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Prehospital critical care

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https://www.readbyqxmd.com/read/27894558/helicopter-scene-response-for-stroke-patients-a-5-year-experience
#1
Andrew Hawk, Catherine Marco, Matt Huang, Bonnie Chow
OBJECTIVE: The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. METHODS: CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27894557/reporting-helicopter-emergency-medical-services-in-major-incidents-a-delphi-study
#2
Sabina Fattah, Anne Siri Johnsen, Stephen J M Sollid, Torben Wisborg, Marius Rehn, Ákos Sóti, Anatolij Truhlář, Andreas J Krüger, Björn Gunnarsson, Dan Gryth, David Ohlén, Espen Fevang, Geir Arne Sunde, Ivo Breitenmoser, Jouni Kurola, Jouni Nurmi, Knut Fredriksen, Leif Rognås, Peter Temesvari, Søren Mikkelsen, Vidar Magnusson, Wolfgang Voelckel
OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences. This type of database presently exists for major incident reporting at www.majorincidentreporting.net. This study aimed to develop a HEMS-specific major incident template. METHODS: This Delphi study included 17 prehospital critical care physicians with current or previous HEMS experience...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27894556/benchmarking-pain-assessment-rate-in-critical-care-transport
#3
Ryan J Reichert, M David Gothard, Hamilton P Schwartz, Michael T Bigham
The purpose of this study is to determine the rate of pain assessment in pediatric neonatal critical care transport (PNCCT). The GAMUT database was interrogated for an 18-month period and excluded programs with less than 10% pediatric or neonatal patient contacts and less than 3 months of any metric data reporting during the study period. We hypothesized pain assessment during PNCCT is superior to prehospital pain assessment rates, although inferior to in-hospital rates. Sixty-two programs representing 104,445 patient contacts were analyzed...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27879534/physician-provided-prehospital-critical-care-effect-on-patient-physiology-dynamics-and-on-scene-time
#4
Bjørn O Reid, Marius Rehn, Oddvar Uleberg, Andreas J Krüger
INTRODUCTION: Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions...
November 22, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27858581/evidence-based-guidelines-for-fatigue-risk-management-in-ems-formulating-research-questions-and-selecting-outcomes
#5
P Daniel Patterson, J Stephen Higgins, Eddy S Lang, Michael S Runyon, Laura K Barger, Jonathan R Studnek, Charity G Moore, Kathy Robinson, Dia Gainor, Allison Infinger, Patricia M Weiss, Denisse J Sequeira, Christian Martin-Gill
BACKGROUND: Greater than half of Emergency Medical Services (EMS) personnel report work-related fatigue, yet there are no guidelines for the management of fatigue in EMS. A novel process has been established for evidence-based guideline (EBG) development germane to clinical EMS questions. This process has not yet been applied to operational EMS questions like fatigue risk management. The objective of this study was to develop content valid research questions in the Population, Intervention, Comparison, and Outcome (PICO) framework, and select outcomes to guide systematic reviews and development of EBGs for EMS fatigue risk management...
November 18, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27858502/prehospital-providers-perceptions-on-providing-patient-and-family-centered-care
#6
Emily M Ayub, Esther M Sampayo, Manish I Shah, Cara B Doughty
BACKGROUND: A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. METHODS: We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course...
November 18, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27832843/time-is-the-enemy-mortality-in-trauma-patients-with-hemorrhage-from-torso-injury-occurs-long-before-the-golden-hour
#7
A Q Alarhayem, J G Myers, D Dent, L Liao, M Muir, D Mueller, S Nicholson, R Cestero, M C Johnson, R Stewart, Grant O'Keefe, B J Eastridge
INTRODUCTION: The concept of the "Golden Hour" has been a time-honored tenet of prehospital trauma care, despite a paucity of data to substantiate its validity. Non-compressible torso hemorrhage has been demonstrated to be a significant cause of mortality in both military and civilian settings. We sought to characterize the impact of prehospital time and torso injury severity on survival. Furthermore, we hypothesized that time would be a significant determinant of mortality in patients with higher Abbreviated Injury Scale (AIS) grades of torso injury (AIS ≥ 4) and field hypotension (prehospital SBP ≤ 110 mmHg) as these injuries are commonly associated with hemorrhage...
October 20, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27771338/tools-for-assessment-of-communication-skills-of-hospital-action-teams-a-systematic-review
#8
Shady A Rehim, Stephanie DeMoor, Richard Olmsted, Daniel L Dent, Jessica Parker-Raley
BACKGROUND: Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE: To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments...
October 19, 2016: Journal of Surgical Education
https://www.readbyqxmd.com/read/27690714/can-ems-providers-provide-appropriate-tidal-volumes-in-a-simulated-adult-sized-patient-with-a-pediatric-sized-bag-valve-mask
#9
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
October 3, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27665426/managing-stress-in-prehospital-care-strategies-used-by-ambulance-nurses
#10
Dan Bohström, Eric Carlström, Nils Sjöström
BACKGROUND: Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. METHODS: A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed...
September 21, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27648771/prehospital-point-of-care-lactate-following-trauma-a-systematic-review
#11
Christopher T Lewis, David N Naumann, Nick Crombie, Mark J Midwinter
BACKGROUND: Serum lactate serves as a surrogate marker for global tissue hypoxia following traumatic injury and has potential to guide resuscitation. Portable, handheld point-of-care monitoring devices enable lactate values to be readily available in the prehospital environment. The current review examines the utility of prehospital lactate (pLa) measurement in the management of trauma. METHODS: MEDLINE and EMBASE databases were searched using predefined criteria (pLa measurement, trauma patients) until March 10, 2016...
