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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Castle, Nicholas
Languages: English
Types: Doctoral thesis
Subjects: R

Classified by OpenAIRE into

mesheuropmc: education
The introduction of chemical, biological, radiation and nuclear personal protective equipment (CBRN-PPE) across the National Health Service (NHS), in 2007, represented an increase in the capacity to treat patients following a CBRN incident. However, little was known on what impact the NHS CBRN-PPE would have on skill performance. \ud \ud To date a number of studies have evaluated various skills performed whilst wearing a range of CBRN-PPE, none of which resembles the NHS CBRN-PPE. This gap in the evidence prompted a series of research studies addressing the following research question, ‘What airway and vascular access skills can be performed whilst wearing the NHS issued chemical, biological, radiation, and nuclear personal protective equipment? The resulting nine published peer-reviewed papers are presented with a critical commentary in three chapters: Chapter 3 (Papers 1 to 4) assesses what clinical skills can be performed using the\ud NHS CBRN-PPE; Chapter 4 (Papers 5 & 6) explores clinicians’ views on the preferences and experiences of airway management whilst wearing CBRN-PPE; and Chapter 5 (Papers 7 to 9) evaluates the optimal strategies of airway management whilst wearing the NHS CBRN-PPE. Chapter 6 is a summary of the findings presented in this thesis and presents a number of new research questions to further expand our knowledge-base, regarding skill performance whilst wearing NHS CBRN-PPE, reflecting the developmental nature of this area of research.\ud \ud The research contained in this thesis utilises a combination of randomised controlled trials, interviews and questionnaires, to ascertain the impact of the NHS CBRN-PPE on skill completion. Papers 1 to 4 recruited a group of mixed clinicians allowing subgroup analysis observing for inter-professional differences regarding skill performance. Whereas, Papers 7 to 9 recruited student paramedics ensuring similar levels of airway management skills, thereby isolating prior expertise as a variable.\ud \ud The research presented in this thesis has been used during simulation training as part preparations for the 2012 Olympics, in the development of a CBRN training DVD and incorporated into a textbook. The results have also been shared with NHS England working party on CBRN-PPE and, are being incorporated into CBRN treatment protocols by an\ud overseas ambulance service.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Baker D. Minds at war. Burgess Hill: Saxon books, 1996.
    • 2. Al-Damouk M, Bleetman A. Impact of the department of health initiatives to equip and train acute trusts to manage chemically contaminated casualties. Emerg Med J 2005;22(5):347-50.
    • 3. Horby P, Murray V, Cummins A, Mackway-Jones K, Euripidou R. The capability of accident and emergency departments to safely decontaminate victims of chemical incidents J Accid Emerg 2000;17(5):344-47.
    • 4. George G, Ramsay K, Rochester M, Seah R, Spencer H, Vijayasankar D, et al. Facilities for chemical decontamination in accident and emergency departments in the United Kingdom. Emerg Med J 2002;19(5):453-57.
    • 5. Mayor S. National Audit Office report shows gaps in emergency planning. BMJ 2002;325(7374):1193.
    • 6. Wimbush S, Davies G, Lockey D. The presentation and management of victims of chemical and biological agents: a survey of knowledge of UK clinicians. Resuscitation 2003;58(3):289-92.
    • 7. Holdsworth D, Bland S, O'Reilly D. CBRN Response and the Future. J R Army Med Corps 2012;158(1):48-63.
    • 8. Byers M, Russell M, Lockey DJ. Clinical care in the "Hot Zone". Emerg Med J 2008;25(2):108-12.
    • 9. Mazzone A. The use of CBRN weapons by non-state terrorists. GSS 2013;4(4):23-30.
    • 10. Sharp TW, Brennan RJ, Keim M, Williams RJ, Eitzen E, Lillibridge S. Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games. Ann Emerg Med 1998;32(2):214-23.
    • 11. Kamenopoulou V, Dimitriou P, Hourdakis CJ, Maltezos A, Matikas T, Potiriadis C, et al. Nuclear security and radiological preparedness for the olympic games, athens 2004: lessons learned for organizing major public events. Health Phys 2006;91(4):318-30.
    • 12. Liu Y, Lei C, Qin B, Chen H, Su X. Medical preparedness for Radiation Emergency for the Olympic Games, Beijing 2008. Health Phys 2010;98(6):784-87.
    • 13. Condron S, Leake C. Poison drones are new Olympic threat, warns colonel in charge of keeping London calm. Mail on Sunday 2012 May 6.
    • 14. Boyle P, Haggerty KD. Planning for the worst: risk, uncertainty and the Olympic Games. Br J Sociol 2012;63(2):241-59.
    • 15. Loyd A. An act of barbarism. The Times 2013;1, 6, 7, 32.
    • 16. BBC. MSF-backed hospitals treated Syria 'chemical victims. BBC Middle East News, 24 August 2013; http://www.bbc.co.uk/news/world-middle-east-23827950 last accessed 10/10/2013.
