The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the situational awareness of medical incident commanders’ (ICs’) scene assessment of mass gatherings. Mass gatherings occur frequently and the potential for injury at these events is considered higher than the general population. These events have generated mass-casualty incidents (MCIs) in the past. The aim of this study was to compare UAV technology to standard practice (SP) in scene assessment using paramedic students during a mass-gathering event (MGE).

This study was conducted in two phases. Phase One consisted of validation of the videos and accompanying data collection tool. Phase One was completed by 11 experienced paramedics from a provincial Emergency Medical Services (EMS) service. Phase Two was a randomized comparison with 47 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada) of the two scene assessment systems. For Phase Two, the paramedic students were randomized into a UAV or a SP group. The data collection tool consisted of two board categories: primary importance with 20 variables and secondary importance with 25 variables. After a brief narrative, participants were either shown UAV footage or the ground footage depending on their study group. After completion of the videos, study participants completed the data collection tool.

The Phase One validation showed good consensus in answers to most questions (average 79%; range 55%-100%). For Phase Two, a Fisher’s exact test was used to compare each variable from the UAV and SP groups using a P value of .05. Phase Two demonstrated a significant difference between the SP and UAV groups in four of 20 primary variables. Additionally, significant differences were found for seven out of 25 secondary variables.

This study demonstrated the accurate, safe, and feasible use of a UAV as a tool for scene assessment by paramedic students at an MGE. No observed statistical difference was noted in a majority of both primary and secondary variables using a UAV for scene assessment versus SP.

We aimed to determine the rate of adverse events during interfacility transport of cardiac patients identified as low risk by a consensus-derived screening tool and transported by primary care flight paramedics (PCP(f)).

We conducted a health records review of adult patients diagnosed with a cardiac condition who were identified as low risk by the screening tool and transported by PCP(f). We excluded patients transported by an advanced care crew, those accompanied by a clinical escort from hospital, and those transported from a scene call, by rotary wing or ground vehicle. We recorded patient and transportation parameters using a piloted-standardized collection tool. We defined adverse events during transport a priori. We report descriptive statistics using mean (standard deviation), [range], (percentage).

We included 400 patients: mean age 66.9 years old, 66.5% male. Mean transport duration was 136.2 (74.9) minutes. Most common comorbidities were hypertension (50.3%) and coronary artery disease (39.5%). Most transports originated out of Northern Ontario and were for cardiac catheterization (61.8%) or coronary artery bypass grafting (26.8%). Overall, the adverse event rate was low (0.3%), with no serious event such as cardiac arrest, death, or airway intervention.

A screening tool can identify cardiac patients at low risk for clinical deterioration during air-medical transport. We believe patients screened with this tool can be transported safely by a PCP(f) crew, leading to potentially significant resource savings.

The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the way medical incident commanders (ICs) respond to mass-casualty incidents (MCIs) in triaging victims. The aim of this study was to compare UAV technology to standard practice (SP) in triaging casualties at an MCI.

A randomized comparison study was conducted with 40 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada). Using a simulated motor vehicle collision (MVC) with moulaged casualties, iterations of 20 students were used for both a day and a night trial. Students were randomized to a UAV or a SP group. After a brief narrative, participants either entered the study environment or used UAV technology where total time to triage completion, GREEN casualty evacuation, time on scene, triage order, and accuracy were recorded.

A statistical difference in the time to completion of 3.63 minutes (95% CI, 2.45 min-4.85 min; P=.002) during the day iteration and a difference of 3.49 minutes (95% CI, 2.08 min-6.06 min; P=.002) for the night trial with UAV groups was noted. There was no difference found in time to GREEN casualty evacuation, time on scene, or triage order. One-hundred-percent accuracy was noted between both groups.

This study demonstrated the feasibility of using a UAV at an MCI. A non-clinical significant difference was noted in total time to completion between both groups. There was no increase in time on scene by using the UAV while demonstrating the feasibility of remotely triaging GREEN casualties prior to first responder arrival.

Jain T, Sibley A, Stryhn H, Hubloue I.Comparison of unmanned aerial vehicle technologyassisted triage versus standard practice in triaging casualties by paramedic students in a mass-casualty incident scenario. Prehosp Disaster Med. 2018;33(4):375–380

During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.

Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.

All students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.

Thirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).

Primary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.

LeeCWC , McLeodSL , Van AarsenK , KlingelM , FrancJM , PeddleMB . First Responder Accuracy Using SALT during Mass-casualty Incident Simulation. Prehosp Disaster Med. 2016;31(2):150–154.

Mass-casualty incidents (MCIs) present a unique challenge with regards to triage as patient volume often outweighs the number of available Emergency Medical Services (EMS) providers. A possible strategy to optimize existing triage systems includes the use of other first responder groups, namely fire and police, to decrease the triage time during MCIs, allowing for more rapid initiation of life-saving treatment and prioritization of patient transport.

First-year primary care paramedic (PCP), fire, and police trainees can apply with similar accuracy an internationally recognized MCI triage tool, Sort, Assess, Life-saving interventions, Treatment/transport (SALT), immediately following a brief training session, and again three months later.

All students enrolled in the PCP, fire, and police foundation programs at two community colleges were invited to participate in a 30-minute didactic session on SALT. Immediately following this session, a 17-item, paper-based test was administered to assess the students’ ability to understand and apply SALT. Three months later, the same test was given to assess knowledge retention.

Of the 464 trainees who completed the initial test, 364 (78.4%) completed the three month follow-up test. Initial test scores were higher (P<.05) for PCPs (87.0%) compared to fire (80.2%) and police (68.0%) trainees. The mean test score for all respondents was higher following the initial didactic session compared to the three month follow-up test (75% vs 64.7%; Δ 10.3%; 95% CI, 8.0%-12.6%). Three month test scores for PCPs (75.4%) were similar to fire (71.4%) students (Δ 4.0%; 95% CI, −2.1% to 10.1%). Both PCP and fire trainees significantly outperformed police (57.8%) trainees. Over-triage errors were the most common, followed by under-triage and then critical errors, for both the initial and follow-up tests.

Amongst first responder trainees, PCPs were able to apply the SALT triage tool with the most accuracy, followed by fire, then police. Over-triage was the most frequent error, while critical errors were rare.

LeeCWC, McLeodSL, PeddleMB. First Responder Accuracy Using SALT after Brief Initial Training. Prehosp Disaster Med. 2015;30(5):447–451.

The undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada.

This study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.

A study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.

Ninety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).

Emergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults’ pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.

RahmanA, CurtisS, DeBruyneB, SookramS, ThomsonD, LutzS, AliS. Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children. Prehosp Disaster Med. 2015;30(1):1-6.