Paris Fire Brigade

About: Paris Fire Brigade is a other organization based out in Paris, France. It is known for research contribution in the topics: Cardiopulmonary resuscitation & Basic life support. The organization has 100 authors who have published 99 publications receiving 907 citations.

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study.

Abstract: Summary Background Although mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods. Methods We did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area. Findings Comparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12–17, 2012–19), the maximum weekly OHCA incidence increased from 13·42 (95% CI 12·77–14·07) to 26·64 (25·72–27·53) per million inhabitants (p Interpretation A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies. Funding The French National Institute of Health and Medical Research (INSERM)

Prehospital Administration of Hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning: 8 Years of Experience in the Paris Fire Brigade

Abstract: Introduction. This article reports the results of a retrospective study of 8 years of experience of the Paris Fire Brigade with the prehospital use of hydroxocobalamin. Methods. The head physician ...

Association of Prehospital Time to In-Hospital Trauma Mortality in a Physician-Staffed Emergency Medicine System.

Abstract: Importance The association between total prehospital time and mortality in physician-staffed trauma systems remains uncertain. Objective To describe the association of total prehospital time and in-hospital mortality in prehospital, physician-staffed trauma systems in France, with the hypothesis that total prehospital time is associated with increased mortality. Design, Setting, and Participants This cohort study was conducted from January 2009 to December 2016. Data for this study were derived from 2 distinct regional trauma registries in France (1 urban and 1 rural) that both have a physician-staffed emergency medical service. Consecutive adult trauma patients admitted to either of the regional trauma referral centers during the study period were included. Data analysis took place from March 2018 to September 2018. Main Outcomes and Measures The association between death and prehospital time was assessed with a multivariable model adjusted with confounders. Total prehospital time was the primary exposure variable, recorded as the time from the arrival of the physician-led prehospital care team on scene to the arrival at the hospital. The main outcome of interest was all-cause in-hospital mortality. Results A total of 10 216 patients were included (mean [SD] age, 41 [18] years; 7937 men [78.3%]) affected by predominantly nonpenetrating injuries (9265 [91.5%]), with a mean (SD) Injury Severity Score of 17 (14) points. Of the patients, 6737 (66.5%) had at least 1 body region with an Abbreviated Injury Scale score of 3 or more. A total of 1259 patients (12.4%) presented in shock (with systolic pressure Conclusions and Relevance In this study, an increase in total prehospital time was associated with increasing in-hospital all-cause mortality in trauma patients at a physician-staffed emergency medical system, after adjustment for case complexity. Prehospital time is a management objective in analogy to physiological targets. These findings plead for a further streamlining of prehospital trauma care and the need to define the optimal intervention-to-time ratio.

Prehospital pulse oximetry: a red flag for early detection of silent hypoxemia in COVID-19 patients.

Abstract: The COVID-19 pandemic, which has been expanding since the first cases in Asia in late 2019, may result in acute respiratory failure (ARF) with severe hypoxemia [1–3]. In prehospital settings, the paucity of clinical respiratory signs has made assessing the severity of some COVID-19 patients challenging. Indeed, even though hypoxic ARF generally leads to an increase in respiratory rate (RR) [4], in some COVID-19 patients, a persistent normal RR was inconsistent with the severity of hypoxia. Based on retrospective data, we aimed to describe the discrepancy between prehospital initial RR (RRi) and initial SpO2 (Spo2i; i.e., before oxygen supplementation, FiO2 = 21%) in COVID-19 patients suffering from ARF. We retrospectively examined consecutive COVID-19 patients suffering from ARF who were treated by the Paris Fire Brigade’s basic life-support (BLS) teams in the prehospital setting. Data were provided from primary home care providers. Based on a previous study [5], we used the SpO2i/RRi ratio as an estimator of the discrepancy insofar as a low numerator is associated with hypoxia, whereas a high denominator is typically associated with respiratory failure. After having measured the SpO2i/RRi values in COVID-19 patients, we compared them to those of nonCOVID-19 patients (i.e., patients with other causes of ARF treated by the BLS teams over the previous 3 years in the same period). Continuous data were described as median (interquartile range) and were compared by applying the KruskalWallis test. The French Society of Anaesthesia and Intensive Care approved the trial protocol on April 7, 2020 (IRB 00010254-2020-055). The study examined 1201 patients who experienced COVID-19 between March 13 and 29, 2020. The median SpO2i/RRi value was significantly higher than that of patients treated in the previous 3 years (5 [4, 5] in 2020 versus 3.4 [2.4–4.5] in 2019, 3.3[2.2–4.4] in 2018, and 3.5[2.5–4.6] in 2017, p < 0.001, Fig. 1). In summary, this retrospective study based on prehospital first responder data highlighted a relatively higher discrepancy between SpO2i and RRi in COVID-19 ARF patients, in comparison with previous non-COVID-19 ARF patients. Without a systematic SpO2i measurement, a normal breathing rate could mask profound hypoxia and make severity assessment in COVID-19 patients all the more difficult in an out-of-hospital setting. Despite differences in worldwide prehospital emergency medical services, pulse oximetry is an accessible tool that prehospital healthcare providers can easily use. In conclusion, prehospital pulse oximetry might be used as a red flag for early detection of “silent hypoxemia” in COVID-19 patients. The prehospital SpO2i/RRi ratio needs further investigation because it might help to identify non-clinically obvious ARFs.

Report of 182 cases of exertional heatstroke in the French armed forces

Abstract: Objectives: Exertional heatstroke (EHS) remains a major problem for the military. The aim of our study was to describe medical history and clinical and biological features of EHS in a large military cohort. Methods: We conducted a retrospective study among military subjects admitted to the Military Teaching Hospital Laveran for EHS from 2004 to 2006. Results: Of the 182 subjects, EHS occurred most often at the end (80%) of a timed race of 8 km in battle clothes (84%) between the months of May and October (87%). The subjects were physically fit. Motivation was the primary intrinsic factor reported. A previous episode of EHS was reported by 15.4% of the subjects. Comas or seizures occurred more frequently in subjects whose temperatures exceeded 41°C (p = 0.03). Alanine aminotransferase was consistently increased in subjects who experienced EHS. We observed acute renal failure in 31.3% of the subjects, liver insufficiency in 12%, and disseminated intravascular coagulation in 1%. High creatine kinase...