    • 17. Baker DJ. Toxic Trauma. a basic clinical guide. London: Springer, 2014.
    • 18. Clarke SFJ, Chilcott RP, Wilson JC, Kamanyire R, Baker DJ, Hallett A. Comprehensive review. Decontamination of multipe casualties who are chemically contaminated: A challenge for acute hospitals. Prehospital Disast Med 2008;23(2):175-81.
    • 19. Mehta PS, Mehta AS, Mehta SJ, Makhijani AB. Bhopal tragedy's health effects. A review of methyl isocyanate toxicity. JAMA 1990;264(21):2781-87.
    • 20. Taylor HL, Orlansky J. The effects of wearing protective chemical warfare combat clothing on human performance. Aviat Space Environ Med:A1-41 1993;64(3 Pt 2):A1-A41.
    • 21. Krueger GP. Psychological and performance effects of chemical-biological protective clothing and equipment. Mil Med 2001;166(12 Suppl):41-43.
    • 22. Southwell J. The NHS CBRN-PPE: , 2012.
    • 23. Karsenty E, Shemer J, Alshech I, Cojocaru B, Moscovitz M, Shapiro Y, et al. Medical aspects of the Iraqi missile attacks on Israel. Isr J Med Sci. 1991;27(11-12):603-07.
    • 24. Barach P, Rivkind A, Israeli A, Berdugo M, Richter E. Emergency preparedness and response in Israel during the Gulf War. Ann Emerg Med 1998;32(2):224-33.
    • 25. Hick JL, Hanfling D, Burstein JL, Markham J, Macintyre AG, Barbera JA. Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations. Ann Emerg Med 2003;42(3):370-80.
    • 26. Georgopoulos PG, Fedele P, Shade P, Lioy PJ, Hodgson M, Longmire A, et al. Hospital response to chemical terrorism: personal protective equipment, training, and operations planning. Am J Ind Med 2004;46(5):432-45.
    • 27. Cone D, Cummings BA. Hospital disaster staffing: if you call, will they come? Am J Disaster Med 2006;1(1):28-36.
    • 28. Heptonstall J, Gent N. CBRN incidents: Clinical management and health protection: Health Protection Agency (UK), 2008.
    • 29. Lockey D, Davies G. The challenges of deliberate chemical/biological attack. Resuscitation 2003;58(3):293-96.
    • 30. Crawford IWF, Mackway-Jones K, Russell DR, Carley SD. Planning for chemical incidents by implementing a Delphi based consensus study. Emerg Med J 2004;21(1):20-23.
    • 31. Crawford IWF, Mackway-Jones K, Russell DR, Carley SD. Delphi based consensus study into planning for chemical incidents. Emerg Med J 2004;21(1):24-28.
    • 32. Baker DJ. Advanced life support for acute toxic injury (TOXALSTM). Eur J Emerg Med. 1996;3(4):256-62.
    • 33. Morita H, Yanagisawa N, Nakajima T, Shimizu M, Hirabayashi H, Okudera H, et al. Sarin poisoning in Matsumoto, Japan. Lancet 1995;346(8970):290-93.
    • 34. Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, et al. Report on 640 victims of Tokyo subway sarin attack. Ann Emerg Med. 1996;28(2):129-35.
    • 35. Okumura T, Suzuki K, Fukuda A, Kohama A, Takasu N, Ishimatsu S, et al. The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med 1998;5(6):618-24.
    • 36. Okumura T, Suzuki K, Fukuda A, Kohama A, Takasu N, Ishimatsu S, et al. The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med 1998;5(6):613-17.
    • 37. Wax PM, Becker CE, Curry SC. Unexpected "Gas" casualties in Moscow: A medical toxicology perspective. Ann Emerg Med 2003;41(5):700-05.
    • 38. BBC. How special forces ended siege: BBC, 2002. http://news.bbc.co.uk/1/hi/world/europe/2363601.stm last accessed 26/12/2013.
    • 39. Franchetti M. 10 years on, victims rage at Putin's silence over siege disaster. The Sunday Times 2012;7 Oct: 29.
    • 40. BBC. The Moscow Theatre Siege. http://www.bbc.co.uk/science/horizon/2004/moscowtheatretrans.shtml last accessed 12/02/2014. Horizon: BBC, 2004.
    • 41. Ohbu S, Yamashina A, Takasu N, Yamaguchi T, Murai T, Nakano K, et al. Sarin poisoning on Tokyo subway. South Med J. 1997 90(6):587-93.
    • 42. Okudera H, Morita H, Iwashita T, Shibata T, Otagiri T, Kobayashi S, et al. Unexpected nerve gas exposure in the city of Matsumoto: report of rescue activity in the first sarin gas terrorism. Am J Emerg Med 1997;15(5):527-258.
    • 43. Castle N, Owen R, Hann M, Clark S, Reeves D, Gurney I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low- and high-dexterity airway and vascular access skills. Resuscitation 2009;80(11):1290-95.
