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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...
September 21, 2018: Prehospital Emergency Care
Ritvij Bowry, May Nour, Teresa Kus, Stephanie Parker, Jonathan Stephenson, Jeffrey Saver, James C Grotta, Daniel Ostermayer
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 pre-hospital environment leading to treatment delays. Intraosseous (IO) access is commonly used in the pre-hospital setting for a variety of conditions and may serve as a viable means for tPA (tissue plasminogen activator) administration. 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...
September 20, 2018: Prehospital Emergency Care
Aaron K Sibley, Trevor N Jain, Michael Butler, Brent Nicholson, David Sibley, Dan Smith, Paul Atkinson
INTRODUCTION: The scene-size-up is a crucial first step in the response to a mass casualty incident (MCI). Unmanned aerial vehicles (UAV) may potentially enhance the scene-size-up with real-time visual feedback during chaotic, evolving or inaccessible events. We performed this study to test the feasibility of paramedics using UAV video from a simulated MCI to identify scene hazards, initiate patient triage, and designate key operational locations. METHODS: We simulated an MCI, including 15 patients plus 4 hazards, on a college campus...
September 20, 2018: Prehospital Emergency Care
Christopher Berry, Douglas Kupas, Mark Olaf, Anne Knorr, Andrea Berger
BACKGROUND: The approach to managing out-of-hospital cardiac arrest (OOHCA) has generally involved either minimal on-scene resuscitation to reduce time to arrival at hospital or extended care at the scene to increase the chance of return of spontaneous circulation (ROSC) before transport. This study compared patient outcomes across EMS agencies with respect to the duration of on-scene time. We hypothesized that EMS agencies with greater average time on-scene would have more favorable outcomes...
September 15, 2018: Prehospital Emergency Care
William Lack, Rachel Seymour, Anna Bickers, Jonathan Studnek, Madhav Karunakar
OBJECTIVE: Early antibiotic administration has been associated with a significant decrease in infection following open fractures. However, antibiotics are most effective at a time when many patients are still being transported for care. There is limited evidence that antibiotics may be safely administered for open fractures when being transported by life-flight personnel. No such data exists for ground ambulance transport of patients with open fractures. The purpose of the study was to assess the safety and feasibility of prophylactic antibiotic delivery in the prehospital setting...
September 14, 2018: Prehospital Emergency Care
Neil H Vigil, Andrew R Grant, Octavio Perez, Robyn N Blust, Vatsal Chikani, Tyler F Vadeboncoeur, Daniel W Spaite, Bentley J Bobrow
BACKGROUND: In 2016, nearly 45,000 deaths in the United States were attributed to suicide making this the 10th leading cause of death for all ages. National survey data suggest that among Emergency Medical Technicians (EMTs), including firefighters and Paramedics, rates of suicide are significantly higher than among the general public. EMTs face high levels of acute and chronic stress as well as high rates of depression and substance abuse, which increase their risk of suicide. OBJECTIVE/AIM: To determine the statewide Mortality Odds Ratio (MOR) of suicide completion among EMTs as compared to non-EMTs in Arizona...
September 14, 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 1,000,000)...
September 11, 2018: Prehospital Emergency Care
William Krebs, Terri Higgins, Martha Buckley, James J Augustine, Bradley D Raetzke, Howard A Werman
Botulism is a potentially lethal disease caused by a toxin released by Clostridium botulinum. Outbreaks of botulism from food sources can lead to a Mass Casualty Incident (MCI) involving sometimes hundreds of individuals. We report on a recent outbreak of botulism treated at a regional community hospital with a focus on emergency medical services (EMS) response and transport considerations. CASE PRESENTATION: There were 53 patient evaluated for botulism at the sending facility. In total, 11 botulism exposures required intubation at the sending facility...
September 10, 2018: Prehospital Emergency Care
Joel Neves Briard, Frédéric Grou-Boileau, Alaa El Bashtaly, Catherine Spenard, François de Champlain, Valérie Homier
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...
