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Prehospital Emergency Care

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https://www.readbyqxmd.com/read/28686547/incidence-of-naloxone-redosing-in-the-age-of-the-new-opioid-epidemic
#1
Ronald Klebacher, Matthew I Harris, Navin Ariyaprakai, Ammundeep Tagore, Vince Robbins, Larissa Sophia Dudley, Robert Bauter, Susmith Koneru, Ryan D Hill, Eric Wasserman, Andrew Shanes, Mark A Merlin
STUDY OBJECTIVE: Naloxone, an opioid-antagonist deliverable by an intra-nasal route, has become widely available and utilized by law enforcement officers as well as basic life support (BLS) providers in the prehospital setting. This study aimed to determine the frequency of repeat naloxone dosing in suspected narcotic overdose (OD) patients and identify patient characteristics. METHODS: A retrospective chart review of patients over 17 years of age with suspected opioid overdose, treated with an initial intranasal (IN) dose of naloxone and subsequently managed by paramedics, was performed from April 2014 to June 2016...
July 7, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28661784/identifying-key-words-in-9-1-1-calls-for-stroke-a-mixed-methods-approach
#2
Christopher T Richards, Baiyang Wang, Eddie Markul, Frank Albarran, Doreen Rottman, Neelum T Aggarwal, Patricia Lindeman, Leslee Stein-Spencer, Joseph M Weber, Kenneth S Pearlman, Katie L Tataris, Jane L Holl, Diego Klabjan, Shyam Prabhakaran
OBJECTIVES: Identifying stroke during a 9-1-1 call is critical to timely prehospital care. However, emergency medical dispatchers (EMDs) recognize stroke in less than half of 9-1-1 calls, potentially due to the words used by callers to communicate stroke signs and symptoms. We hypothesized that callers do not typically use words and phrases considered to be classical descriptors of stroke, such as focal neurologic deficits, but that a mixed-methods approach can identify words and phrases commonly used by 9-1-1 callers to describe acute stroke victims...
June 29, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28661715/patient-characteristics-and-temporal-trends-in-police-transport-of-blunt-trauma-patients-a-multicenter-retrospective-cohort-study
#3
Elinore J Kaufman, Sara F Jacoby, Catherine E Sharoky, Brendan G Carr, M Kit Delgado, Patrick M Reilly, Daniel N Holena
BACKGROUND: Police transport (PT) of penetrating trauma patients has the potential to decrease prehospital times for patients with life-threatening hemorrhage and is part of official policy in Philadelphia, Pennsylvania. We hypothesized that rates of PT of bluntly injured patients have increased over the past decade. METHODS: We used Pennsylvania Trauma Outcomes Study registry data from 2006-15 to identify bluntly injured adult patients transported to all 8 trauma centers in Philadelphia...
June 29, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28661712/out-of-hospital-and-inter-hospital-under-triage-to-designated-tertiary-trauma-centers-among-injured-older-adults-a-10-year-statewide-geospatial-adjusted-analysis
#4
Tabitha Garwe, Kenneth Stewart, Julie Stoner, Craig D Newgard, Melissa Scott, Ying Zhang, Timothy Cathey, John Sacra, Roxie M Albrecht
OBJECTIVE: While out-of-hospital under-triage of seriously injured older adults to tertiary trauma centers has long been acknowledged, no study has adjusted for place of injury or evaluated the extent of inter-facility under-triage. We sought to determine distance and confounder adjusted odds of treatment at a tertiary trauma center (TTC) for older adult trauma patients compared to younger trauma patients, for patients transported from the scene of injury and those transferred from a non-tertiary trauma (NTTC) center...
June 29, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28661710/use-of-hemostatic-nasal-plugs-in-emergency-medical-services-in-the-netherlands-a-prospective-study-of-33-cases
#5
Ruben Te Grotenhuis, Pierre M van Grunsven, Wim M J M Heutz, Edward C T H Tan
BACKGROUND: Epistaxis is a common medical emergency with possible life-threatening complications. In the prehospital setting, epistaxis can be treated with nasal tampons. HemCon® Nasal Plug is a nasal tampon impregnated with oxidized cellulose, which has hemostatic properties. OBJECTIVE: The objective of this study was to determine the effectiveness and usability of HemCon Nasal Plugs in the treatment of severe epistaxis in the prehospital setting. METHODS: From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with HemCon Nasal Plugs...
