JEMS Editor-in-Chief Comments on Orthopaedic Research Findings

Several reports presented are very applicable to EMS and worthy of review.

 

 
 
 

A.J. Heightman, MPA, EMT-P | | Tuesday, February 7, 2012


A.J. Heightman, JEMS Editor-in-Chief:
This week, the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) is taking place at the Moscone Convention Center in San Francisco. Several research reports being presented to the attendees are very applicable to EMS and worthy of being passed along.

Economic Factors Impact Orthopaedic Trauma Volume
Orthopaedic trauma cases decline in weak economy

Previous studies have found that human behavior during a recession is remarkably different than that during a bullish economy. For example, people tend to spend more time focused on working and less time engaging in leisure and recreation activities, resulting in fewer motor vehicle and other accidents.

According to a 10-year study at a Level 1 regional trauma center, economic trends do impact orthopaedic trauma volume.  Between 1999 and 2009, a local county's population steadily grew at an annual rate between .9 and 2.9 percent. Unemployment rates peaked in 2002 at 5.4 percent, declined to 3.3 percent in 2006, and rose again in 2009 to 10.7 percent.

While general trauma volume increased during the later years, there was a significant negative association between orthopaedic trauma volume and county unemployment rates of the previous year. 

EMS MESSAGE:  EMS crews should expect that, as the economy declines. They may see less orthopaedic trauma caused by recreational incidents, but an increase in injuries that result from crime and violence associated with the desperation of individuals seeking money from any source in a down econmy.

Modern, Low-Energy Ammunition Can Cause Deep Tissue Damage

Orthopaedic surgeons (and EMS crews) should pay close attention to handgun injuries, provide aggressive care when needed

Gunshot injuries are typically categorized as low- or high-energy based on the weapon's missile velocity and mass. Typically, low energy injuries are treated with simple wound care, with or without antibiotics, regardless of the presence of a fracture. In contrast, high energy injuries are treated more aggressively. 

However, modern low-energy handgun ammunition is designed to inflict significant soft tissue damage, which can cause infection and compartment syndrome (a painful condition that occurs when pressure within the muscles builds to dangerous levels).

A review of ballistics data from forensic scientists and law enforcement officers in a major U.S. city police department, as well as gunshot-induced fractures from a single level 1 trauma center, found that low-energy handgun injuries have become more prevalent, and with hollow point ammunition (designed to expand when entering the body), can cause severe underlying tissue injury that may be overlooked by clinicians. 

Orthopaedic surgeons need to be aware of this powerful new ammunition, and the likelihood that even "low energy" handguns can cause substantial bone and soft tissue injury.

EMS MESSAGE:  Because "low energy" handguns can cause substantial bone and soft tissue injury, EMS crews should not assume that wounds inflicted by a small caliber, perhaps found at the scene, will be insignificant and should be assessed and treated aggressively, with consideration of transport to a trauma center.

Risk of Pulmonary Embolism (PE) Greatest During First Week Following Total Joint Replacement
Prolonged use of therapies to minimize blood clot risk may be unnecessary

The elevated risk of pulmonary embolism (PE) – a blood clot that travels from the leg to the lungs – has been well established, yet little is known about the natural course and timing of this potentially fatal condition.

The records of 25,660 patients who received total joint replacement (TJR) between 2000 and 2010 were reviewed. All patients received the anticoagulation (blood thinning) drug Coumadin immediately following surgery and each was monitored, but not screened, for PE.

Pulmonary embolisms that  occurred within 90 days of the joint replacement was documented.
The median occurrence of PE was two days following surgery, with 254 out of 286 cases of PE (88.8 percent) occurring within the first seven days after surgery.  Based on the findings of this study, anticoagulation treatment beyond seven days may not be necessary.

EMS MESSAGE:  While the message for orthopaedic surgeons is that most PEs (89%) occur within the seven day period immediately following a patient’s surgery and allow them to be taken off Coumadin sooner in the future, there is an important assessment and history fact presented in these results for emergency response crews. That message is that EMS crews that respond to respiratory distress cases in patients within the first seven days after a total joint replacement (TJR) should be highly suspicious of pulmonary embolisms (PEs). 


Content source: PR Newswire on behalf of the AAOS




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: News, research, orthpaedic trauma

 
Author Thumb

A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.

BROWSE FULL BIO & ARTICLES >

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

The Evolution of Civilian High Threat Medical Guidelines

How mass killing events have proven a need for new guidelines.
More >

Multimedia Thumb

Baltimore Man Rescued from Building Collapse

Rowhouse collapse traps a worker in the basement area.
Watch It >


Multimedia Thumb

A Night with Wisconsin’s Busiest Medic Unit

Ride along one night with the paramedics of MED 5.
Watch It >


Multimedia Thumb

Patient Dies in West Virginia Ambulance Rollover

Marion County Rescue Squad crew is injured in collision.
Watch It >


Multimedia Thumb

Rescue Volunteers in Syria

White Helmets group at work during fighting.
More >


Multimedia Thumb

Boulder Pins Colorado Hiker

Wilderness EMS team frees trapped hiker.
More >


Multimedia Thumb

North Dakota Oilfield Medics

Tactics used in offshore platforms tailored to the remote areas.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


More Product Videos >