Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study

Nunn, Andrew M.; Prakash, Priya; Inaba, Kenji; Escalante, Alvarez; Maher, Zoë; Yamaguchi, Seiji; Kim, Dennis Y.; MacIel, James; Chiu, William C.; Drumheller, Byron C.; Hazelton, Joshua P.; Mukherjee, Kaushik; Luo-Owen, Xian; Nygaard, Rachel M; Marek, Ashley P.; Morse, Bryan C.; Fitzgerald, Caitlin A.; Bosarge, Patrick L.; Jawa, Randeep S.; Rowell, Susan; Magnotti, Louis J.; Ong, Adrian W.; Brahmbhatt, Tejal S.; Grossman, Michael D.; Seamon, Mark J.

doi:10.1097/ta.0000000000001940

Cited by 31 publications

(28 citation statements)

References 29 publications

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“…In a trauma centre study, the compliance rates for use of masks and eye protection, after an educational intervention, were 16% and 44%, respectively [26]. ED clinicians are regularly at risk of facial contamination during invasive procedures, intubation and other resuscitative measures [27]. They are also exposed to both seasonal and emerging respiratory infectious diseases.…”

Section: Introductionmentioning

confidence: 99%

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Barratt

Gilbert

Shaban

et al. 2020

Australasian Emergency Care

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a b s t r a c tBackground: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE-specifically gloves and masks-during routine care in the ED. Methods: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results: Thirty-one behavioural themes were identified that influenced participants' use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted. (R. Barratt).severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and pandemic influenza A [2]. Healthcareassociated transmission of these viral infections, into previously unaffected communities, was a key feature of the early stages of, for example, SARS in Toronto and MERS in Seoul [3,4]. A notable feature of both outbreaks was the high proportion of those affected who were healthcare workers, with reports of up to 27% and 57% for MERS and SARS, respectively [5]. First responders and emergency department (ED) clinicians are at high risk of exposure to both common and emerging communicable diseases of high consequence, as they are in close contact with symptomatic patients before a diagnosis is made [5][6][7]. For example, ED staff are among

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Section: Introductionmentioning

confidence: 99%

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Barratt

Gilbert

Shaban

et al. 2020

Australasian Emergency Care

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“…As mentioned previously, resuscitation of these patients requires a substantial reallocation of resources, which invariably distracts from the care of other ED patients. In addition, resuscitative thoracotomies convey a measurable risk to physician staff performing the procedure 12 . Previous work has been done on attempts to identify patients with higher chances of survival including point‐of‐care ultrasound; however, a persistent limitation in the care of these patients is the lack of reliable total downtime 13 .…”

Section: Discussionmentioning

confidence: 99%

Improving out‐of‐hospital notification in traumatic cardiac arrests with novel usage of smartphone application

Kelly

Clare

2020

JACEP Open

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Introduction Timely out‐of‐hospital notifications in patients with traumatic cardiac arrest are associated improvements in mortality. Details surrounding these events are often limited, and decisions to perform advanced resuscitative procedures must be made based on limited data. This study evaluated the ability of a mobile application (app) called Citizen (sp0n Inc., New York, NY) to address these issues by providing a novel, secondary source of out‐of‐hospital information in traumatic cardiac arrest. Citizen sends notifications to mobile devices in response to nearby detected public safety events, and we sought to evaluate its utility in prenotification for traumatic cardiac arrest. Methods This was a retrospective observational study. Patients ≥ 15 years of age with traumatic cardiac arrest attributed to penetrating trauma were included. The 2 coprimary outcomes observed were the time difference between the app notification and emergency medical services notification, and the app's success rate in generating a notification for each patient in traumatic cardiac arrest. Results From February 2, 2019 to October 10, 2019, there were 43 patients who met the criteria for this study. On average, the Citizen app notification arrived 12.9 minutes before emergency medical services radio notification (95% confidence interval, 9.2–16.6; P < 0.001). Citizen generated a notification for 36 of 43 patients (84%). Conclusion The Citizen app generates earlier notifications in traumatic cardiac arrest compared with standard radio communications. It also provides a previously unavailable secondary source of information for making rapid resuscitative decisions upon the arrival of the arresting patient to the emergency department. Further research is needed to determine how to optimally integrate the app into existing trauma systems.

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“…In 2018, the ACS Committee on Trauma and the American College of Emergency Physicians (ACEP) issued a joint statement outlining indications for REBOA [41]. They also provided guidelines for REBOA use and implementation, patient transfer and management EDT is associated with an increased risk of provider occupational injury and exposure to trauma patient blood-borne illnesses [26,30]. Studies conducted in the United States have reported that the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus infection among trauma patients may approach 4.3% and 14%, respectively [30].…”

Section: Edtmentioning

confidence: 99%

“…They also provided guidelines for REBOA use and implementation, patient transfer and management EDT is associated with an increased risk of provider occupational injury and exposure to trauma patient blood-borne illnesses [26,30]. Studies conducted in the United States have reported that the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus infection among trauma patients may approach 4.3% and 14%, respectively [30]. In a multicenter prospective cohort study conducted across 16 predominantly level 1 American trauma centers, 7.2% of 305 EDTs were complicated by occupational exposures [30].…”

Section: Edtmentioning

confidence: 99%

“…Studies conducted in the United States have reported that the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus infection among trauma patients may approach 4.3% and 14%, respectively [30]. In a multicenter prospective cohort study conducted across 16 predominantly level 1 American trauma centers, 7.2% of 305 EDTs were complicated by occupational exposures [30]. Those providers who suffered exposures were primarily trainees (68%) who endured percutaneous (86%) (i.e.…”

Section: Edtmentioning

confidence: 99%

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Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage

Roberts

Cotton²,

Duchesne³

et al. 2021

JEVTM

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Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.

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Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study

Abstract: Therapeutic/care management study, level III.

Cited by 31 publications

References 29 publications

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Improving out‐of‐hospital notification in traumatic cardiac arrests with novel usage of smartphone application

Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage

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