    • 44. Castle N, Owen R, Clark S, Hann M, Reeces D. Comparison of techniques for securing the endotracheal tube while wearing chemical, biological, radiological, or nuclear protection: a manikin study Prehosp Disast Med 2010;25(6):589-94.
    • 45. Castle N, Owen R, Clarke SFJ, Hann M, Reeves D, Gurney I. Does position of the patient adversely affect successful intubation whilst wearing CBRN-PPE? Resuscitation 2010;81(9):1166-71.
    • 46. Heggie C, Baker D. “Training the Frontline” - the CBRNE Pilot Course for Emergency Department staff: March 2009, Homerton Hospital Chemical Hazards and Poisons Report 2009;15(September):24-26.
    • 47. Maynard R, Chilcot R, Clarke S, Castle N, Thompson J. What if...? CBRN training for Emergency Department Staff. London: dependable productions TV, 2011.
    • 48. Baker D, Karalliedde L, Murray V, Maynard R, Parkinson N, editors. Essentials of Toxicology for Health Protection. A handbook for field professionals. 2 ed. Oxford: Oxford University Press, 2012.
    • 49. MacFarlane C, van Loggerenberg C, Kloeck W. International EMS systems in South Africa--past, present, and future. Resuscitation 2005;64(2):145-48.
    • 50. Naidoo R. Personal communication: Paramedic training in South Africa. Head of Department, Durban University of Technology. , 2014.
    • 51. Castle N, Bowen J, Spencer N. Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs? Clin Toxicol 2010;48(6):522-27.
    • 52. Castle N. Care after chemical, biological, radiation or nuclear events. Emerg Nurse 2010;18(7):26-36.
    • 53. Castle N. A qualitative interview based study of clinician's opinions of what intubation aids should be used following a CBRN incident? Journal of Paramedic Practise 2012;4(4):226-34.
    • 54. Castle N, Pillay Y, Spencer N. What is the optimal position of an intubator wearing CBRN-PPE when intubating on the floor: a manikin study. Resuscitation 2011;82(5):588-92.
    • 55. Castle N, Pillay Y, Spencer N. Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: a manikin study. Anaesthesia 2011;66(1):983-88.
    • 56. Castle N, Pillay Y, Spencer N. Comparison of six different intubation aids for use while wearing CBRN-PPE: a manikin study. Resuscitation 2011;82(12):1548-52.
    • 57. Herriott N, Stuart AJ, Leonardi GS. Estimating the number of chemical incidents: Methodological approaches, needs and difficulties. Epidemiology 2004;15:S130- S31.
    • 58. Han KH, Walker R, Kuhri M. An integrated response to chemical incidents--the UK perspective. Resuscitation 1999;42(2):133-40.
    • 59. Saunders P, Ward G. Decontamination of chemically contaminated casualties: implications for health service and a regional strategy. Pre-Hosp Immed Care 2000;4(3):122-25.
    • 60. Burgess JL, Blackmon GM, Brodkin CA, Robertson WO. Hospital preparedness for hazardous materials incidents and treatment of contaminated patients. West J Med 1997;167(6):387-91.
    • 61. Wetter DC, Daniell WE, Treser CD. Hospital preparedness for victims of chemical or biological terrorism. Am J Public Health 2001;91(5):710-16.
    • 62. O'Sullivan TL, Dow D, Turner MC, Lemyre L, Corneil W, Krewski D, et al. Disaster and emergency management: Canadian nurses' perceptions of preparedness on hospital front lines. Prehosp Disaster Med 2008;23(3):s11-8.
    • 63. Totenhofer RI, Kierce M. It's a disaster: emergency departments' preparation for a chemical incident or disaster. Accid Emerg Nurs 1999;7(3):141-47.
    • 64. Duong D. Disaster education and training of emergency nurses in South Australia. Australasian Emergency Nursing Journal 2009;12:86-92.
    • 65. Mortelmans LJ, Van Boxstael S, De Cauwer HG, Sabbe MB, study ABSoEaDMB. Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents: are we there yet? Eur J Emerg Med 2013;Aug 23:Epub ahead of print.
    • 66. Domres BD, Rashid A, Grundgeiger J, Gromer S, Kees T, Hecker N, et al. European survey on decontamination in mass casualty incidents. Am J Disaster Med 2009;4(3):147-52.
    • 110. Peleg k, Kellermann AL. Enhancing Hospital Surge Capacity for Mass Casualty Events. JAMA 2009;302(5):565-67.
    • 111. Palmer I. The psychological dimension of Chemical, Biological, Radiological and Nuclear (CBRN) terrorism. J R Army Med Corps 2004;150(1):3-9.
    • 112. Kales SN, Christiani DC. Acute chemical emergencies. N Engl J Med 2004;350(8):800- 08.
    • 113. Young CF, Persell DJ. Biological, chemical, and nuclear terrorism readiness: major concerns and preparedness of future nurses. Disaster Manag Response 2004;2(4):109-14.
    • 114. Martin SD. Nurses' ability and willingness to work during pandemic flu. J Nurs Manag 2011;19(1):98-108.
