2020 Trauma/Critical Care Presentations

Andrew Warren, OMSII1, Rebecca Ryznar, PhD1, Ryan Henschell, OMSIII1, William Suddarth, OMSII1, Alex Knippenberg, OMSII1, Andrew Glen, PhD1, Anthony LaPorta, MD1, Ryan Shelton, NREMTP2, Renato Rapada, DO1; 1Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, 2South Metro Fire Rescue, Parker, Colorado

Objectives: Military-style training and policies are becoming common in civilian law enforcement, fire and EMS departments. Active shooter events are requiring first responders to employ tactics previously used only in combat scenarios. Most notably is the establishment of a “warm zone” – an area that has been secured and cleared by law enforcement that serves as an area for patient care before a larger area or entire building is cleared of threats. Naturally, this type of environment increases the fear and stress of the first responders. The objective of our study was to measure how paramedics physiologically respond to stressors associated with warm zone simulations.

Methods: A wireless Caretaker 4 monitoring device was placed on the wrist and middle finger of paramedics engaged in active shooter drill training sessions to measure heart rate, respiratory rate, systolic and diastolic blood pressure. Measurements were taken from the time of dispatch to handoff at the ER. Additionally, the real-time charting platform, T6, was used to communicate patient vitals and injury patterns to receiving trauma centers.

Results: Mean averages and sample standard deviations were calculated for monitored vital signs at baseline, throughout the drill, and proximal to the transfer of care to emergency medicine hospital staff. This data was evaluated to determine possible correlations between demographics, experience level, and associated physiologic response for each paramedic's training. Preliminary analysis indicates a significant decrease in induced stress response with more years of military training. For many of the subjects, the most stressful part of the drill was the handoff at the receiving hospital. The T6 platform was used by the trauma centers to prepare appropriate supplies and prioritize interventions for incoming patients. Four patients were prepped for operative procedures and a perimortem C-section was decided upon in the emergency room due to recognition of pattern changes from the T6 monitoring.

Conclusion: A greater number of years in the military correlated with decreased changes in averages and standard deviation of systolic, diastolic, pulse, and mean arterial pressures. Results from our study support the value and habituation effect of such warm zone care training sessions for military, EMS, and law enforcement. The T6 platform proved to be useful in preparing hospitals to accept patients by allowing for triage to partially completed in route. Previous experience and implementation of T6 proved to be useful at minimizing stress during mass casualty events and increasing the success of the operation, respectively.