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Prehospital critical care

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https://www.readbyqxmd.com/read/28910212/feasibility-of-paramedic-performed-prehospital-lung-ultrasound-in-medical-patients-with-respiratory-distress
#1
Torben K Becker, Christian Martin-Gill, Clifton W Callaway, Francis X Guyette, Christopher Schott
OBJECTIVE: Prehospital ultrasound is not yet widely implemented. Most studies report on convenience samples and trauma patients, often by prehospital physicians or critical care clinicians. We assessed the feasibility of paramedic performed prehospital lung ultrasound in medical patients with respiratory distress. METHODS: Paramedics at 2 ambulance stations in the city of Pittsburgh, Pennsylvania, USA underwent a 2-hour training session in prehospital lung ultrasound using the SonoSite iViz, a handheld ultrasound device...
September 14, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28807071/single-rescuer-ventilation-using-a-bag-valve-mask-with-removable-external-handle-a-randomized-crossover-trial
#2
Paul Reed, Baruch Zobrist, Monica Casmaer, Steven G Schauer, Nurani Kester, Michael D April
Introduction Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting. Hypothesis Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model. METHODS: This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark)...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28795061/a-multi-agent-based-approach-for-prehospital-emergency-management
#3
Reza Safdari, Jaleh Shoshtarian Malak, Niloofar Mohammadzadeh, Azimeh Danesh Shahraki
OBJECTIVE: To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. METHODS: Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed...
July 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28792281/pan-asian-trauma-outcomes-study-patos-rationale-and-methodology-of-an-international-and-multicenter-trauma-registry
#4
So Yeon Kong, Sang Do Shin, Hideharu Tanaka, Akio Kimura, Kyoung Jun Song, Goh E Shaun, Wen-Chu Chiang, Kentaro Kajino, Sabariah Faizah Jamaluddin, Dae Han Wi, Ju Ok Park, Sung Woo Moon, Young Sun Ro, David C Cone, James F Holmes
BACKGROUND: Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28766306/interpretation-of-brain-ct-scans-in-the-field-by-critical-care-physicians-in-a-mobile-stroke-unit
#5
Maren Ranhoff Hov, Erik Zakariassen, Thomas Lindner, Terje Nome, Kristi G Bache, Jo Røislien, Jostein Gleditsch, Volker Solyga, David Russell, Christian G Lund
BACKGROUND AND PURPOSE: In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU)...
July 27, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28748771/acute-care-referral-systems-in-liberia-transfer-and-referral-capabilities-in-a-low-income-country
#6
Jimin Kim, Maria Barreix, Christine Babcock, Corey B Bills
Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia...
July 27, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28746084/epidemiology-and-location-of-primary-retrieval-missions-in-a-scottish-aeromedical-service
#7
Gregg Neagle, Lisa Curatolo, John Ferris, Mike Donald, Stephen Hearns, Alasdair R Corfield
INTRODUCTION: Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road...
July 25, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28717647/intracranial-hematoma-detection-by-near-infrared-spectroscopy-in-a-helicopter-emergency-medical-service-practical-experience
#8
Patrick Schober, Sebastiaan M Bossers, Lothar A Schwarte
In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a "first-time-right" monitor in healthy volunteers (n = 17, hospital employees, no neurologic history)...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28701849/blunt-trauma-neck-with-complete-tracheal-transection-a-diagnostic-and-therapeutic-challenge-to-the-trauma-team
#9
K N J Prakash Raju, D Anandhi, R Surendar, Ashwith Shetty, Vinay R Pandit
Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28693524/national-consensus-on-communication-in-prehospital-trauma-care-the-denim-study
#10
Annelieke Maria Karien Harmsen, Leo Maria George Geeraedts, Georgios Fredericus Giannakopoulos, Maartje Terra, Herman M T Christiaans, Lidwine Brigitta Mokkink, Frank Willem Bloemers
BACKGROUND: In the Netherlands prehospital trauma care is provided by emergency medical services (EMS) nurses. This care is extended by Physician staffed Helicopter Emergency Medical Services (P-HEMS) for the more severely injured patient. Prehospital communication is a factor of influence on the identification of these patients and the dispatch of P-HEMS. Though prehospital communication it is often perceived to be incomplete and unstructured. To elucidated factors of influence on prehospital triage and the identification of the severely injured patient a Delphi study was performed...
July 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28676492/local-emergency-medical-response-after-a-terrorist-attack-in-norway-a-qualitative-study
#11
Aleidis S Brandrud, Michael Bretthauer, Guttorm Brattebø, May Jb Pedersen, Kent Håpnes, Karin Møller, Trond Bjorge, Bjørnar Nyen, Lars Strauman, Ada Schreiner, Gro S Haldorsen, Maria Bergli, Eugene Nelson, Tamara S Morgan, Per Hjortdahl
INTRODUCTION: On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare...
