Ep 29. NAEMT Radio - Prehospital Antibiotics for Open Fractures

Guests for this edition of the NAEMT Radio are NAEMT Medical Director, Dr Doug Kupas, who is medical director for Geisinger EMS and co-director of Mobile Integrated Healthcare for Geisinger Health System and Dr. Joey Johnson is an associate professor of orthopedic surgery and director of clinical research at the University of Alabama at Birmingham. 

Drs Kupas and Johnson join host Rob Lawrence to discuss Prehospital Antibiotic Administration for Suspected Open Fractures and identify that open fractures cause significant morbidity for orthopedic patients and early antibiotic administration has been shown to decrease infectious sequelae of these fractures. They discuss that prehospital administration of antibiotics has been shown to decrease time to antibiotics while maintaining a strong safety profile and identify that the COT and OTA jointly backed a position statement on the use of prehospital antibiotics in suspected open fractures and conclude that the prehospital administration of antibiotics for open fracture prophylaxis is safe, inexpensive and effective for decreasing the sequalae of open fractures.

Discussion Points

• Open fractures cause significant morbidity for orthopedic patients.
  • Open tibia fractures have been shown to have an infection rate as high as 20%.
  • Fracture related infection has been shown to seriously decrease quality of life and increase the direct costs to health centers and patients for care
• Early antibiotic administration has been shown to decrease infectious sequelae of these fractures.
  • Lack et al delineated a 65-minute window for the administration of prophylactic antibiotics in Type III open tibia fractures, after which infection rates rose significantly
  • There is good data on early administration for gram+ prophylaxis, gram- data is much less clear.
• Prehospital administration of antibiotics has been shown to decrease time to antibiotics while maintaining a strong safety profile
  • Multiple studies have shown that prehospital administration of antibiotics for open fracture prophylaxis is safe, inexpensive and can decrease time to abx
  • Additionally, various studies have shown that EMS can be very effective at open fracture diagnosis in the field
• The COT and OTA jointly backed a position statement on the use of prehospital antibiotics in suspected open fractures.
• Several recommendations of use were presented in this position statement.
  • In a responsive patient with no history of penicillin allergy, the administration by EMS of a 1^st generation cephalosporin should be performed after the management of life-threats.
  • In an obtunded patient with a protected airway, the administration by EMS of a 1^st generation cephalosporin should be performed after the management of life-threats.
  • In a responsive patient with a documented penicillin allergy, the administration by EMS of a 1^st generation cephalosporin should be performed with close monitoring after the management of life-threats.
  • Critically, administration of antibiotics should not delay transport to a trauma center or any other lifesaving interventions.
• Prehospital administration of antibiotics for open fracture prophylaxis is safe, inexpensive and effective for decreasing the sequalae of open fractures.

Resources

PCRF abstracts from EMS World.

Prehospital Care Research Forum Abstracts 2023 (tandfonline.com) 

Peth A, Gregorio DJ, Studebaker SA, Muniz AD, Camacho CG, Williams B, Kupas DF, Brown LH. Safety and timeliness of emergency medical service administration of antibiotics for traumatic injuries. (PCRF Abstract) Prehosp Emerg Care. 2024;28(S1):S118-S119.

 

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About our Guests

Dr. Joey Johnson is an associate professor of orthopedic surgery and director of clinical research at the University of Alabama at Birmingham. He graduated from the University of Georgia prior to attending Emory Medical School. He completed his residency and first orthopedic trauma fellowship at Brown University prior to completing an AO Short Term Fellowship at Leeds General Infirmary in the UK. He is a fellow of the American Academy of Orthopedic Surgery, a board certified orthopedic trauma surgeon and current Future Trauma Leader on the American College of Surgeons Committee on Trauma.

Dr. Douglas Kupas is medical director for Geisinger EMS and co-director of Mobile Integrated Healthcare for Geisinger Health System, his professional home for the past 30 years. He is a professor of emergency medicine and an EMS physician who is board-certified in both EMS and emergency medicine. Dr. Kupas also serves as the director of the Resuscitation Program at Geisinger. Dr. Kupas is an avid researcher and passionate advocate for EMS practitioners and patient safety. His clinical interests include CPR, hypothermia, end-of-life care, trauma triage, EMS patient and practitioner safety and EMS airway management.

Dr. Kupas’s EMS career began 40 years ago when he joined Lower Kiski Ambulance Service in Leechburg, PA, on his 16th birthday as a volunteer. He later became a paramedic and a physician. He earned his medical degree from Jefferson Medical College of Thomas Jefferson University and completed his residency in emergency medicine at Geisinger Medical Center in Danville, PA. Dr. Kupas is the Medical Director of NAEMT, President-Elect of NAEMSP, and serves on the EMS Subboard of the American Board of Emergency Medicine. In 2020, Dr. Kupas received the Rocco V. Morando Lifetime Achievement Award from NAEMT and NREMT.