H D Backer1, S Collins. 1. Department of Emergency Medicine, Kaiser Permanente Medical Center, Hayward, Department of Sports Medicine, Kaiser Permanente, Medical Center, Walnut Creek, CA, USA.
Abstract
STUDY OBJECTIVES: To test the feasibility of using handheld, battery-operated chemical analyzers by EMS personnel in a wilderness environment to aid in the diagnosis and management of heat illness. METHODS: During the summer of 1996, 3 portable clinical analyzers (i-STAT Corp, Princeton, NJ) were kept at different locations along the main hiking trail into the Grand Canyon. An operational protocol was designed for field use, and Park Service EMS personnel used the instruments at their discretion, primarily to determine serum sodium concentration and identify cases of hyponatremia. Data were collected on all EMS encounters. This study reviews our experience with the instruments. RESULTS: The i-STAT analyzer was used for 64 patients in the backcountry; of these uses, at least 22 were in the field and the remainder in backcountry ranger stations. Eight error messages were recorded in 6 patients. Subsequently, all but 1 had a successful determination. Among patients evacuated for further evaluation and care, serum sodium values were highly consistent with later analysis using standard laboratory equipment. The instrument was used in 31 (48%) of 64 of patients evaluated and released for self-treatment and self-evacuation, and 31 (36%) of 87 of patients evacuated by EMS personnel from the canyon. Nine cases of hyponatremia were confirmed in the field, allowing appropriate intervention. CONCLUSION: Portable clinical analyzers can reliably be used in a hot wilderness environment. In our application, it allowed identification of exercise-associated hyponatremia, an important cause of serious heat illness during endurance exercise in a hot environment. The results helped make treatment and disposition decisions.
STUDY OBJECTIVES: To test the feasibility of using handheld, battery-operated chemical analyzers by EMS personnel in a wilderness environment to aid in the diagnosis and management of heat illness. METHODS: During the summer of 1996, 3 portable clinical analyzers (i-STAT Corp, Princeton, NJ) were kept at different locations along the main hiking trail into the Grand Canyon. An operational protocol was designed for field use, and Park Service EMS personnel used the instruments at their discretion, primarily to determine serum sodium concentration and identify cases of hyponatremia. Data were collected on all EMS encounters. This study reviews our experience with the instruments. RESULTS: The i-STAT analyzer was used for 64 patients in the backcountry; of these uses, at least 22 were in the field and the remainder in backcountry ranger stations. Eight error messages were recorded in 6 patients. Subsequently, all but 1 had a successful determination. Among patients evacuated for further evaluation and care, serum sodium values were highly consistent with later analysis using standard laboratory equipment. The instrument was used in 31 (48%) of 64 of patients evaluated and released for self-treatment and self-evacuation, and 31 (36%) of 87 of patients evacuated by EMS personnel from the canyon. Nine cases of hyponatremia were confirmed in the field, allowing appropriate intervention. CONCLUSION: Portable clinical analyzers can reliably be used in a hot wilderness environment. In our application, it allowed identification of exercise-associated hyponatremia, an important cause of serious heat illness during endurance exercise in a hot environment. The results helped make treatment and disposition decisions.
Authors: Ian E Blanchard; Ryan Kozicky; Dana Dalgarno; Justin Simms; Stacy Goulder; Tyler S Williamson; Susan Biesbroek; Lenore Page; Karen Leaman; Suzanne Snozyk; Lyle Redman; Keith Spackman; Christopher J Doig; Eddy S Lang; Gerald Lazarenko Journal: BMC Emerg Med Date: 2019-05-02