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Prehospital Emergency Care

Holly E Depinet, Michelle Eckerle, Olga Semenova, Jareen Meinzen-Derr, Lynn Babcock
OBJECTIVE: To inform the future development of a pediatric prehospital sepsis tool, we sought to 1) describe the characteristics, emergent care, and outcomes for children with septic shock who are transported by emergency medicine services (EMS) and compare them to those self-transported; and 2) determine the EMS capture rate of common sepsis screening parameters and the concordance between the parameters documented in the EMS record and in the emergency department (ED) record. METHODS: This is a retrospective cohort study of children ages 0 through 21 years who presented to a pediatric ED with septic shock between 11/2013 and 06/2016...
November 15, 2018: Prehospital Emergency Care
Juan March, Joanna L Adams, Roberto Portela, Stephen Taylor, John G McManus
INTRODUCTION: There is little published data in regards to Emergency Medical Services (EMS) fellowship programs. The purpose of this study was to obtain program characteristics and diversity data regarding EMS fellowship programs. METHODS: A survey was sent to program directors at all EMS fellowship programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). Data collected included: year program started, year program accredited, unfilled fellow positions, number of EMS faculty, gender, and race/ethnicity...
November 8, 2018: Prehospital Emergency Care
Chia-Chang Chuang, Jiann-Yeou Rau, Meng-Kuan Lai, Chung-Liang Shih
OBJECTIVE: Strong earthquakes often cause massive structural and nonstructural damage, timely assessment of the catastrophe related massive casualty incidents (MCIs) for deploying rescue resource are critical in order to minimize ongoing fatalities. A magnitude 6.6 earthquake struck southern Taiwan on February 6, 2016 (the so-called 02/06 Meinong earthquake). It led to 117 deaths and 522 injuries. Advanced technologies including aerial devices and innovation concept were adopted for more effective rescue efforts...
November 8, 2018: Prehospital Emergency Care
David A Kranc, A Wooten Jones, Joshua Nackenson, Christopher A Davis, Benjamin N Abo, Seth C Hawkins
Point-of-care ultrasound has been shown to have a demonstrable impact in the austere/out-of-hospital environment. As ultrasounds become more affordable and portable, a myriad of uses in austere environments are becoming recognized. We present a case of a stranded hiker with an ultrasound-confirmed glenohumeral joint dislocation who underwent ultrasound-guided intra-articular lidocaine injection and ultrasound-confirmed reduction. This procedure allowed the patient to hike out under his own power, avoiding the potential dangers of extrication to both patient and rescuers...
November 7, 2018: Prehospital Emergency Care
Mat Goebel, Christopher Tainter, Christopher Kahn, James V Dunford, John Serra, Jodie Pierce, J Joelle Donofrio
BACKGROUND: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. METHODS: This is a retrospective chart review of known LVAD patients that belong to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's 2 emergency departments between January 2012 and December 2015...
November 5, 2018: Prehospital Emergency Care
Matthew J Douma, Christopher Picard, Domhnall O'Dochartaigh, Peter G Brindley
INTRODUCTION: Following life-threatening junctional trauma, the goal is to limit blood loss while expediting transfer to operative rescue. Unfortunately, life-threatening abdominal-pelvic or junctional hemorrhage is often not amenable to direct compression and few temporizing strategies are available beyond hemostatic dressings, hypotensive resuscitation, and balanced transfusion. OBJECTIVES: In this study, we evaluated proximal external aortic compression to arrest blood flow in healthy adult men...
November 2, 2018: Prehospital Emergency Care
Michael A Kaufmann, David R Nelson, Puneet Kaushik, N Clay Mann, Beth Mitchell
OBJECTIVES: The objectives of this study were to evaluate demographic/clinical characteristics and treatment/transportation decisions by emergency medical services (EMS) for patients with hypoglycemia and link EMS activations to patient disposition, outcomes, and costs to the emergency medical system. This evaluation was to identify potential areas where improvements in prehospital healthcare could be made. METHODS: This was a retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) registry and three national surveys: Nationwide Emergency Department Sample (NEDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and Medical Expenditure Panel Survey (MEPS) from 2013, to examine care of hypoglycemia from the prehospital and the emergency department (ED) perspectives...
