Prehospital Emergency Care

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Objective: This study assesses the likelihood of clinical improvement and adverse events from EMS-administered diltiazem. Current prehospital protocols direct paramedics to administer diltiazem, a calcium channel blocker, to decrease the heart rate (HR) of symptomatic, hemodynamically stable patients with rapid atrial fibrillation. However, diltiazem can also cause systemic hypotension and bradycardia, which can precipitate end-organ injury.  Methods: To assess whether the rate control benefit of prehospital diltiazem outweighs the risk of adverse events, we conducted a retrospective chart review of all adult patients who received diltiazem from Maryland Advanced Life Support EMS clinicians between January 1, 2019, and March 31, 2022...

IntroductionShock is circulatory insufficiency, inadequate oxygen delivery, and cellular hypoxia. Intravenous fluids are essential for shock management. Despite treatment, patients can face persistent shock with ongoing hypotension, contributing to higher mortality. This analysis aims to quantify hypotensive non-traumatic cases in an Australian ambulance service, determine persistent hypotension prevalence, and assess paramedic-administered intravascular fluids' impact on blood pressure changes.MethodsThis study is a retrospective analysis of prehospital fluid resuscitation by New South Wales Ambulance paramedics during 2022...

OBJECTIVE: Intraosseous (IO) access is frequently utilized during the resuscitation of out-of-hospital cardiac arrest (OHCA) patients. Due to proximity to the heart and differential flow rates, the anatomical site of IO access may impact patient outcomes. Using a large dataset, we aimed to compare the outcomes of OHCA patients who received upper or lower extremity IO access during resuscitation. METHODS: The ESO Data Collaborative public use research datasets were used for this retrospective study...

BACKGROUND AND AIMS: The Medical Priority Dispatch System (MPDS) ® is used to triage 9-1-1 calls according to acuity, with certain coding receiving telecommunicator cardiopulmonary resuscitation (T-CPR) for suspected out-of-hospital cardiac arrest (OHCA). However, this may be challenging for those with drug poisoning emergencies, who may resemble OHCA. We sought to examine the performance of the system to correctly identify cases requiring T-CPR, specifically at overdose prevention services (OPS)...

Point of Care Ultrasound (POCUS) has seen increasing use in the prehospital environment over the last decade, primarily with the extended focused assessment with sonography in trauma (eFAST) exam. Previous studies have shown prehospital eFAST exams are feasible in the helicopter transport environment but have yet to demonstrate effects on clinical care. This retrospective case series identified 655 patients with blunt thoraco-abdominal trauma or concern for pneumothorax due to penetrating injury transported by a single helicopter EMS (HEMS) program over a two-year period after introducing POCUS...

Background: Emergency Medical Service (EMS) clinicians experience high levels of occupational stress due to long hours, short staffing, and patient deaths, among other factors. While gender has been partially examined, little is known regarding the role of empathy on occupational stress and mental health (MH) outcomes among EMS clinicians. Therefore, the current study examines the moderating role of empathy and, separately, gender on associations between occupational stress and mental health. Methods: A cross-sectional examination of EMS clinician occupational and personal wellbeing was conducted via an anonymous, electronic survey...

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BACKGROUND: In 2019, the National EMS Quality Alliance (NEMSQA) established a suite of 11 evidence-based EMS quality measures, yet little is known regarding EMS performance on a national level. Our objective was to describe EMS performance at a response and agency level using the National EMS Information System (NEMSIS) dataset. METHODS: The 2019 NEMSIS research dataset of all EMS 9-1-1 responses in the United States was utilized to calculate 10 of 11 NEMSQA quality measures...

BACKGROUND: An ambulance traffic crash not only leads to injuries among Emergency Medical Service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, and seatbelt use for casualties (i.e., both fatal and non-fatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. METHODS: We conducted a nationwide survey of all fire departments in Japan...

BACKGROUND: Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians. METHODS: A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies...

INTRODUCTION: Routine continuous monitoring of endotracheal tube placement with waveform capnography is considered standard of care in the prehospital setting. However, maintaining this standard in neonatal patients remains a challenge due to low tidal volumes that do not tolerate the additional dead space ETCO2 attachments add. Additionally, continuous ETCO2 can increase the risk of ETT dislodgement or kinking because of the weight and size of the capnography attachments relative to the patient and tube size...

OBJECTIVES: To investigate the potential efficacy of a commercial continuous positive airway pressure (CPAP) ventilator to provide effective respiratory support in a simulated scenario of out-of-hospital cardiac arrest (OHCA). METHODS: The study was conducted on a high-fidelity manikin (SimMan 3 GTM , Laerdal, NOR) connected to the ASL 5000TM Lung Simulator (IngMar Medical, USA). To simulate OHCA, we set no spontaneous respiratory acts and physiological respiratory system resistance (13 cmH2 O/L...

BACKGROUND: The frequency and type of prehospital blood product delivery across Australia and Aotearoa-New Zealand is unknown. This study aims to describe transfusion practice across different services in the two nations, as well as identifying potential barriers to the carriage of blood products. METHODOLOGY: Prehospital and retrieval medicine services operating teams of doctors, specialist paramedics, and/or flight nurses out of specialty bases across Australia and Aotearoa-New Zealand were sent a standardized questionnaire regarding their base characteristics and their current blood transfusion practice...

BACKGROUND: The objective of this study is to identify patient and EMS agency factors associated with timely reperfusion of patients with ST-elevation myocardial infarction (STEMI). METHODS: We conducted a cohort study of adult patients (≥18 years old) with STEMI activations from 2016-2020. Data was obtained from a regional STEMI registry, which included eight rural county EMS agencies and three North Carolina percutaneous coronary intervention (PCI) centers...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Prehospital post-resuscitation hypotension and hypoxia have been associated with adverse outcomes in the context of out-of-hospital cardiac arrest (OHCA). We aimed to investigate the association between clinical outcomes and post-resuscitation hypoxia alone, hypotension alone, and combined hypoxia and hypotension. METHODS: We used the 2018-2021 ESO annual datasets to conduct this study. All EMS-treated non-traumatic OHCA patients who had a documented prehospital return of spontaneous circulation (ROSC) and two or more SpO2 readings and systolic blood pressures recorded were evaluated for inclusion...

OBJECTIVES: Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder. METHODS: The trauma registry was used to identify all trauma patients admitted to an urban Level I trauma center between January 2013 and December 2017...

Airway management is a cornerstone of emergency medical care. This project aimed to create evidence-based guidelines based on the systematic review recently conducted by the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel was assembled to review the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The panel made specific recommendations on the different PICO (population, intervention, comparison, outcome) questions reviewed in the AHRQ review and created good practice statements that summarize and operationalize these recommendations...