    • 115. Martin SD, Brown LM, Reid WM. Predictors of nurses' intentions to work during the 2009 influenza A (H1N1) pandemic. Am J Nurs 2013;113(12):24-31.
    • 116. Snipes C, Miramonti C, Chisholm C, Chisholm R. Reporting for duty during mass casualty events: a survey of factors influencing emergency medicine physicians. J Grad Med Educ 2013;5(3):417-26.
    • 117. Considine J, Mitchell B. Chemical, biological and radiological incidents: preparedness and perceptions of emergency nurses. Disasters 2009;33(3):482-97.
    • 118. Goverment HM. HM Government: Preparing for emergencies: What you need to know. In: Goverment H, editor. Available at http://www.preparingforemergencies.gov.uk. Last accessed 04/02/2014.
    • 119. Kilner T. Triage decisions of prehospital emergnecy health care providers, using a multiple casualty scenario paper exercise Emerg Med J 2002;19:348-53.
    • 120. Iserson KV, Moskop JC. Triage in Medicine, Part I: Concept, History, and Types. Ann Emerg Med 2007;49(3):275-81.
    • 121. Hodgetts T, Mackway-Jones K. Major Incident Medical Management & Support: the Practical Approach. 3rd ed. London: BMJ Publishing 2012.
    • 122. Hallett H. The Rt. Hon Lady Justice. Coroner's inquest's into the London Bombings of 7 July 2005: Report under Rule 43 of The Coroner's Rules 1984, 6 May 2011:1-65.
    • 123. Hodgetts TJ. A revolutionary approach to improve combat casualty care [PhD]. City University, 2012.
    • 124. Hodgetts TJ, Hanlan CG, Newey CG. Battlefield First Aid: a simple, systematic approach for every soldier. J R Army Med Corps 1999;145(2):55-9.
    • 125. Krauss B. Capnography as a rapid assessment and triage tool for chemical terrorism. Pediatr Emerg Care. 2005 21(8):493-97.
    • 126. Tong JL, Taylor A, House J, Smith JE. Assessing Airway Patency and Breathing In NBC Category 4R - The RG Method. J R Army Med Corps 2006;152(3):139-42.
    • 127. Malpas M. Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident. Emerg Med J 2011;28(12):1061-62.
    • 128. Maplas M. Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident. Emerg Med J 2011;28(12):1061-62.
    • 129. Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, et al. European Resuscitation Council Guidelines for Resuscitation 2005 Section 7. Cardiac arrest in special circumstances. Resuscitation 2005;67(S1):S135-S70.
    • 130. Russell R, Hodgetts TJ, Mahoney PF, Castle N. Disaster rules. London: BMJ books, 2011.
    • 131. O'Keefe GM, Zane RD. Lightning injuries. Emerg Med Clin North Am 2004;22(2):369- 403.
    • 132. Kilner TM, Brace SJ, Cooke MW, Stallard N, Bleetman A, Perkins GD. In 'big bang' major incidents do triage tools accurately predict clinical priority?: a systematic review of the literature. Injury 2011;42(5):460-68.
    • 133. Anonymous. Medical support in chemical operations. J R Army Med Corps 2002;149:335-43.
    • 134. Nichol J, Rennell T. Medic. London: Penguin Books, 2009.
    • 135. Horne S, Vassallo J, Read J, Ball S. UK triage--an improved tool for an evolving threat. Injury 2013;44(1):23-28.
    • 136. Challen K, Walter D. Major incident triage: comparative validation using data from 7th July bombings. Injury 2013;44(5):629-33.
    • 137. Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med 2001;38(5):541-48.
    • 138. Kleber C, Cwojdzinski D, Strehl M, Poloczek S, Haas NP. Results of in-hospital triage in 17 mass casualty trainings: underestimation of life-threatening injuries and need for re-triage. Am J Disaster Med 2013;8(1):5-11.
    • 139. Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas TL, et al. Masscasualty triage: time for an evidence-based approach. Prehosp Disaster Med 2008;23(1):3-8.
    • 140. Rehn M, Andersen JE, Vigerust T, Krüger AJ, Lossius HM. A concept for major incident triage: full-scaled simulation feasibility study. BMC Emerg Med 2010;Aug(10):1-21.
    • 141. Kilner T, Hall FJ. Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise. Prehosp Disaster Med 2005;20(1):40-46.
    • 142. Battistella FD, Nugent W, Owings JT, Anderson JT. Field triage of the pulseless trauma patient. Arch Surg 1999;134(7):742-45.
    • 143. Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain Jr NE, Krohmer J. Guidelines for Withholding or Termination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest: Joint Position Statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg 2003;1(1):106-12.
    • 144. Boyd M, Vanek VW, Bourguet CC. Emergency room resuscitative thoracotomy: when is it indicated? J Trauma 1992;33(5):714-21.
    • 145. Lockey D, Crewdson K, Davies G. Trauma Cardiac Arrest: Who Are the Survivors? Annals of Emergency Medicine 2006;48(3):240-44.