June 29, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657831/case-report-life-saving-application-of-commercial-tourniquet-in-pediatric-extremity-hemorrhage
#6
David W Callaway, Andrew Puciaty, Josh Robertson, Tony Hannon, Sarah E Fabiano
Hemorrhage is the leading preventable cause of death in civilian and military trauma. Recent data from the ongoing conflicts in Iraq and Afghanistan suggest that early and aggressive tourniquet utilization is a safe and effective way to dramatically reduce mortality from extremity hemorrhage. As a result, prehospital tourniquet use is now endorsed by a majority of professional emergency medicine, emergency medical service and trauma professional societies. However, there currently exists scant evidence supporting the efficacy of commercially available tourniquets in controlling extremity hemorrhage in pediatric trauma patients...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657819/cares-a-community-wide-collaboration-identifies-super-utilizers-and-reduces-their-9-1-1-call-emergency-department-and-hospital-visit-rates
#7
E Stein Bronsky, Constance McGraw, Robin Johnson, Kristin Giordano, Alessandro Orlando, David Bar-Or
BACKGROUND: A subset of individuals who inefficiently and frequently use emergency department (ED) services are called "super-utilizers." Our healthcare system is fragmented and complex, making it difficult for providers to identify super-utilizers and address their wide range of health issues. OBJECTIVE: The objective of our study was to evaluate a novel community-wide collaboration program called CARES (Community Assistance Referral and Education Services) designed to identify super-utilizers through local partnering organizations...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657816/retrospective-evaluation-of-risk-factors-for-pediatric-secondary-transport
#8
Jennifer N Fishe, Kevin J Psoter, Bruce L Klein, Jennifer F Anders
OBJECTIVE: Emergency medical services (EMS) typically transports patients to the nearest emergency department (ED). After initial presentation, children who require specialized care must undergo secondary transport, exposing them to additional risks and delaying definitive treatment. EMS direct transport protocols exist for major trauma and certain adult medical conditions, however the same cannot be said for pediatric medical conditions or injuries that do not meet trauma center criteria ('minor trauma')...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657809/medical-oversight-educational-core-content-and-proposed-scopes-of-practice-of-wilderness-ems-providers-a-joint-project-developed-by-wilderness-ems-educators-medical-directors-and-regulators-using-a-delphi-approach
#9
Michael G Millin, David E Johnson, Tod Schimelpfenig, Keith Conover, Matthew Sholl, Jonnathan Busko, Rachael Alter, Will Smith, Jennifer Symonds, Peter Taillac, Seth C Hawkins
INTRODUCTION: A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. METHODS: Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657802/exiting-the-emergency-medical-services-profession-and-characteristics-associated-with-intent-to-return-to-practice
#10
Rebecca E Cash, Remle P Crowe, Riddhima Agarwal, Severo A Rodriguez, Ashish R Panchal
OBJECTIVE: Inadequate staffing of agencies, increasing attrition rates, and frequent turnover of personnel make employee retention an ongoing concern for Emergency Medical Services (EMS). Faced with increasing demand for EMS, understanding the causes underlying turnover is critical. The objectives of this study were to describe the proportion of individuals that left EMS, likelihood of returning to the profession, and key factors contributing to the decision to leave EMS. METHODS: This was a cross-sectional study of nationally-certified EMS professionals who left EMS...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657800/effects-of-emergency-medical-services-agency-ownership-status-on-patient-transport
#11
Jackson Déziel
OBJECTIVES: Medical insurers have clearly defined which ambulance services will be reimbursed and which will not. Thus, ambulance agencies that provide emergency 9-1-1 services must be highly cognizant of their organization's revenue needs. This presents a distinction between publicly funded and privately funded organizations. This study seeks to identify any differences in the transport decision among agency ownership types. METHODS: This retrospective study captured all 9-1-1 ambulance requests in the state of Virginia for the years 2009 through 2013...
