Loma Linda University

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Jeff Grange, MD
Medical Director, Cardiopulmonary Sciences, Emergency Medical Care
School of Allied Health Professions
Associate Professor, Emergency Medicine
School of Medicine
Publications    Book Review - Scholarly Journals--Published
  • Dyreyes JQ, Grange JT, Smith D, Jin P, Guldner G: In-car Airway Options for NASCAR Drivers (abstract). Western Journal of Emergency Medicine, 2008; 9(1): 70-71. ( 9/2008 )
  Scholarly Journals--Published
  • Grange JT, Bodnar JA, Corbett SW: Motocross Medicine. Current Sports Medicine Reports 8(3): 125-130. ( 6/2009 )
    Motocross is an increasingly popular but high-risk sport. This article reviews the history of motocross, the relevant medical literature, the unique medical issues, safety equipment, and the expert recommended approach to providing support for such events. Assessment of an injured rider on or near a track requires a provider to first ensure scene safety, then assess for airway, cervical spine, and head injuries before proceeding. Although extremity injuries are the most common injury, motocross riders frequently sustain significant spine and head trauma as well. Caregivers need to have a complete understanding of the protective gear used in motocross. They also need to be able to understand what injuries can be treated at the scene and which need transport to a hospital for more definitive care.
  • Jeff T. Grange, Michael Ghim. "Live from Loma Linda: Telemedicine project brings tertiary care center to the field.." Journal of Emergency Medical Services 31.9 (2006): 66-69. ( 9/2006 )
  • JT Grange, HC Bock, SC Davis. "Motorsports EMS: an emerging subspecialty." Journal of Emergency Medical Services 29.5 (2004): 92-114. ( 5/2004 )
  • JT Grange, A Cotton. "Motorsports Medicine." Current Sports Medicine Reports 3. (2004): 131-140. ( 3/2004 ) Link...
    Motorsports is the fastest growing professional sport in the United States. Each year approximately 14 drivers die, and many others are paralyzed or seriously injured. Although there is a common misconception that motorsports medicine is analogous to standard emergency or sports medicine, due to the unique racing environment a traditional approach to emergency medical services can be ineffective and may expose drivers, spectators, and medical personnel to great danger. This article is a general review of the evolving subspecialty of motorsports medicine.
  • JT Grange, GW Baumann, R Vaezazizi. "On-site physicians reduce ambulance transports at mass gatherings." Prehospital Emergency Care 7.3 (2003): 322-326. ( 7/2003 ) Link...
    OBJECTIVES: To prospectively determine if on-site physicians at a mass gathering reduced the number of ambulance transports to local medical facilities. The authors also wished to determine the level of care provider (emergency medical technician, EMT-P, registered nurse, or medical doctor) required to treat and disposition each patient. METHODS: This study determined whether each patient presenting to on-site first aid stations at California Speedway during a large motorsports event would require ambulance transport to the hospital per the local emergency medical services (EMS) protocols. Whether the on-site physician prevented certain ambulance transports also was determined. Additionally, the minimum level of provider that could treat and disposition each patient was determined. RESULTS: On-site physicians significantly reduced (p < 0.001) the number of ambulance transports at this mass gathering. Ambulance transports to local hospitals were reduced by 89% (from 116 to 13). Fifty-two percent of the patients were able to be treated and dispositioned (cardiac arrests, minor first aid, etc.) by a paramedic. Registered nurses were able to treat and disposition another 39% of the patients with pre-established protocols written by the track medical director. These patients had abrasions requiring tetanus shots, mild to moderate heat exhaustion that resolved with intravenous hydration, and other minor complaints. Finally, about 9% of the patients required physician-level care (suturing, prescriptions, etc.) to treat and disposition them. CONCLUSION: On-site physician-level medical care at large mass gatherings significantly reduces the number of patients requiring transport to hospitals, thus reducing the impact on the local EMS system and surrounding medical facilities.
  • JT Grange, GW Baumann. "The California 500: Medical Care at a NASCAR Winston Cup Race." Prehospital Emergency Care 6.3 (2002): 315-318. ( 7/2002 ) Link...