    • 146. Lockey DJ, Mackenzie R, Redhead J, Wise D, Harris T, Weaver A, et al. London bombings July 2005: the immediate pre-hospital medical response. Resuscitation 2005;66(2):ix-xii.
    • 147. Baker D. Management of respiratory failure in toxic disasters. Resuscitation 1999;42(2):125-31.
    • 148. White SM. Chemical and biological weapons. Implications for anaesthesia and intensive care. Br J Anaesth 2002;89(2):306-24.
    • 149. Berkenstadt H, Marganitt B, Atsmon J. Combined chemical and conventional injuries-- pathophysiological, diagnostic and therapeutic aspects. Isr J Med Sci 1991;27(11- 12):623-26.
    • 150. Geller RJ, Singleton KL, Tarantino ML, Drenzek CL, Toomey KE. Nosocomial poisoning associated with emergency department treatment of organophosphate toxicity-- Georgia, 2000. J Toxicol Clin Toxicol 2001;39(1):109-11.
    • 151. Lam KK, Lau FL. An incident of hydrogen cyanide poisoning. Am J Emerg Med 2000;18(2):172-75.
    • 152. Saadeh AM, Farsakh NA, al-Ali MK. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart 1997;77(5):461-64.
    • 153. Singh S, Chaudhry D, Behera D, Gupta D, Jindal SK. Aggressive atropinisation and continuous pralidoxime (2-PAM) infusion in patients with severe organophosphate poisoning: experience of a northwest Indian hospital. Hum Exp Toxicol 2001;20(1):15-8.
    • 154. Sungur M, Güven M. Intensive care management of organophosphate insecticide poisoning. Crit Care 2001;5(4):211-15.
    • 155. Munidasa UA, Gawarammana IB, Kularatne SA, Kumarasiri PV, Goonasekera CD. Survival pattern in patients with acute organophosphate poisoning receiving intensive care. J Toxicol Clin Toxicol 2004;42(4):343-47.
    • 156. Stacey R, Morfey D, Payne S. Secondary contamination in organophosphate poisoning analysis of an incident. Q J Med 2004;97(2):75-80.
    • 157. Fortin JL, Giocanti JP, Ruttimann M, Kowalski JJ. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol (Phila) 2006;44(Suppl 1):37-44.
    • 158. Mumma BE, Shellenbarger D, Callaway CW, Katzb KD, Guyette FX, Rittenberger JC. Neurologic recovery following cardiac arrest due to carbon monoxide poisoning. Resuscitation 2009;80(7):835.
    • 159. Schrickel JW, Lewalter T, Lüderitz B, Nickenig G, Klehr HU, Rabe C. Recovery from ultra-high dose organophosphate poisoning after "in-the-field" antidote treatment: potential lessons for civil defense. J Emerg Med 2009;37(3):279-82.
    • 160. Bebarta VS, Pitotti RL, Borys DJ, Morgan DL. Seven years of cyanide ingestions in the USA: critically ill patients are common, but antidote use is not. Emerg Med J 2011;28(2):155-58.
    • 161. Bertolote JM, Fleischmann A, Eddleston M, Gunnell D. Deaths from pesticide poisoning: a global response. Br J Psychiatry 2006;189(Sept):201-03.
    • 162. Truscott A. Suicide fad threatens neighbours, rescuers. CMAJ 2008;179(4):312-3.
    • 163. Reedy SJ, Schwartz MD, Morgan BW. Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States. West J Emerg Med 2011;12(3):300-4.
    • 164. Berkowitz Z, Horton DK, Kaye WE. Hazardous substances releases causing fatalities and/or people transported to hospitals: Rural/Agricultural vs. other areas Prehosp Disaster Med 2004;19(3):213-20.
    • 165. Horton DK, Berkowitz Z. Secondary contamination of ED personnel from hazardous materials events, 1995-2001. Am J Emerg Med 2003;21(3):199-204.
    • 166. Goldik Z, Bornstein J, Eden A, Ben-Abraham R. Airway management by physicians wearing anti-chemical warfare gear: comparison between laryngeal mask airway and endotracheal intubation. Eur J Anaesthesiol 2002;19(3):166-69.
    • 167. Ben-Abraham R, Gur I, Vater Y, Weinbroum AA. Intraosseous emergency access by physicians wearing full protective gear. Acad Emerg Med 2003;10(12):1407-10.
    • 168. Flaishon R, Sotman A, Ben-Abraham R, Rudick V, Varssano D, Weinbroum AA. Antichemical protective gear prolongs time to successful airway management: a randomized, crossover study in humans. Anesthesiology 2004;100(2):260-66.
    • 169. Flaishon R, Sotman A, Friedman A, Ben-Abraham R, Rudick V, Weinbroum AA. Laryngeal mask airway insertion by anesthetists and nonanesthetists wearing unconventional protective gear: a prospective, randomized, crossover study in humans. Anesthesiology 2004;100(2):267-73.
