Publications by authors named "Valérie Homier"

11 Publications

  • Page 1 of 1

Assessment of Canadian Public Automated External Defibrillator Registries.

CJC Open 2021 Apr 26;3(4):504-509. Epub 2020 Dec 26.

Department of Emergency Medicine, McGill University, Montréal, Québec, Canada.

Background: Public automated external defibrillator (AED) registries aim to increase layperson defibrillation for victims of out-of-hospital cardiac arrest. This study aims to characterize Canadian AED registries and the process by which these databases are updated and used.

Methods: A survey was administered to representatives from each eligible AED registry. Collected data included information on registry management, AED validation process, linkage to emergency medical dispatch (EMD), and number of AEDs per registry. Three unregistered AEDs in each region were then located and registered into their respective registry. The primary endpoint was the proportion of AEDs that became visible in the registry within 1 month.

Results: Of the 9 Canadian provinces that have registries, 7 are provincial, whereas 2 contain smaller independent registries. The survey was completed by 90% of contacted registries. The number of AEDs per registry ranged from 21 to 443 per 100,000 persons. Six registries are managed by a provincial government, 6 use a standardized validation process, and 8 are linked to EMD. Of the 21 AEDs registered by our study personnel in 7/10 registries, 9 (43%) were made available to the public within 1 month of registration. Only 1 registry employed an AED validation process that included direct contact with AED managers.

Conclusions: Canadian public AED registries demonstrate significant differences in their governance and administrative processes. A majority of registries are integrated with EMD for out-of-hospital cardiac arrest, but not all registries use a standardized validation process to ensure accuracy of AED information submitted by the public.
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http://dx.doi.org/10.1016/j.cjco.2020.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129479PMC
April 2021

The EDIT Survey: Identifying Emergency Department Information Technology Knowledge and Training Gaps.

Disaster Med Public Health Prep 2021 Mar 15:1-6. Epub 2021 Mar 15.

Department of Emergency Medicine, McGill University, Montreal, PQ, Canada.

Objective: To review Emergency Department internet connectivity, cyber risk factors, perception of risks and preparedness, security policies, training and mitigation strategies.

Methods: A validated targeted survey was sent to Canadian ED physicians and nurses between March 5, 2019 and April 28, 2019.

Results: There were 349 responses, with physicians making up 84% of the respondents (59% urban teaching, 35% community teaching, 6% community non-teaching hospitals). All had multiple passwords, 93% had more than 1 user account, over 90% had to log repeatedly each workday, 52% had to change their passwords every 3 months, 75% had multiple methods of authentication and 53% reported using a terminal where someone else was already logged in. Passwords were used to review laboratory and radiology data, access medical records and manage patient flow. Majority of the respondents (51%) did not know if they worked with internet linked devices. Only 7% identified an 'air gapped' computer in their facility and 76% used personal devices for patient care, with less than a third of those allowing the IT department to review their device. A total of 26 respondents received no cyber security training.

Conclusion: This paper revealed significant computer-human interface dysfunctionality and readiness gaps in the event of an IT failure. These stemmed from poor system design, poor planning and lack of training. The paper identified areas with technical or training solutions and suggested mitigation strategies.
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http://dx.doi.org/10.1017/dmp.2020.474DOI Listing
March 2021

Tourniquet application by schoolchildren-a randomized crossover study of three commercially available models.

J Trauma Acute Care Surg 2021 04;90(4):666-672

From the Faculty of Medicine (A.E.B., F.M., L.L.-H.), Université de Montreal; Pediatric Emergency Medicine (E.K.), Montreal Children's Hospital, Montreal, Quebec; Faculty of Medicine (J.M.F.), University of Alberta, Edmonton, Alberta; and Adult Emergency Medicine (V.H.), McGill University Health Centre, Montreal, Quebec, Canada.

Background: Life-threatening hemorrhage is a major cause of preventable mortality in trauma. Studies have demonstrated the effectiveness and safety of commercial tourniquets when used by adult civilians. However, there are no data about tourniquet application by children.This study's goal is to determine which of three commercially available tourniquets is most effective when used by children.

