ABSTRACTS
Does Med-Control Policy Affect Use of Prehospital Needle Decompression in Noncardiac Arrest Trauma Patients? A Retrospective StudyAuthor: Gilbert Andry, MS | | Associate Authors: Elizabeth Lacy, BIS, NRP, Tommy Brown, MD, Harrison Travis, Alison Smith, MD, PhD, John Hunt, MD, MPH, FACS, Lance Stuke, MD, MPH, FACS, Jonathan Schoen, MD, Alan Marr, MD, FACS, Patrick Greiffenstein, MD, FACS
Introduction Emergency medical service (EMS) providers are trained to perform prehospital needle decompressions (PHND) on patients with suspected tension pneumothorax. Objective To determine if the use of PHND changed with the advent of a policy foregoing medical approval of PHND for nontrauma patients. Methods Charts of adult trauma patients presenting to a Level 1 trauma center from January 2012 through December 2020 with PHND were retrospectively reviewed. Criteria for PHND included at least one of the following: traumatic cardiac arrest, SBP < 90 mm Hg, HR > 120, and RR > 29 plus clinical suspicion for pneumothorax. Patients were divided into two groups based on a change in state EMS protocol that no longer required physician approval for PHND. Univariate analyses were performed to compare dichotomous variables. Results A total of 402 PHND patients were identified with 128 before rule change (BRC) and 274 after rule change (ARC). When excluding cardiac arrest (n = 236, 58%), 31.4% (n = 16) in the BRC group met at least one criterion compared with 23.5% (n = 27) in the ARC group (p = 0.28). Overall noncardiac arrest patients receiving PHND did not meet at least one criterion 74.1% of the time, but this remained statistically unchanged throughout the study period (68.6% BRC vs. 76.5% ARC, p = 0.28), even when factoring in overall trauma rates. More patients survived arrest after PHND in the ARC period (1/77 v. 4/159, p = 0.54) as well, but this also did not reach statistical significance. Conclusion The change in EMS protocol did not have an impact on the incidence of trauma patients receiving PHND with or without criteria for tension pneumothorax; however, overall incidence of use of PHND in patients who did not meet any criteria is still high. This study highlights the need to optimally train EMS providers to allow them to make critical, time-sensitive, independent clinical decisions in the prehospital setting.
|