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28657797/role-of-emergency-medical-dispatch-in-responding-to-acute-stroke-expanding-beyond-high-priority-dispatch
#12
Mehul D Patel
No abstract text is available yet for this article.
June 28, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28641035/hypoglycemia-patients-and-transport-by-ems-in-alameda-county-2013-15
#13
Howard H Moffet, E Margaret Warton, Lee Siegel, Karl Sporer, Kasia J Lipska, Andrew J Karter
OBJECTIVE: To estimate the rate, characteristics, and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). METHODS: This study was based on data for 601,077 Alameda County EMS encounters during 2013-15. Subjects were defined as having hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dl or "unspecified low"). The outcome of interest was patient transport or non-transport to an emergency department or other care setting; we excluded 33,177 (6%) encounters which lacked clear disposition outcomes...
June 22, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622075/meaningful-interventions-in-prehospital-and-retrieval-medicine
#14
Cliff Reid, Brian Burns
No abstract text is available yet for this article.
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622074/disparities-in-feedback-provision-to-emergency-medical-services-professionals
#15
Rebecca E Cash, Remle P Crowe, Severo A Rodriguez, Ashish R Panchal
INTRODUCTION: Feedback to EMS professionals is a critical component for optimizing patient care and outcomes in the prehospital setting. There is a paucity of data concerning the feedback received by prehospital providers. OBJECTIVES: The objective of this study was to describe the prevalence of feedback received by EMS professionals in the past 30 days including the types, sources, modes, and utility of feedback. The secondary objective was to identify factors associated with receiving any feedback and, specifically, feedback regarding medical care provided...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622073/neighborhood-poverty-and-9-1-1-ambulance-contacts
#16
Josh Seim, Joshua English, Karl Sporer
BACKGROUND: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. METHODS: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622071/survival-in-out-of-hospital-rapid-sequence-intubation-of-non-traumatic-brain-pathologies
#17
Pieter Francsois Fouche, Paul Andrew Jennings, Karen Smith, Malcolm Boyle, Gabriel Blecher, Jonathan Knott, Mani Raji, Pamela Rosengarten, Michael Roberto Augello, Stephen Bernard
INTRODUCTION: Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622069/spontaneous-coronary-artery-dissection-in-a-woman-with-a-past-medical-history-of-subarachnoid-hemorrhage-a-case-report
#18
Jean Bardon, Fabien Picard, Franck Barbou, Olivier Varenne, Benoît Vivien
Spontaneous coronary artery dissection (SCAD) is an uncommon disease. We report the case of a 50 year-old woman with a past medical history of aneurysmal subarachnoid hemorrhage, presenting with acute chest pain and diffuse ST segment elevation on ECG. Coronary angiogram revealed a SCAD of the left anterior descending coronary artery. The association between cerebral aneurysms and SCAD should trigger providers concern for fibromuscular dysplasia. We hereby report on a rare and atypical case involving the relationship between fibromuscular dysplasia and SCAD...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622064/re-comparison-of-helicopter-emergency-medical-services-transport-types-and-delays-on-patient-outcomes-at-two-level-i-trauma-centers
#19
Brodie Nolan, Alun Ackery
No abstract text is available yet for this article.
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28489506/prehospital-intubation-is-associated-with-favorable-outcomes-and-lower-mortality-in-protect-iii
#20
Kurt R Denninghoff, Tomas Nuño, Qi Pauls, Sharon D Yeatts, Robert Silbergleit, Yuko Y Palesch, Lisa H Merck, Geoff T Manley, David W Wright
OBJECTIVE: Traumatic brain injury (TBI) causes more than 2.5 million emergency department visits, hospitalizations, or deaths annually. Prehospital endotracheal intubation has been associated with poor outcomes in patients with TBI in several retrospective observational studies. We evaluated the relationship between prehospital intubation, functional outcomes, and mortality using high quality data on clinical practice collected prospectively during a randomized multicenter clinical trial...
May 10, 2017: Prehospital Emergency Care
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