November 2, 2018: Prehospital Emergency Care
Colin B Page, Lachlan E Parker, Stephen J Rashford, Katherine Z Isoardi, Geoffrey K Isbister
STUDY OBJECTIVE: Although uncommon, children (<16 years) with acute behavioural disturbance are a significant issue for emergency medical service providers. In this study we aimed to investigate the safety and effectiveness of droperidol in children with prehospital acute behavioural disturbance. METHODS: This was a prospective observational study over 1 year investigating the use of droperidol (0.1-0.2 mg/kg) for children (< 16 y) with acute behavioural disturbance...
October 31, 2018: Prehospital Emergency Care
Hilary A Hewes, Michael Ely, Rachel Richards, Manish I Shah, Stephanie Busch, Diane Pilkey, Katherine Dixon Hert, Lenora M Olson
OBJECTIVE: Pediatric patients represent low frequency but potentially high-risk encounters for EMS providers. Scant information is available from EMS agencies on the frequency of pediatric skill evaluation and the presence of pediatric emergency care coordination, both which may help EMS systems optimize care for children. The objective of our study was to assess the frequency and type of methods used to assess psychomotor skills competency using pediatric-specific equipment and pediatric care coordination in EMS ground transport agencies...
October 31, 2018: Prehospital Emergency Care
P Daniel Patterson, Charity G Moore, Francis X Guyette, Jack M Doman, Matthew D Weaver, Denisse J Sequeira, Howard A Werman, Doug Swanson, David Hostler, Joshua Lynch, Lindsey Russo, Linda Hines, Karen Swecker, Andrew J Kroemer, Michael S Runyon, Daniel J Buysse
OBJECTIVE: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. METHODS: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 ( NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days...
October 29, 2018: Prehospital Emergency Care
Howard D Backer, Nicole T D'Arcy, Adam J Davis, Bruce Barton, Karl A Sporer
OBJECTIVE: Ambulance patient offload time (APOT) also known colloquially as "Wall time" has been described in various jurisdictions but seems to be highly variable. Any attempt to improve APOT requires the use of common definitions and standard methodology to measure the extent of the problem. METHODS: An Ambulance Offload Delay Task Force in California developed a set of standard definitions and methodology to measure APOT for transported 9-1-1 patients...
October 25, 2018: Prehospital Emergency Care
Hannah Gardener, Paul E Pepe, Tatjana Rundek, Kefeng Wang, Chuanhui Dong, Maria Ciliberti, Carolina Gutierrez, Antonio Gandia, Peter Antevy, Wayne Hodges, Nils Mueller-Kronast, Charles Sand, Jose G Romano, Ralph L Sacco
OBJECTIVE: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex...
October 25, 2018: Prehospital Emergency Care
Ritvij Bowry, May Nour, Teresa Kus, Stephanie Parker, Jonathan Stephenson, Jeffrey Saver, James C Grotta, Daniel Ostermayer
OBJECTIVE: Mobile stroke units offer improved time to administration of thrombolytics for ischemic stroke patients. Acquisition of intravenous (IV) access, however, can be challenging in the prehospital environment leading to treatment delays. Intraosseous (IO) access is commonly used in the prehospital setting for a variety of conditions and may serve as a viable means for tPA (tissue plasminogen activator) administration. METHODS/RESULTS: We describe 3 cases in which tPA was administered via IO access on a mobile stroke unit as part of the Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services (BEST-MSU) trial...
October 25, 2018: Prehospital Emergency Care
Michael W Bachman, Brendan C Anzalone, Jefferson G Williams, Mallory B DeLuca, Donald G Garner, James E Preddy, Jose G Cabanas, J Brent Myers
OBJECTIVE: An integrated response to active threat events is essential to saving lives. Coordination of law enforcement officer (LEO) and emergency medical services (EMS) roles requires joint training, as maximizing survival is a shared responsibility. We sought to evaluate the performance of an integrated LEO-EMS Rescue Task Force (RTF) response to a simulated active shooter incident utilizing objective performance measures. METHODS: Following prior didactic training, we conducted a series of evaluation scenarios for EMS providers and patrol officers in our urban/suburban advanced life support EMS system (pop...