    • 170. King JM, Frelin AJ. Impact of the chemical protective ensemble on the perfromance of basic medical tasks. Mil Med 1984;149(9):496-501.
    • 171. Thorne S. Data analysis in qualitative research. Evid Based Nurs 2000;3:68-70
    • 172. Trochim WM, Donnelly JP. Research methods knowledge base. Mason, USA: Atomic Dog, 2008.
    • 173. Freshwater D, Rolfe G. Critical reflexivity: A politically and ethically engaged research method for nursing. NT Research 2001;6(1):526-37.
    • 174. Rolfe G, Freshwater D, Jasper M. Critical Reflection for Nursing and the Helping Professions: a user's guide. Basingtoke, UK: Palgrave Macmillan, 2001.
    • 175. Schön DA. The Reflective Practitioner: How Professionals Think in Action. San Francisco: Basic Books, 1983.
    • 176. Reason P, Bradbury H. Handbook of action research: Participants inquiry and practise. London: Sage, 2008.
    • 177. Akobeng AK. Principles of evidence based medicine. Arch Dis Child 2005;90(8):837- 40.
    • 178. Arad M, Berkenstadt H, Zelingher J, Laor A, Shemer J, Atsmon J. The effects of continuous operation in a chemical protective ensemble on the performance of medical tasks in trauma management. J Trauma 1993;35(5):800-04.
    • 179. Berkenstadt H, Arad M, Nahtomi O, Atsmon J. The effect of a chemical protective ensemble on intravenous line insertion by emergency medical technicians. Mil Med 1999;164(10):737-39.
    • 180. Brinker A, Gray SA, Schumacher J. Influence of air-purifying respirators on the simulated first response emergency treatment of CBRN victims. Resuscitation 2007;74(2):310-16.
    • 181. Brinker A, Stratling WM, Schumacher J. Evaluation of bag-valve-mask ventilation in simulated toxic enviroments. Anaesthesia 2008;63(11):1234-37.
    • 182. Schumacher J, Runte J, Brinker A, Prior K, Heringlake M, Eichler W. Respiratory protection during high-fidelity simulated resuscitation of casualties contaminated with chemical warfare agents. Anaesthesia 2008;63(6):593-98.
    • 183. Schumacher J, Gray SA, Weidelt L, Brinker A, Prior K, Stratling WM. Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances. Emerg Med J 2009;26(7):501- 05.
    • 184. Schumacher J, Weidelt L, Gray SA, Brinker A. Evaluation of bag-valve-mask ventilation by paramedics in simulated chemical, biological, radiological, or nuclear environments. Prehosp Disaster Med 2009;24(5):398-401.
    • 185. Ben-Abraham R, Flaishon R, Sotman A, Ezri T, Weissenberg M, Weinbroum AA. Cuffed oropharyngeal airway (COPA) placement is delayed by wearing antichemical protective gear. Emerg Med J 2008;25(12):847-50.
    • 186. Suyama J, Knutsen CC, Northington WE, Hahn M, Hostler D. IO versus IV access while wearing personal protective equipment in a HAZMAT scenario. Prehosp Emerg Care 2007;11(4):467-72.
    • 187. Bensel CK. The effects of various thicknesses of chemical protective gloves on manual dexterity. Ergonomics 1993;36(6):687-96.
    • 188. Sawyer J, Bennett A. Comparing the level of dexterity offered by latex and nitrile SafeSkin gloves. Ann Occup Hyg 2006;50(3):289-96.
    • 189. Berkenstadt H, Ziv A, Barsuk D, Levine I, Cohen A, Vardi A. The use of advanced simulation in the training of anesthesiologists to treat chemical warfare casualties. Anesth Analg 2003;96(6):1739-42.
    • 190. Gurney I. Personal communication: treatment of CBRN casualties. Lt Col Gurney RAMC. , 2014.
    • 191. Coates MJ, Jundi AS, James MR. Chemical protective clothing; a study into the ability of staff to perform lifesaving procedures. J Accid Emerg Med 2000;17(2):115-18.
    • 192. Garner A, Laurence H, Lee A. Practicality of performing medical procedures in chemical protective ensembles. Emerg Med Australas 2004;16(2):108-13.
    • 193. Grugle NL, Kleiner BM. Effects of chemical protective equipment on team process performance in small unit rescue operations. Appl Ergon 2007;38(5):591-600.
    • 194. Mohr S, Weigand MA, Hofer S, Martin E, Gries A, Walther A, et al. Developing the skill of laryngeal mask insertion: prospective single center study. Anaesthesist 2013;62(6):447-52.
    • 195. Konrad C, Schüpfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: Is there a recommended number of cases for anesthetic procedures? Anesth Analg 1998;86(3):635-9.
    • 196. de Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg 2002;95(2):411-6.
    • 197. Komatsu R, Kasuya Y, Yogo H, Sessler DI, Mascha E, Yang D, et al. Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method. Anesthesiology 2010;112(6):1525-31.
