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Biomedical subjects

Craig D Newgard

Publications and source records attributed to Craig D Newgard.

24 records · Page 2Linked to original sources
PubMed2002

Crash scene photography in motor vehicle crashes without air bag deployment.

OBJECTIVE: To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment. METHODS: A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review. RESULTS: Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables. CONCLUSIONS: Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment.

Abbreviated Injury Scale↗
PubMedDate not supplied

Is it possible to safely triage callers to EMS dispatch centers to alternative resources?

OBJECTIVES: To develop guidelines allowing emergency medical services (EMS) dispatchers to safely match callers to an EMS response or, alternatively, to a nontraditional resource. METHODS: This was a prospective cohort study of callers to an urban EMS dispatch center and an associated review of EMS patient care forms and emergency department (ED) patient care records. The following five "nature codes" (patient chief complaints) were included: back pain, fall, bleeding or laceration, sick, and trauma. Callers included in the study had been assigned the lowest severity level (Alpha), according to existing dispatch criteria. An a priori list of EMS and ED "important findings," indicating need for an EMS response, was used as the outcome variable. Classification and regression tree (CART) analysis was used to develop a decision rule to further identify a low-risk subgroup of patients who could potentially be served by alternative resources. RESULTS: From November 1, 1998, to May 31, 1999, 656 subjects were entered into the study, including 263 males (40%) and 389 females (59%). The mean age was 51 years (range, 0-101 years). One hundred twenty-five (19%) callers had an important EMS finding, including the administration of comfort medications, morphine, benzodiazepines, and droperidol. Forty-six subjects (7%) had an important ED finding. When EMS and ED findings were combined, 158 subjects (24%) had an "important finding." Using CART analysis, having an age <12 years predicted a subset of patients who did not have an important finding suggesting the need for an EMS response. Using cross-validation, this decision rule had a 99% sensitivity, 13% specificity, and 98% negative predictive value. CONCLUSION: The authors were able to use a demographic variable (age) to predict a population of callers to a 911 dispatch center triaged to the lowest acuity category, who have a very low risk of having an EMS or ED important finding. The decision rule developed here is preliminary, requiring further validation.

Adolescent↗
PubMedDate not supplied

Emergency Medical Treatment and Active Labor Act and trauma triage.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was conceived as a means to ensure that patients with emergent conditions would receive stabilizing care and to avert the potentially dangerous, economically driven, interhospital transfer of patients. This legislation and its subsequent application arrived near the time that regional and statewide trauma systems were established. Trauma systems were developed to guide optimal resource use for the injured patient regardless of the patient's ability to pay. Unfortunately, when coupled with current economic and litigation threats to community emergency and surgical practitioners, EMTALA represents a threat to the continuation of the trauma system concept. Trauma systems are dependent on a tiered hospital network where severely injured patients are taken to a hospital with resources aligned to manage the worst of injuries. When primary triage from the field cannot accomplish this task, secondary triage from a nondesignated or lower-level hospital to the higher-level trauma center is needed. EMTALA has served as a driver to change the priority for secondary triage from addressing the needs of the severely injured patient to filling community hospital surgical specialist emergency department on-call coverage gaps for less severely injured patients. Further, legal action associated with claims of EMTALA violations has needlessly extended medical examination and "stabilization" efforts at community emergency departments prior to needed secondary triage. Higher-level trauma centers will benefit from codifying system-wide emergency medical services practices related to primary and secondary triage, establishing trauma center capacity and divert practices, and initiating "transfer center" operations that control transfer of patients to these centers.

Emergency Medical Services↗