Methods: A randomized crossover study was conducted in four elementary schools in Montreal to compare three commercially available tourniquets. The study population is primary school children aged 10 to 12 years (5th-6th grade). A total of 181 students were invited to participate; 96 obtained parental approval and were recruited. Participants underwent a short 7-minute video training on the use of three commercial tourniquets and were subsequently given a 2-minute practice period. Students were evaluated on their ability to successfully apply the tourniquet and the time to complete application. After applying all three tourniquets, the students selected their favorite model. The primary outcome is the proportion of successful applications per tourniquet model. Secondary outcomes include time to successful application for each tourniquet model and tourniquet model preference.

Results: The mechanical advantage tourniquet (MAT) outperformed the combat application tourniquet (CAT) and the stretch wrap and tuck tourniquet (SWATT) in terms of success rate (MAT, 67%; CAT, 44%; SWATT, 24%; p < 0.0001), time to application (MAT, 57 seconds; CAT, 80 seconds; SWATT, 90 seconds; p < 0.0001), and preference (MAT, 64%; CAT, 30%; SWATT, 6%; p < 0.0001).

Conclusion: In this study, the MAT performs better in terms of success rate, time to application, and preference when used by school-aged children. This study can be helpful when facilities are purchasing tourniquets for use by students.
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http://dx.doi.org/10.1097/TA.0000000000003055DOI Listing
April 2021

Drone versus ground delivery of simulated blood products to an urban trauma center: The Montreal Medi-Drone pilot study.

J Trauma Acute Care Surg 2021 03;90(3):515-521

From the Department of Emergency Medicine, McGill University (V.H., F.d.C.), Montreal, Canada; Division of Emergency Medicine, Montreal Children's Hospital of the McGill University Health Centre (E.K.), Montreal, Canada; Transfusion Medicine Service, (P.P.) McGill University Health Centre, Montreal, Canada Vice-présidence aux affaires médicales et à l'innovation, Héma-Québec (D.B.), Quebec, Canada; County of Renfrew Paramedic Service (M.N.), Pembroke, Canada; Department of Family Medicine and Emergency Medicine (M.-A.R.), Université de Montréal, Montreal, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (M.-A.R.), Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada; Department of Medicine (P.P.), McGill University, Montreal, Canada; Faculty of Medicine (M.M., F.G.-B.), McGill University, Montreal, Canada; Department of Pediatrics (E.K.), McGill University, Montreal, Canada; Department of Family and Emergency Medicine (R.F), Laval University, Quebec, Canada; Research Chair in Innovation and Emergency Medicine (R.F.) Laval University - Dessercom - CISSS Chaudière-Appalaches, Levis, Canada; VITAM Research Centre (R.F.), Quebec, Canada.

Background: Timely and safe distribution of quality blood products is a major challenge faced by blood banks around the world. Our primary objective was to determine if simulated blood product delivery to an urban trauma center would be more rapidly achieved by unmanned aerial vehicle (UAV) than by ground transportation. A secondary objective was to determine the feasibility of maintaining simulated blood product temperatures within a targeted range.

Methods: In this prospective pilot study, we used two distinct methods to compare UAV flight duration and ground transport times. Simulated blood products included packed red blood cells, platelet concentrate, and fresh frozen plasma. For each blood product type, three UAV flights were conducted. Temperature was monitored during transport using a probe coupled to a data logger inside each simulated blood product unit.

Results: All flights were conducted successfully without any adverse events or safety concerns reported. The heaviest payload transported was 6.4 kg, and the drone speed throughout all nine flights was 10 m/s. The mean UAV transportation time was significantly faster than ground delivery (17:06 ± 00:04 minutes vs. 28:54 ± 01:12 minutes, p < 0.0001). The mean ± SD initial temperature for packed red blood cells was 4.4°C ± 0.1°C with a maximum 5% mean temperature variability from departure to landing. For platelet concentrates, the mean ± SD initial temperature was 21.6°C ± 0.5°C, and the maximum variability observed was 0.3%. The mean ± SD initial fresh frozen plasma temperature was -19°C ± 2°C, and the greatest temperature variability was from -17°C ± 2°C to -16°C ± 2°C.