    • 198. Wahlen BM, Roewer N, Lange M, Kranke P. Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of preexisting skills: a manikin study. Anaesthesia 2009;64(5):549-54.
    • 199. Wang HE, Seitz SR, Hostler D, Yealy DM. Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care 2005;9(2):156-62.
    • 200. Bernhard M, Mohr S, Weigand MA, Martin E, Walther A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand 2012;56(2):164-71.
    • 201. Doglioni N, Cavallin F, Zanardo V, Trevisanuto D. Intubation training in neonatal patients: a review of one trainee's first 150 procedures. J Matern Fetal Neonatal Med 2012;25(8):1302-4.
    • 202. Toda J, Toda AA, Arakawa J. Learning curve for paramedic endotracheal intubation and complications. Int J Emerg Med 2013;6(1):38.
    • 203. Rujirojindakul P, McNeil E, Rueangchira-Urai R, Siripunt N. Learning curves of macintosh laryngoscope in nurse anesthetist trainees using cumulative sum method. Anesthesiol Res Pract. 2014;850731.
    • 204. MacDonald RD, LeBlanc V, McArthur B, Dubrowski A. Performance of resuscitation skills by paramedic personnel in chemical protective suits. Prehosp Emerg Care 2006;10(2):254-159.
    • 205. Rebmann T, Clements BW, Bailey JA, Evans RG. Organophosphate antidote autoinjectors vs. traditional administration: a time motion study. J Emerg Med 2009;37(2):139-43.
    • 206. Vardi A, Berkenstadt H, Levin I, Bentencur A, Ziv A. Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol. Anesth Analg 2004;98(6):1753-58.
    • 207. Lamhaut L, Dagron C, Apriotesei R, Gouvernaire J, Elie C, Marx JS, et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation 2010;81(1):65-68.
    • 208. Hung OR, Dyck JB, Varvel J, Shafer SL, Stanski DR. Comparative absorption kinetics of intramuscular midazolam and diazepam. Can J Anaesth 1996;43(5 (part 1)):450-5.
    • 209. Chamberlain JM, Altieri MA, Futterman C, Young GM, Ochsenschlager D, Waisman Y. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care. 1997;13(2):92-4.
    • 210. Leidel BA, Kirchhoff C, Bogner V, Stegmaier J, Mutschler W, Kanz KG, et al. Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 2009;3(1):24- 31.
    • 211. Von Hoff DD, Kuhn JG, Burris HAr, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med 2008;26(1):31-8.
    • 212. Eisenkraft A, Gilat E, Chapman S, Baranes S, Egoz I, Levy A. Efficacy of the bone injection gun in the treatment of organophosphate poisoning. Biopharm Drug Dispos 2007;28(3):145-50.
    • 213. Murray DB, Eddleston M, Thomas S, Jefferson RD, Thompson A, Dunn M, et al. Rapid and complete bioavailability of antidotes for organophosphorus nerve agent and cyanide poisoning in minipigs after intraosseous administration. Ann Emerg Med 2012;60(4):424-30.
    • 214. Towne AR, DeLorenzo RJ. Use of intramuscular midazolam for status epilepticus. J Emerg Med 1999;17(2):323-8.
    • 215. Grob D. The manifestations and treatment of poisoning due to nerve gas and other organic phosphate anticholinesterase compounds. AMA Arch Intern Med 1956;98(2):221-39.
    • 216. Ketchum JS, Sidell FR, Crowell EB, Aghajanian GK, Hayes AH. Atropine, scopolamine, and ditran: comparative pharmacology and antagonists in man. Psychopharmacologia 1973;28(2):121-45.
    • 217. Sidell FR, Markis JE, Groff W, Kaminskis A. Enhancement of drug absorption after administration by an automatic injector. J Pharmacokinet Biopharm 1974;2(3):197- 210.
    • 218. Friedl KE, Hannan CJ, Schadler PW, Jacob WH. Atropine absorption after intramuscular administration with 2-pralidoxime chloride by two automatic injector devices. J Pharm Sci 1989;78(9):728-31.
    • 219. Nyberg AG, Cassel G, Jeneskog T, Karlsson L, Larsson R, Lundström M, et al. Pharmacokinetics of HI-6 and atropine in anaesthetized pigs after administration by a new autoinjector. Biopharm Drug Dispos 1995;16(8):635-51.
    • 220. Anonymous. Nerve agents. J R Army Med Corps 2002;148:344-57.
    • 221. Ben Abraham R, Weinbroum AA. Resuscitative challenges in nerve agent poisoning. Eur J Emerg Med 2003;10(3):169-75.
    • 222. Barelli A, Biondi I, Soave M, Tafani C, Bononi F. The comprehensive medical preparedness in chemical emergencies: 'the chain of chemical survival'. Eur J Emerg Med 2008;15(2):110-8.
    • 223. Martyn J. Clinical pharmacology and drug therapy in the burned patient. Anesthesiology 1986;65(1):67-75.
