Is it a fight-or-flight response?
As reports of violence against ambulance staff are increasing, this study is interesting. The researchers conducted a simulation-based study to evaluate the responses of emergency medical service (EMS) professionals to patient encounters with threats of violence. A total of 270 EMS professionals participated as individual members of two-person crews in one of four standardised patient care scenarios: a possible overdose, an intoxicated person, domestic violence, and an aggressive family member. Each scenario lasted for 8 minutes and inevitably spiralled to a point where EMS personnel should escape the scene. Trained evaluators recorded the performance using standardised data elements. The primary outcome was escape from the unsafe scene before the scenario ended, while secondary outcomes were related to verbal de-escalation attempts based upon a standard 5-point scale.
Most participants were certified at paramedic level (79%); the rest were evenly split between advanced emergency medical technicians (AEMT) and EMTs. The majority (66%) of participants were male and 45% had 10 or more years of EMS service. There were also 13% with prior military service, 10% with experience in law enforcement and 23% who had received crisis intervention training (CIT).
For the primary outcome, as years of experience increased, the number escaping decreased (p-=0.02). Of those with military experience, 33% escaped compared with 57% without (p=0.01), and more of those with CIT escaped than those without (p<0.01). Previous law enforcement experience had no impact. Interestingly, paramedics demonstrated lower odds of leaving the scene compared with EMTs but showed much higher odds of making an adequate de-escalation attempt. Those with 20 or more years of EMS experience exhibited 68% lower odds of escaping compared to those with 2 or fewer years of experience (OR: 0.32; 95% CI: 0.13–0.79).
The study was American and simulation-based so extrapolation to UK practice is limited; however, it is an interesting starting point for considering our own actions in threatening environments.
From E-Scooter to ED…
Despite certain restrictions in many UK cities, electric scooters (E-scooters) are becoming popular as an alternative to cars for short journeys in densely populated areas. However, public awareness of the proper use of E-scooters is limited and accidents are rising. In the year ending June 2021, there were 931 casualties in accidents involving E-scooters in the UK, with three deaths. To date, there are few large studies specifying injury patterns in E-scooter-related incidents. However, this study from Berlin adds data to the current knowledge, which will help to identify risk factors and suggest safety improvements, as well as inform practice.
The study team undertook a prospective observational multicentre study across four central emergency departments (EDs) in the district of Berlin-Mitte. They included all patients who attended the ED between June and December 2019 following an E-scooter incident, whether brought in by ambulance or self-presenting. Patient-specific data were gathered prospectively alongside information on the severity, diagnosis, and treatment of injuries.
In total, 248 patients were admitted during the study period; 52% were male and the median age was 29 years (range 5–81). Three-quarters (75%) of incidents occurred between July and September, presumably related to better weather and holiday periods. Meanwhile, 40% of the accidents occurred between noon and 18:00, with a noticeable increase of injuries across weekends. The main causes of incident were violation of traffic regulations, the user's inattentiveness, a risk-taking driving style, and alcohol consumption.
The lower limbs were affected the most, mainly with soft tissue damage, and head injuries were close behind. Fractures requiring surgery occurred more frequently in the upper limbs. Notably, traumatic brain injury occurred most frequently in those driving under the influence of alcohol, even if the riders were experienced in handling E-scooters. Patterns of injury are perhaps not unexpected, but it is useful to have supporting data.