Conclusions: Unmanned aerial vehicle transportation of simulated blood products was significantly faster than ground delivery. Simulated blood product temperatures remained within their respective acceptable ranges throughout transport. Further studies assessing UAV transport of real blood products in populated areas are warranted.

Level Of Evidence: Therapeutic/care management, level IV.
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http://dx.doi.org/10.1097/TA.0000000000002961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899218PMC
March 2021

Identification of Swimmers in Distress Using Unmanned Aerial Vehicles: Experience at the Mont-Tremblant IRONMAN Triathlon.

Prehosp Emerg Care 2020 May-Jun;24(3):451-458. Epub 2019 Sep 10.

This preliminary report describes our experience using unmanned aerial vehicles (UAVs) to identify swimmers in distress at the 2018 Mont-Tremblant IRONMAN triathlon (Quebec, Canada). In a prospective pilot study, we sought to determine whether UAV surveillance could identify swimmers showing signs of distress quicker than conventional methods (i.e., lifeguards on the ground and on watercraft). In addition, we investigated the feasibility of using UAVs for medical surveillance at a triathlon event in terms of operations, costs, safety, legal parameters, and added value. Prior to the race, we screened participants for medical conditions that could elevate their risk of injury during the swim portion of the triathlon. Athletes deemed to be at increased risk were given a yellow swimming cap to enhance their surveillance by trained observers watching a live video feed from the UAVs. On race day, a total of 3 UAVs (2 mobile, 1 tethered) were launched over Lake Tremblant and provided 3 observers with live video of the swimmers. Of the 2,473 race participants, there were 25 athletes with pre-identified medical conditions who wore a yellow cap during the swim. We did not detect any signs of distress among swimmers wearing yellow caps. Among the remaining 2,448 athletes, there were 5 swimmers who demonstrated signs of distress and required mobilization of water rescue boats; UAV surveillance identified 1 of these 5 distress events before it was seen by lifeguards on rescue boats. None of the athletes in the IRONMAN suffered an adverse event while swimming. Several technical and safety issues related to UAV surveillance arose including poor visibility, equipment loss, and flight autonomy. While our preliminary findings suggest that using UAVs to identify distressed swimmers during an IRONMAN race is feasible and safe, more research is necessary to determine how to optimize UAV surveillance at mass sporting events and integrate this technology within the existing emergency response teams.
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http://dx.doi.org/10.1080/10903127.2019.1657211DOI Listing
January 2021

A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response.

Prehosp Disaster Med 2018 Oct;33(5):471-477

4University of Alberta,Edmonton,Alberta,Canada.

IntroductionA crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a "calling tree" protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored.

Methods: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time.

Results: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006).

Conclusion: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods. HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM. A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response. Prehosp Disaster Med. 2018;33(5):471-477.
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http://dx.doi.org/10.1017/S1049023X18000912DOI Listing
October 2018

Automated External Defibrillator Geolocalization with a Mobile Application, Verbal Assistance or No Assistance: A Pilot Randomized Simulation (AED G-MAP).

Prehosp Emerg Care 2019 May-Jun;23(3):420-429. Epub 2018 Sep 10.

Objective: Shockable rythms are common among victims of witnessed public out-of-hospital cardiac arrest (OHCA), but bystander defibrillation with a public automated external defibrillator (PAED) is rare. Instructions from the emergency medical dispatcher and mobile applications were developed to expedite the localization of PAEDs, but their effectiveness has not been compared.

Methods: Participants were enrolled in a three-armed randomized simulation where they witnessed a simulated OHCA on a university campus, were instructed to locate a PAED and provide defibrillation. Participants were stratified and randomized to: (1) no assistance in finding the PAED, (2) assistance from a geolocalization mobile application (AED-Quebec), or (3) verbal assistance. Data collectors tracked each participant's time elapsed and distance traveled to shock.

