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Background: Barriers to EMS care can result in suboptimal outcomes and preventable morbidity and mortality. Large EMS databases such as the National Emergency Medical Services Information System (NEMSIS) dataset provide valuable data on the relative incidence of such barriers to care., Methods: A retrospective cross-sectional analysis was performed using the NEMSIS database. Cases of violent trauma were collected based on gender and racial group. Each group was analyzed for the ratio of cases that involved an EMS barrier to care. Chi-square testing was used to assess associations, and the relative risk was used as the measure of strength of association. For all tests, statistical significance was set at the 0.05 level., Results: 719,812 cases of violent trauma were analyzed using the NEMSIS dataset. EMS encountered barriers to care for white and non-white patients was found to be 4.9% and 4.0% respectively. The difference between groups was found to be 0.9% (95% CI [0.7%, 1.1%] p < 0.0001). RR was 1.23 for white patients (95% CI [1.19, 1.26]), and 0.82 (95% CI [0.79, 0.84]) for non-white. EMS barriers to care for male and female patients was found to be 6.03% and 3.34%, respectively. The difference between groups was found to be 2.7% (95% CI [2.6%, 2.8%] p < 0.0001). RR for male patients was 1.80 (95% Cl [1.76, 1.84]) while RR for female patients was 0.55 (95% CI [0.54, 0.57])., Conclusions: Racially white patients and male patients have a statistically significant higher risk of encountering an EMS barrier to care in cases of violent trauma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat. The purpose of this study was to assess medical decision-making capabilities of law enforcement personnel under these circumstances., Methods: Web-based surveys were administered to all sworn officers within the county jurisdiction. Thirty-eight key actions were predetermined for nine injured officer scenarios, with each correct action worth one point. Descriptive statistics and t-tests were used to analyze results., Results: Ninety-seven officers (65.1% response rate) responded to the survey. The majority of officers (68.0%) were trained to the first-responder level. Overall mean score for the scenarios was 15.5 +/- 3.6 (range 7-25). A higher level of medical training (EMT-B/P versus first responder) was associated with a higher mean score (16.6 +/- 3.4, p = 0.05 vs. 15.0 +/- 3.6, p = 0.05). Tactical unit assignment was associated with a lower score compared with non-assigned officers (13.5 +/- 2.9 vs. 16.0 +/- 3.6, p = 0.0085). No difference was noted based upon previous military experience. Ninety-two percent of respondents expressed interest in a law enforcement-oriented advanced first-aid course., Conclusions: Tactical medical decision-making capability, as assessed through the nine scenarios, was sub-optimal. In this post 9/11 era, development of law enforcement-specific medical training appears appropriate.

Objective: To determine whether the FAST examination might be a useful adjunct to simple triage and rapid treatment (START) in the secondary triage of mass-casualty victims already classified as delayed (Yellow)., Methods: A retrospective chart review was conducted of all adult trauma patients evaluated by the trauma surgery service at a level 1 trauma center between January 1 and December 31, 2003. Patients were retrospectively triaged to one of three START categories: immediate (Red), delayed (Yellow), or expectant (Black). The FAST results were obtained from the medical records., Results: FAST results were available for 359 patients, of which 27 were classified as positive. Twenty (6.9%) of 286 patients retrospectively triaged as delayed (Yellow) had positive FAST studies. Of these, six underwent operative intervention within 24 hours of arrival. A total of 232 patients had both FAST and computed tomography (CT) studies performed, of which 19 FAST studies were inconclusive. In the remaining 213 patients, six of 27 had falsely positive studies, while 24 of 186 had falsely negative studies., Conclusions: Portable ultrasound technology might have identified 20 delayed (Yellow) patients with evidence of hemoperitoneum, thereby expediting evacuation to definitive care. However, only 30% of these patients subsequently underwent an operative intervention within 24 hours of arrival. Both over- and undertriage were significant problems. As such, the current study does not support the routine use of FAST ultrasound as a secondary triage tool.