July 4, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28661784/identifying-key-words-in-9-1-1-calls-for-stroke-a-mixed-methods-approach
#12
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/28622155/triad-ix-can-a-patient-testimonial-safely-help-ensure-prehospital-appropriate-critical-versus-end-of-life-care
#13
Ferdinando Mirarchi, Christopher Cammarata, Timothy E Cooney, Kristin Juhasz, Stanley A Terman
OBJECTIVE: The present study sought to assess the clarity of Physician Orders for Life-Sustaining Treatment (POLST) or Living Will (LW) documents alone or in combination with a video message/testimonial (VM). METHODS: Emergency medical services (EMS) personnel responded to survey questions about the meaning of stand-alone POLST and LW documents and those used in conjunction with emergent care scenarios. Personnel were randomized to receive documents only or documents with VM...
June 16, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28622074/disparities-in-feedback-provision-to-emergency-medical-services-professionals
#14
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/28601206/prolonged-field-care-beyond-the-golden-hour
#15
REVIEW
Sean Keenan, Jamie C Riesberg
Prolonged field care (PFC) has emerged as a recent area of focus for US military Special Operations Forces (SOF) medical experts. Focused on the current reality of providing medical care to military forces often deployed in remote and austere locations far from medical support or a robust casualty evacuation chain, PFC encompasses evolving operational situations not unlike many wilderness medicine practice environments. SOF currently operates in all areas of the world and on a variety of different missions, which finds these small teams far from the accustomed practice environment of robust deployed medical infrastructure commonly seen during the last 15 years of military conflicts...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28587694/a-survey-of-front-line-paramedics-examining-the-professional-relationship-between-paramedics-and-physician-medical-oversight
#16
Christopher R Foerster, Walter Tavares, Ilkka Virkkunen, Antti Kämäräinen
OBJECTIVE: Paramedicine is often dependent on physician medical directors and their associated programs for direction and oversight. A positive relationship between paramedics and their oversight physicians promotes safety and quality care while a strained or ineffective one may threaten these goals. The objective of this study was to explore and understand the professional relationship between paramedics and physician medical oversight as viewed by front-line paramedics. METHODS: All active front-line paramedics from four municipal paramedic services involving three medical oversight groups in Ontario were invited to complete an online survey...
June 7, 2017: CJEM
https://www.readbyqxmd.com/read/28557070/color-and-power-doppler-sonography-for-pneumothorax-detection
#17
John R Richards, Julianne M Awrey, Sarah E Medeiros, John P McGahan
The use of B- and M-mode sonography for detection of pneumothorax has been well described and studied. It is now widely incorporated by sonographers, emergency physicians, trauma surgeons, radiologists, and critical care specialists worldwide. Lung sonography can be performed rapidly at the bedside or in the prehospital setting. It is more sensitive, specific, and accurate than plain chest radiography. The use of color and power Doppler sonography as an adjunct to B- and M-mode imaging for detection of pneumothorax has been described in a small number of studies and case reports but is much less widely known or used...
October 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28509774/the-role-of-the-anaesthesiologist-in-air-ambulance-medicine
#18
Stephen J M Sollid, Marius Rehn
PURPOSE OF REVIEW: The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. RECENT FINDINGS: Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions...
August 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28501815/can-the-prehospital-national-early-warning-score-identify-patients-most-at-risk-from-subsequent-deterioration
#19
Joanna Shaw, Rachael T Fothergill, Sophie Clark, Fionna Moore
INTRODUCTION: The National Early Warning Score (NEWS) aids the early recognition of those at risk of becoming critically ill. NEWS has been recommended for use by ambulance services, but very little work has been undertaken to date to determine its suitability. This paper examines whether a prehospital NEWS derived from ambulance service clinical observations is associated with the hospital ED disposition. METHODS: Prehospital NEWS was retrospectively calculated from the ambulance service clinical records of 287 patients who were treated by the ambulance service and transported to hospital...
August 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28499679/aeromedical-ultrasound-the-evaluation-of-point-of-care-ultrasound-during-helicopter-transport
#20
Jeffrey G Yates, Denise Baylous
INTRODUCTION: This study correlated the eFAST findings performed in-flight by the flight crew with the findings obtained by the trauma team upon initial evaluation at a level 1 trauma center and with the subsequent CT scans that were performed or the surgeon's operative note. We hypothesize that aeromedical eFAST examinations are highly correlated with the trauma teams findings. METHODS: This prospective, observational study evaluated 190 traumatically injured patients from June 2014 to December 2015 in Southeast Virginia and Northeast North Carolina...
May 2017: Air Medical Journal
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