s instruction. You should be well-trained in the procedures directed in your protocol, especially if your department or organization is detailed as the EMS unit for local football games.
We recommend conducting annual training with the school or team’s training and medical staff so that everyone is on the same page and a potential incident can be managed as safely and quickly as possible. In addition, we recommend the patient be transported to the closest trauma center or air transported if necessary.
Prehospital Treatment of Athletes Wearing a Helmet and Shoulder Pads

1. Theodore N, Aarabi B, Dhall SS, et al. Transportation of patients with acute traumatic cervical spine injuries.Neurosurgery. 2013;72(Suppl2):35–39.
2. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–175.

Mayoría de jóvenes tiene accidentes estando ebrios
"Rep. Dominicana 1er país del mundo en muertes por accidentes de trafico"
13-14 y 15 de Diciembre 2015
Santo Domingo, DN. Rep. Dominicana
La Vega, Rep. Dominicana
Comité de Trauma Colegio Dominicano de Cirujanos
Leer reportaje del Listin Diario en el enlace