    • 224. Clark A, Cabell LA, McDonough JA. Non-newtonian suspension formulations for improved stability and delivery of autoinjectable CBRN coutermeasures. Mil. Med. Sci. Lett 2014;83:18-27.
    • 225. Santos D, Carron PN, Yersin B, Pasquier M. EZ-IO(®) intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature. Resuscitation 2013;84(4):440-5.
    • 226. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 4.Adult advanced life support. Resuscitation 2010;81(10):1305-52.
    • 227. Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46(5):456-61.
    • 228. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma 2009;67(3):606-11.
    • 229. Levitan RM, Bortle CD, Snyder TA, Nitsch DA, Pisaturo JT, Butler KH. Use of a batteryoperated needle driver for intraosseous access by novice users: skill acquisition with cadavers. Ann Emerg Med 2009;54(5):692-4.
    • 230. Tobias JD, Ross AK. Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use. Anesth Analg 2010;110(2):391-401.
    • 231. Shavit I, Hoffmann Y, Galbraith R, Waisman Y. Comparison of two mechanical intraosseous infusion devices: a pilot, randomized crossover trial. Resuscitation 2009;80(9):1029-33.
    • 232. Leidel BA, Kirchhoff C, Braunstein V, Bogner V, Biberthaler P, Kanz KG. Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study. Resuscitation 2010;81(8):994-99.
    • 233. Sunde GA, Heradstveit BE, Vikenes BH, Heltne JK. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scand J Trauma Resusc Emerg Med 2010;Oct(18):52-56.
    • 234. Frascone RJ, Jensen JP, Kaye K, Salzman JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care 2007;11(2):164-71.
    • 235. Brenner T, Bernhard M, Helm M, Doll S, Völkl A, Ganion N, et al. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation 2008;78(3):314-9.
    • 236. Muskat PC. Mass casualty chemical exposure and implications for respiratory failure. Respir Care 2008;53(1):58-63; discussion 63-6.
    • 237. Davis DP, Fisher R, Buono C, Brainard C, Smith S, Ochs G, et al. Predictors of intubation success and therapeutic value of paramedic airway management in a large, urban EMS system. Prehosp Emerg Care 2006;10(3):356-62.
    • 238. Benumof JL, Dagg R, Benumof R. Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine. Anesthesiology 1997;87(4):979-82.
    • 239. Davis DP, Hwang JQ, Dunford JV. Rate of decline in oxygen saturation at various pulse oximetry values with prehospital rapid sequence intubation. Prehosp Emerg Care 2008;12(1):46-51.
    • 240. Benger J, Nolan J, Clancy M, editors. Emergency Airway Management. Cambridge: Cambridge University Press, 2008.
    • 241. Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe RG, et al. Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation. Anaesthesia 2012;67(4):371-76.
    • 242. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004;59(7):675- 94.
    • 243. Lockey D, Carter J, Nolan J, Porter K, Deakin C, Zideman DA, et al. AAGBI safety Guideline Pre-hospital Anaesthesia. The Association of Anaesthetists of Great Britain and Ireland. http://www.aagbi.org/sites/default/files/prehospital_glossy09.pdf. Last accessed April 2013, 2009.
    • 244. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway: Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118(2):251-70.
    • 245. Le DH, Reed DB, Weinstein G, Gregory M, Brown LH. Paramedic use of endotracheal tube introducers for the difficult airway. Prehosp Emerg Care 2001;5(2):155-58.
    • 246. Baker PA, Flanagan BT, Greenland KB, Morris R, Owen H, Riley RH, et al. Equipment to manage a difficult airway during anaesthesia. Anaesth Intensive Care 2011;39(1):16-34.
    • 247. Deakin CD, Peters R, Tomlinson P, Cassidy M. Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emerg Med J 2005;22(1):64-67.
    • 248. Udayasiri R, Knott J, Taylor D McD, Papson J, Leow F, Hassan FA. Emergency department staff can effectively resuscitate in level C personal protective equipment. Emerg Med Australas 2007;19(2):113-21.
    • 249. Weinbroum AA, Rudick V, Paret G, Kluger Y, Ben-Abraham R. Anaesthesia and critical care considerations in nerve agent warfare trauma casualties. Resuscitation 2000;47(2):113-23.
    • 250. Luria S, Vidan A, Nahtomi O, Khanin A, Alcalay M. Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods. Mil Med 2001;166(1):82-84.
    • 251. Lee A, Fan L, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (metaanalysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg 2006;102(6):1867-78.
    • 252. Rissanen S, Jousela I, Jeong JR, Rintamäki H. Heat stress and bulkiness of chemical protective clothing impair performance of medical personnel in basic lifesaving tasks. Ergonomics. 2008 Jul;51(7):1011-22 2008;51(7):1011-22.
    • 253. Murray MJ, Vermeulen MJ, Morrison LJ, Waite T. Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training. CJEM 2002;4(5):338-43.
    • 254. Hein C, Owen H, Plummer J. A 12-month audit of laryngeal mask airway (LMA) use in a South Australian ambulance service. Resuscitation 2008;79(2):219-24.
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