September 10, 2018: Prehospital Emergency Care
Jared Strote, Rachel A Harper
OBJECTIVES: Many police officers receive medical training for limited assessments and interventions. In most situations where medical issues arise, however, emergency medical services (EMS) are called for evaluation, treatment, and transport. Given the limited amount of information about such encounters we examined officer calls for EMS help in a single system to better describe these encounters. METHODS: Requests for medical help from a fire-based EMS system by police in a moderate-sized city in 2014 and 2015 were identified...
September 10, 2018: Prehospital Emergency Care
Julie E Sinclair, Mike Austin, Mark Froats, Shannon Leduc, Justin Maloney, Richard Dionne, Andy Reed, Christian Vaillancourt
BACKGROUND: In Ontario, Canada, there currently are no prehospital treat-and-release protocols and the safety of this practice remains unclear. We sought to describe the characteristics, management, and outcomes of patients with hypoglycemia treated by paramedics, and to determine the predictors of repeat access to prehospital or emergency department (ED) care within 72 hours of initial paramedic assessment. METHODS: We performed a health record review of paramedic call reports and ED records over a 12-month period...
September 10, 2018: Prehospital Emergency Care
Aaron Michael Burnett, Ralph J Frascone, Johannes Brechtken, David Warren, Brian Roach, Andrew R Zinkel
We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a total of 2 hours and 50 minutes who was diagnosed with ST elevation myocardial infarction (STEMI) during a brief 10 min period of return of spontaneous circulation (ROSC). The patient underwent successful percutaneous coronary intervention (PCI) while receiving mechanical chest compressions for ongoing VF. Our case demonstrates the potential for neurologically intact survival in VF cardiac arrest patients despite prolonged periods of VF who are treated with mechanical CPR and intra-arrest PCI...
September 10, 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 four different mass casualty triage systems (SALT, JumpSTART, Triage Sieve, and CareFlight) when used for children...
September 9, 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, little 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 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...
September 7, 2018: Prehospital Emergency Care
David Christopher Cone
No abstract text is available yet for this article.
September 7, 2018: Prehospital Emergency Care
Philip S Nawrocki, Matthew Levy, Nelson Tang, Shawn Trautman, Asa Margolis
INTRODUCTION: Interfacility transport of the pregnant patient poses a challenge for prehospital providers as it is an infrequent but potentially high acuity encounter. Knowledge of clinically significant events (CSEs) that occur during these transports is important both to optimize patient safety and also to help enhance crew training and preparedness. This study evaluated a critical care transport program's 5-year longitudinal experience transporting pregnant patients by ground and air, and described CSEs that occurred during the out-of-hospital phase of care...
September 6, 2018: Prehospital Emergency Care
Sean M Caffrey, Leaugeay C Barnes, David Olvera
A joint position statement of the National Association of EMS Educators (NAEMSE), the National EMS Management Association (NEMSMA) and the International Association of Flight and Critical Care Paramedics (IAFCCP).
September 6, 2018: Prehospital Emergency Care
Deborah P Waldrop, Jacqueline M McGinley, Michael W Dailey, Brian Clemency
BACKGROUND: The primary charge of Emergency Medical Services (EMS) is to save lives. However, EMS personnel are frequently called to scenes where prolonging life may not be the primary goal. When someone is nearing death, family members may feel compelled to call 911 because they are feeling uncertain about how to manage symptoms at the end of life. OBJECTIVE: We sought to explore prehospital providers' perspectives on how the awareness of dying and documentation of end-of-life wishes influence decision-making on emergency calls near the end of life...
September 5, 2018: Prehospital Emergency Care
Jillian Dorsam, Steven Cornelius, Julie McLean, Gregory J Zarow, Alexandra Walchak, Sean 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, Tactical Combat Casualty Care (TCCC) has approved three SC devices: The Tactical CricKit® (TCK), Control-Cric™(CC), and Bougie-assisted Technique (BAT). However, no previous studies have compared these devices in application time, application success, user ratings, and user preference...
September 1, 2018: Prehospital Emergency Care
Brian D Sumner, Emily A Grimsley, Niall H Cochrane, Ryan R Keane, Alexis B Sandler, Paul C Mullan, Karen J O'Connell
BACKGROUND: The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration. OBJECTIVE: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations...
August 30, 2018: Prehospital Emergency Care
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