    Background. Stock car racing is America's fastest-growing professional sport. With more than 5.5 million paid admittances and another 148 million watching the 34-race NASCAR Winston Cup series on television, emergency physicians are increasingly called upon to organize medical support for such events. Currently, little reliable information is available to assist in determining what specific personnel and equipment are necessary to optimally support a race event. Objective. To characterize the spectrum of presenting injuries and illnesses at a NASCAR Winston Cup event. Methods. This study was a retrospective review of all patients presenting to nine on-site first aid stations from June 19 to 22, 1997, for the inaugural California 500 race weekend at California Speedway in Fontana, California. Staffing of the nine first aid stations was provided by 20 paramedics, 25 emergency nurses, five emergency physicians, nine advanced life support (ALS) ambulances with two crew members each, and a medically configured helicopter with flight crew. Results. Of the 923 patients seen, 38 were drivers/crew, 230 were track employees, and 644 were spectators. One hundred thirty-six of the patients were treated in the two infield facilities, while 787 were treated in the grandstand first aid stations. Patients seen per hour peaked just before the start of the race at 73 patients seen. Of the ten patients transported to the hospital, three required admission. No deaths occurred. Conclusion. These data may assist individuals planning medical support for large motorsports venues.
  • JT Grange. "Planning for Large Events." Current Sports Medicine Reports 1. (2002): 156-161. ( 6/2002 ) Link...
    Physicians are increasingly called upon to provide medical support for mass gatherings such as concerts, sporting events, political conventions, and other special events. Until recently, individuals planning such support have had little reliable information to assist them in determining what specific personnel and equipment are necessary to optimally support a mass gathering. Recently, the National Association of Emergency Medical Services Physicians established and published the most definitive and up-to-date document to assist a physician with planning medical care for a mass gathering: Mass Gathering Medical Care: The Medical Director's Checklist. As one of the most important developments in mass gathering medicine, this article highlights and discusses key areas of the document.
  • JT Grange, SW Corbett. "Violence Against Emergency Medical Services Personnel." Prehospital Emergency Care 6.2 (2002): 186-190. ( 4/2002 ) Link...
    Background. Emergency medical services (EMS) providers may be exposed to violent behavior while performing their routine duties. Objectives. To determine the prevalence of violence against EMS providers in the prehospital setting and to determine factors associated with such violence. Methods. Consecutive medical calls for EMS agencies in a southern California metropolitan area were prospectively analyzed for one month. Following each call, prehospital personnel recorded information about any episodes of violence (verbal or physical) during the run as well as variables felt to be associated with these behaviors. Results. There were 4,102 cases available for analysis. Overall, some sort of violence occurred in 8.5% (349/4,102) of patient encounters. Of this reported violence, 52.7% (184/349) was directed against prehospital care providers, while 47.3% (165/349) was directed against others. The prevalence of violence directed against prehospital care personnel was therefore 4.5% (184/4,102). Patients accounted for most (89.7%; 165/184) of this violent behavior. The type of violence varied, with 20.7% (38/184) being verbal only, 48.9% (90/184) being physical, and 30.4% (56/184) constituting both verbal and physical attacks. Male sex, patient age, and hour of the day were significantly associated with episodes of violence. Logistic regression analysis provided odds ratios (ORs) with confidence intervals (CIs) for factors that were predictive of violent behavior. These included police presence (OR 2.8; 95% CI 1.8-4.4), apparent presence of gang members (OR 2.9; 95% CI 1.6-5.3), perceived psychiatric disorder (OR 5.9; 95% CI 3.5-9.9), and perceived presence of alcohol or drug use (OR 7.0; 95% CI 4.4-11.2). Conclusion. Emergency medical services providers in some areas are at substantial risk for encountering violence in the prehospital setting. Certain situational factors may be used to predict the risk of encountering violence. Training, protocols, and protective gear for dealing with violent situations should be encouraged for all prehospital personnel.
  • JT Grange, R Kozak, J Gonzalex. "Penetrating Injury from a Less-Lethal Bean Bag Gun." Journal of Trauma 52.3 (2002): 576-578. ( 3/2002 ) Link...
