Adverse Events in the Efficacy of Crotalidae Polyvalent Immune Fab Antivenom vs Placebo in Recovery from Copperhead Snakebite Trial

Objective: To compare the incidence of hypersensitivity reactions following copperhead envenomation treated with Fab antivenom (FabAV) or placebo. Methods: Patients with copperhead snakebites received treatment and follow-up in a prospective, randomized, double-blind, placebo-controlled trial of FabAV or placebo. The treatment allocation ratio was 2:1 (FabAV:placebo). All of the included patients received at least one dose of study treatment....

Commentary on “Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis”

In this issue of the Southern Medical Journal, Schauer and associates address the vitally important issue of airway management in combat casualty care.1 Using data from the Department of Defense Trauma Registry, the authors provide qualitative information on the “what, where, when, and how” of airway placement in wounded patients during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)....

Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis

Objectives: Airway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management. Methods: We used a series of emergency department procedure codes to identify patients within the Department of Defense Trauma Registry from January 2007 to August 2016....

Differences Between Snakebites with Concomitant Use of Alcohol or Drugs and Single Snakebites

Objectives: Published reports have suggested that the concurrent use of alcohol or drugs occurs among some snakebite victims, but no national assessment of such data exists. Methods: We used data from US poison control centers collected during telephone calls in calendar years 2000–2013 to compare snake envenomations with concomitant use of drugs, alcohol, or both to snakebites lacking such use. Results: A total of 608 snakebites with...

Assessing Disaster Preparedness Among Select Children’s Summer Camps in the United States and Canada

Objective: Children’s summer camps are at risk for multiple pediatric casualties during a disaster. The degree to which summer camps have instituted disaster preparedness is unknown. We assessed disaster preparedness among selected camps nationally for a range of disasters. Methods: We partnered with a national, web-based electronic health records system to send camp leadership of 315 camp organizations a 14-question online survey of...

Chester Step Test as a Reliable, Reproducible Method of Assessing Physical Fitness of Disaster Deployment Personnel

Field disaster response typically is strenuous, difficult work, both physically and mentally.1–3 Although hard evidence is lacking, it may be inferred that responders lacking appropriate physical fitness are at increased risk of injury or compromising safety operations during a...

Transfusion Practice in Trauma Resuscitation

Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood–derived platelets to...

Survey of Hospital Employees’ Personal Preparedness and Willingness to Work Following a Disaster

Objectives: Little is known about the personal readiness of hospital staff for disasters. As many as 30% of hospital staff say that they plan not to report for work during a large-scale disaster. We sought to understand the personal disaster preparedness for hospital staff. Methods: Surveys were distributed to the staff of a large academic tertiary-care hospital by either a paper-based version distributed through the departmental safety...

Implementing a Disaster Preparedness Curriculum for Medical Students

Objectives: Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are...

Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists

Objectives: The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal...

Introduction to Special Series on Disaster Medicine

The Southern Medical Journal extends its appreciation to guest editor Lancer A. Scott, MD, and his colleagues for the development of the special series on disaster medicine in this issue of the Journal. Dr Scott continues to be a strong advocate for the importance of continued assessment of and preparation for future potential disaster events in the United States and around the globe. Our world has become more dangerous, both in terms of...

Disaster Medicine in the Post-9/11 Era

As I write this introduction to the special series on disaster medicine in this issue of the Southern Medical Journal, I am struck by the fact that nearly 16 years have passed since the terrorist attacks of September 11, 2001—16 years! For those of us in the academic community who are committed to advancing disaster medicine, 16 years is a long time. It seems like just yesterday we stood together and expressed great hope about the advances...

Patients with Access and Functional Needs in a Disaster

Individuals with special healthcare needs have some of the highest morbidity and mortality rates during disasters. Efforts to triage, transport, shelter, or treat vulnerable populations often fail to take into consideration disabilities and social situations, including caregiver availability. Communication, medical care, independence, supervision, and transportation needs should be considered in emergency preparedness planning. Inconsistencies...

Mitigating Matthew: 5 Lessons to Help Improve Hospital Preparedness in a Hurricane

Hurricane Matthew (Fig. 1) made landfall in the United States on October 8, 2016 near McClellanville, South Carolina, located just north of Charleston. The storm caused nearly $10 to $15 billion in damages along the southeast coastline, representing the 22nd most damaging storm in US history.1 The uncertainty regarding the storm’s path and strength caused great concern for hospital emergency management...

A Comparison of QTc Intervals in Alcohol Withdrawal Patients Versus Acute Coronary Syndrome Patients

Objectives: Patients with an alcohol use disorder experiencing acute intoxication or withdrawal may be at risk for electrocardiograph (ECG) abnormalities, including prolongation of repolarization (long QTc ) that may contribute to arrhythmias and may be associated with a threefold increase in the likelihood of sudden cardiac events. Patients with acute coronary syndrome may have prolonged QTc as well. To our knowledge, no previous studies have...

When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

Objectives: Health information exchanges (HIEs) make possible the construction of databases to characterize patients as multisystem users (MSUs), those visiting emergency departments (EDs) of more than one hospital system within a region during a 1-year period. HIE data can inform an algorithm highlighting patients for whom information is more likely to be present in the HIE, leading to a higher yield HIE experience for ED clinicians and...

A Comprehensive View of Frequent Emergency Department Users Based on Data from a Regional HIE

Objectives: A small but significant number of patients make frequent emergency department (ED) visits to multiple EDs within a region. We have a unique health information exchange (HIE) that includes every ED encounter in all hospital systems in our region. Using our HIE we were able to characterize all frequent ED users in our region, regardless of hospital visited or payer class. The objective of our study was to use data from an HIE to...

Health Information Exchange in the ED: What Do ED Clinicians Think?

Objectives: Our regional health information exchange (HIE), known as Carolina eHealth Alliance (CeHA)-HIE, serves all major hospital systems in our region and is accessible to emergency department (ED) clinicians in those systems. We wanted to understand reasons for low CeHA-HIE utilization and explore options for improving it. Methods: We implemented a 24-item user survey among ED clinician users of CeHA-HIE to investigate their perceptions...

Commentary on “Longitudinal Trends in the Prevalence of Diabetes Mellitus in an Urban Emergency Department”

As emergency medicine physicians, we often encounter patients with diabetes mellitus (DM). These patients present with a variety of continuing problems, including episodic hyperglycemia, hypoglycemia from medication errors (mostly oral agents), diabetic-related infections of the limbs, pain management problems caused by diabetic neuropathy, bladder dysfunction, blindness, and renal insufficiency.1,2 Diabetic patients require the use of...

Commentary on “Survival of Trauma Victims Transported by Helicopter Who Required CPR Within the First Hour of Hospital Arrival”

In early December 2015, a Helicopter Emergency Medical Service (HEMS) flight crew was dispatched in California to transport a patient. The helicopter took off in inclement weather conditions--heavy rain and fog--and subsequently crashed. The pilot, paramedic, nurse, and patient aboard ultimately died. At this point we do not know the exact cause of the crash, but it should be noted that this particular helicopter transport crew were known to be...