October 17, 2018: Prehospital Emergency Care
Robert W Heffernan, E Brooke Lerner, Courtney H McKee, Lorin R Browne, M Riccardo Colella, J Marc Liu, Richard B Schwartz
INTRODUCTION: It was previously difficult to compare the accuracy of different mass casualty triage systems to one another. This pilot study is one of the first attempts to operationalize an expert panel's criterion standard definitions of triage categories in a pediatric population in order to compare accuracy between different systems. OBJECTIVE: To compare the accuracy of 4 different mass casualty triage systems (SALT, JumpSTART, Triage Sieve, and CareFlight) when used for children...
October 17, 2018: Prehospital Emergency Care
James B Fitzgibbon, Emily Lovallo, Jeremiah Escajeda, Marek A Radomski, Christian Martin-Gill
INTRODUCTION: Point-of-care ultrasound (POCUS) has been suggested as a useful tool to predict survival and guide interventions in out-of-hospital cardiac arrest (OHCA). While POCUS has been deployed in prehospital settings, a minimal amount of data exists on prehospital use, particularly by personnel with limited ultrasound experience. We aimed to characterize the feasibility and barriers to prehospital POCUS during OHCA by emergency medicine services (EMS) physicians in training. METHODS: We deployed the SonoSite iViz portable ultrasound device for use by EMS physicians for OHCA in an urban EMS system...
October 17, 2018: Prehospital Emergency Care
Jillian M Dorsam, Steven R Cornelius, Julie B McLean, Gregory J Zarow, Alexandra C Walchak, Sean P Conley, Paul J D Roszko
BACKGROUND: Airway obstruction is the second leading cause of preventable battlefield death, at least in part because surgical cricothyrotomy (SC) failure rates remain unacceptably high. Ideally, SC should be a rapid, simple, easily-learned, and reliably-performed procedure. Currently, 3 SC devices meet Tactical Combat Casualty Care (TCCC) standards: The Tactical CricKit® (TCK), Control-CricTM (CC), and Bougie-assisted Technique (BAT). However, no previous studies have compared these devices in application time, application success, user ratings, and user preference...
October 17, 2018: Prehospital Emergency Care
David Fe Stuhlmiller, John R Clark, Sean Caffrey, Mark Betterton, Chris Nollette, William Raynovich
Critical care paramedicine is a specialty practice of the EMS profession. Development of a bachelor's degree is supported as a requirement for entry-level paramedic education and training and targeted specialty continuing education as a requirement for certifying critical care paramedics. Critical care paramedic certification is required for the establishment of national practice standards, recognition and standardization of scopes of practice at the state-level. Maintenance of critical care paramedic certification and appropriate regulatory requirements for third-party reimbursements are also supported...
October 16, 2018: Prehospital Emergency Care
H Evan Dingle, Saralyn R Williams
We present an illustrative case of a 24-year old male who developed cardiovascular and multi-organ system toxicity after inhaling a keyboard dust cleaner containing a halogenated hydrocarbon. In the field, the patient demonstrated neurotoxic effects in addition to electrocardiographic changes concerning for toxic myocarditis. We discuss the types of hydrocarbons, methods of abuse, and toxic effects of their inhalation including "sudden sniffing death" from myocardial sensitization.
October 15, 2018: Prehospital Emergency Care
Sean M Caffrey, Leaugeay C Barnes, David J Olvera
The National Association of EMS Educators, the National EMS Management Association, and the International Association of Flight and Critical Care Paramedics believe the time has come for paramedics to be trained through a formal education process that culminates with an associate degree. Once implemented a degree requirement will improve the care delivered by paramedics and enhance paramedicine as a heath profession.
October 11, 2018: Prehospital Emergency Care
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