  • JT Grange, SM Green, W Downs. "Concert Medicine: Spectrum of Medical Problems Encountered at 405 Major Concerts." Academic Emergency Medicine 6.3 (1999): 202-207. ( 6/1999 ) Link...
    Objectives: To identify factors predictive of patient load at major commercial concert first-aid stations, and to characterize the spectrum of presenting injuries and illnesses at such events. Methods: This study was a retrospective case series of patients presenting to on-site first-aid stations at five major concert venues in southern California over a five-year period. The authors compared the number of patients per ten thousand attendees (PPTT) with four potential predictors (music type, overall attendance, temperature, and indoor vs outdoor location) using univariate techniques and negative binomial regression. The spectrum of chief complaints observed is described. Results: There were 1,492 total patients out of 4,638,099 total attendees at 405 separate concerts. The median patient load per concert was 2.1 PPTT, ranging from 0 PPTT at 53 concerts to 71 PPTT at a punk rock festival that turned into a riot. Patient load varied significantly by music category (p = 0.0001) but not with overall attendance, temperature, or indoor vs outdoor location. Median PPTT by music category ranged from 1.3 PPTT for rhythm and blues to 12.6 PPTT for gospel/Christian, with negative binomial regression indicating that rock concerts had 2.5 times (95% CI = 2.0 to 3.0) the overall patient load of non-rock concerts. Music type, however, was able to account for only 4% of the variability observed in the regression model. Trauma-related complaints predominated overall, with similar rates at rock and non-rock concerts. Four cardiac arrests occurred at classical concerts. Conclusion: Rock concert first-aid stations evaluated 2.5 times the patient load of non-rock concerts overall, although there was substantial concert-to-concert variability. Trauma-related complaints predominate at both rock and non-rock events. These data may assist individuals and organizations planning support for such events.
  • SW Corbett, JT Grange, TL Thomas. "Exposure of Prehospital Providers to Violence." Prehospital Emergency Care 2.2 (1998): 127-131. ( 4/1998 ) Link...
    OBJECTIVE: To evaluate the experience of prehospital care providers with violence. METHODS: A survey addressing experiences with prehospital violence was administered to a convenience sample of emergency medical services (EMS) providers in a southern California metropolitan area. Descriptive statistics are reported. RESULTS: Of 774 EMS providers surveyed, 522 (67%) returned the questionnaire. Members of law enforcement were excluded because their experience with violence, weapons, and tactics is not typical of most paramedics. This left a sample of 490 for further analysis. These prehospital care providers had a median of ten years' experience on the job. They tended to be male (93%) and white (80%). All together, 61% recounted assault on the job, with 25% reporting injury from the assault. Respondents reported a median of three episodes, and the number of assaults for each individual was unrelated to the number of years of experience on the job (r = 0.068). Of those injured, 37% required medical attention. On the other hand, 35% reported that their company had a specific protocol for managing violent situations and 28% stated ever having received formal training in the management of violent encounters. This limited training notwithstanding, nearly all (95%) providers described restraining patients. Use of protective gear was reported (73%), and some (19%) admitted to ever carrying a weapon on the job. CONCLUSIONS: By their own report, EMS providers encounter a substantial amount of violence and injury due to assault on the job. Formal training and protocols to provide a standardized safe approach for such encounters are lacking. Although the limitations of survey data are recognized, further research characterizing the level of violence and potential interventions seems warranted.
  Books and Chapters
  • Jeff T. Grange, Stephen W. Corbett. Air Medical Research. Salt Lake City: Air Medical Physician Association, 2006. ( 1/2006 )
  • Jeff T. Grange, Stephen W. Corbett. Helicopters at Special Events. Salt Lake City: Air Medical Physician Association, 2006. ( 1/2006 )
  • JT Grange. Mass Gathering Medical Care in Sports Injuries and Emergencies: A Quick Response Manual. New York, NY: McGraw-Hill, 2003. ( 1/2003 )
  • JT Grange. Motorsports Medicine in Sports Injuries and Emergencies: A Quick Response Manual. New York, NY: McGraw Hill, 2003. 331 - 335 ( 1/2003 )
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