Results: Of the 52 volunteers participating in the study (46% male, mean age 37), 17 were randomized to the no assistance group, 18 to the mobile application group and 17 to the verbal group. Median (IQR) time to shock was, respectively, 10:00 min (7:49-10:00), 9:44 (6:30-10:00), and 5:23 (4:11-9:08), with statistically significant differences between the verbal group and the other groups (p ≤ 0.01). The success rate for defibrillation in <10 minutes was 35%, 56% and 76%. Multivariate regression of all participants pooled showed that knowledge of campus geography was the strongest predictor of shock in <10 minutes (aOR =14.3, 95% CI 1.85-99.9). Among participants without prior geographical knowledge, verbal assistance provided a trend towards decreased time to shock, but the differences over no assistance (7:28 vs. 10:00, p = 0.10) and over the mobile app (7:28 vs. 10:00, p = 0.11) were not statistically significant.

Conclusion: In a simulated environment, verbally providing OHCA bystanders with the nearest PAED's location appeared to be effective in reducing the time to defibrillation in comparison to no assistance and to an AED geolocalizing mobile app, but further research is required to confirm this hypothesis, ascertain the external validity of these results, and evaluate the real-life implications of these strategies.
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http://dx.doi.org/10.1080/10903127.2018.1511017DOI Listing
August 2019

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage.

Prehosp Disaster Med 2018 Jun 17;33(3):273-278. Epub 2018 Apr 17.

McGill University Health Center,Emergency Medicine,Montreal, Quebec,Canada.

IntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility's human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.

Methods: This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.

Results: There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as "less personal" than the manual triage method, but they also perceived the former as "better organized."

Conclusion: Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs. BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273-278.
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http://dx.doi.org/10.1017/S1049023X1800033XDOI Listing
June 2018

A hospital mass casualty exercise using city buses and a tent as a hybrid system for patient decontamination.

Am J Disaster Med 2017 ;12(3):189-196

Assistant Professor, Department of Medicine, McGill University, Quebec, Canada; Emergency Physician, McGill University Health Center, Quebec, Canada.

Objective: A hospital mass casualty simulation exercise testing feasibility of two city buses and a tent as a hybrid system for patient decontamination.

Design: Observational study of a single mass casualty simulation exercise involving patient decontamination SETTING: Held on May 26, 2016 at the Montreal General Hospital, a Level 1 Trauma center without a garage.

Patients, Participants: Twenty-one medical staff including nurses, doctors, and patient attendants, and 30 volunteer-simulated patients.

Interventions: The foregrounds of the hospital were cordoned off to create a single-entry point for the simulated patients that were identified as contaminated (C) by staff wearing personal protective equipment. Non-contaminated patients were directed to a separate hospital entrance. C patients were triaged in Bus 1 to determine priority for decontamination. Bus 2 served as a holding area for stable patients awaiting decontamination. Patients were decontaminated in appropriate tent sections (non-ambulatory, ambulatory male or female) and then directed to the emergency department.

Results: Direct observation and participant feedback suggested that buses may provide adequate shelter for C patients. However, buses had limited capacity for non-ambulatory patients, who were not easily transported inside. Furthermore, areas of improvement were identified in communication, staffing, equipment, and coordination of operations.

Conclusions: The use of city buses as triage and waiting zones prior to decontamination appears feasible for centers without a garage and facing unpredictable weather conditions. Further simulations are required for fine-tuning and testing real-time unfolding of tasks, ideally during an unannounced exercise.
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http://dx.doi.org/10.5055/ajdm.2017.0273DOI Listing
April 2018

Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department.

CJEM 2007 Sep;9(5):347-51

Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.

Objective: Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context.

Methods: We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit.

Results: Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%-1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%).

Conclusion: Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.
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http://dx.doi.org/10.1017/s1481803500015293DOI Listing
September 2007
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