Thursday, October 9, 2014

Helicopter-based in-water resuscitation with chest compressions: a pilot study


Article: Helicopter-based in-water resuscitation with chest compressions: a pilot study
Authors: Winkler, BL, et al.
Journal: Emergency Medicine Journal

I have covered some of Dr Winkler's articles in the past, primarily concerning mannequin-based in-water resuscitation studies.  This article reviews a recent pilot study he performed to evaluate a possible helicopter-based protocol for performing in-water resuscitation.  The protocol involves the following:

  • Dispatching rescue divers from a helicopter on scene
  • Deploying inflatable platform
  • Placing LMA airway and ventilating with Oxylator
  • Applying Lucas chest compression device
  • Inserting intraosseous needle
This rescue protocol was carried out in a wave pool from a simulated helicopter platform in calm and choppy water.  The idea of the study was to "investigate the feasibility and time requirement of the in-water resuscitation measures..."

I have always enjoyed reading the innovative study designs Dr Winkler comes up with, but what concerns me is that these studies may be missing the point and complicating things.  Many folks get caught up in fancy devices and techniques without focusing on basic airway techniques.  I understand where Dr Winkler is coming from and applaud his efforts to improve in-water resuscitation, but these articles need to be read with the understanding that any time used to insert devices and carried out complex protocols may be taking away from much needed ventilations and transport to advanced care.  In the case of helicopter rescue, it would be more beneficial, in my mind, to perfect protocols for getting a victim in to the helicopter and on the way to advanced care as fast as possible.  There is no reason to bring the resuscitation bay to the patient when you have a perfectly good one hovering right above you.  

Overall I am impressed that they were able to deploy and use all of this equipment in to the aquatic environment.  Definitely too many moving parts and too much room for error for my taste, but I enjoy the innovative science.

Reference

Saving of Children's Lives from Drowning in Bangladesh


Article: Saving of Children’s Lives from Drowning Project in Bangladesh
Authors: Hyder, AA et al
Journal: American Journal of Preventative Medicine, 2014 (Article in press)

The Johns Hopkins International Injury Research Unit and the Bloomberg Philanthropies have awarded a large grant to the International Center for Diarrhoeal Disease Research, Bangladesh and the Center for Injury Prevention and Research Bangladesh (CIPRB) to fund the Saving of Children’s Lives from Drowning Project in Bangladesh.  (More info here)

This article discusses the planned interventions for the project, which include providing playpens (seen above), access to a daycare, or both to around 80,0000 children.  The project will then compare pre and post-intervention community awareness and death rates.

Over the past decade, a larger focus has been placed on developing countries for drowning prevention  interventions.  We have seen a lot of impressive work from CIPRB in the past, including projects run by our friend Tom Mecrow, and I am excited to see the outcome of this project.  It represents a unique approach to large-scale drowning prevention, bypassing the usual interventions of swimming and water safety training.  These interventions are ideal but are a large resource and logistics burden, and restricted by the age of the children involved.  Hopefully success with this project will provide a proven means for improving the burden of drowning on a country-wide scale.

Article Abstract Link