October 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27618374/demographic-clinical-and-health-system-characteristics-associated-with-pain-assessment-documentation-and-pain-severity-in-u-s-military-patients-in-combat-zone-emergency-departments-2010-2013
#12
Virginia Schmied Blackman, Bruce A Cooper, Kathleen Puntillo, Linda S Franck
Emergency department (ED) pain assessment documentation in trauma patients is critical to ED pain care. This retrospective, cross-sectional study used trauma registry data to evaluate U.S. military combat zone trauma patients injured between 2010 and 2013 requiring ≥ 24-hr inpatient care. Study aims were to identify the frequency of combat zone ED pain assessment documentation and describe pain severity. Secondary aims were to construct statistical models to explain variation in pain assessment documentation and pain severity...
September 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/27608817/parental-care-seeking-behavior-and-prehospital-timelines-of-care-in-childhood-arterial-ischemic-stroke
#13
Mark T Mackay, Belinda Stojanovski, Ian Mosley, Leonid Churilov, Geoffrey A Donnan, Paul Monagle
BACKGROUND AND PURPOSE: Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS: A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014...
October 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27536530/alcohol-use-in-the-prehospital-setting-a-diagnostic-challenge-in-patients-treated-by-a-physician-staffed-mobile-intensive-care-unit
#14
Terhi Kauppila, Janne Virta, Leena Lindgren, Ilkka Virkkunen, Antti Kämäräinen
BACKGROUND: Alcohol use among emergency patients has been studied earlier, but the data regarding alcohol use especially among critically ill and injured patients treated in the prehospital setting is scarce. The aim of this study was to evaluate the incidence of alcohol use and the characteristics of cases attended by a physician staffed mobile intensive care unit (MICU). FINDINGS: During a 2 month period, exhaled air alcohol concentration-measured as a part of routine patient examination in all adolescent and adult patients treated by the MICU-was recorded...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27530816/creation-and-validation-of-a-novel-mobile-simulation-laboratory-for-high-fidelity-prehospital-difficult-airway-simulation
#15
Jason J Bischof, Ashish R Panchal, Geoffrey I Finnegan, Thomas E Terndrup
UNLABELLED: Introduction Endotracheal intubation (ETI) is a complex clinical skill complicated by the inherent challenge of providing care in the prehospital setting. Literature reports a low success rate of prehospital ETI attempts, partly due to the care environment and partly to the lack of consistent standardized training opportunities of prehospital providers in ETI. Hypothesis/Problem The availability of a mobile simulation laboratory (MSL) to study clinically critical interventions is needed in the prehospital setting to enhance instruction and maintain proficiency...
October 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27515164/external-validation-of-a-prehospital-risk-score-for-critical-illness
#16
Daniel R Kievlan, Christian Martin-Gill, Jeremy M Kahn, Clifton W Callaway, Donald M Yealy, Derek C Angus, Christopher W Seymour
BACKGROUND: Identification of critically ill patients during prehospital care could facilitate early treatment and aid in the regionalization of critical care. Tools to consistently identify those in the field with or at higher risk of developing critical illness do not exist. We sought to validate a prehospital critical illness risk score that uses objective clinical variables in a contemporary cohort of geographically and temporally distinct prehospital encounters. METHODS: We linked prehospital encounters at 21 emergency medical services (EMS) agencies to inpatient electronic health records at nine hospitals in southwestern Pennsylvania from 2010 to 2012...
August 11, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27512532/utilizations-and-perceptions-of-emergency-medical-services-by-patients-with-st-segments-elevation-acute-myocardial-infarction-in-abu-dhabi-a-multicenter-study
#17
Edward Lance Callachan, Alawi A Alsheikh-Ali, Satish Chandrasekhar Nair, Stevan Bruijns, Lee A Wallis
BACKGROUND: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. OBJECTIVES: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. METHODS: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi...
April 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/27505936/beyond-blood-sugar
#18
Matt Zavadsky, Desiree Partain
Because POC testing has been shown to alter prehospital care in up to 30% of its uses, it may be logical for prehospital systems to consider implementing a POC testing system. Information gleaned from the i-STAT data can be used to treat electrolyte imbalances, adjust medications and ventilator settings, and even change IV fluid use. MIH providers can also use the data from POC testing to provide important feedback to physicians about enrolled patients. All of these uses support critical clinical decision making by field EMS providers, and will perhaps even help promote the value proposition we're all striving for in our EMS delivery models...
June 2016: JEMS: a Journal of Emergency Medical Services
https://www.readbyqxmd.com/read/27484298/characteristics-and-outcomes-of-blood-product-transfusion-during-critical-care-transport
#19
Jorge Mena-Munoz, Udayan Srivastava, Christian Martin-Gill, Brian Suffoletto, Clifton W Callaway, Francis X Guyette
BACKGROUND: Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport. STUDY DESIGN AND METHODS: We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities...
September 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27450605/integration-of-tactical-emergency-casualty-care-into-the-national-tactical-emergency-medical-support-competency-domains
#20
Andre Pennardt, Rich Kamin, Craig Llewellyn, Geoff Shapiro, Philip A Carmona, Richard B Schwartz
Tactical emergency medical support (TEMS) is a critical component of the out-of-hospital response to domestic high-threat incidents such as hostage scenarios, warrant service, active shooter or violent incidents, terrorist attacks, and other intentional mass casualty-producing acts. From its grass-roots inception in the form of medical support of select law enforcement special weapons and tactics (SWAT) units in the 1980s, the TEMS subspecialty of prehospital care has rapidly grown and evolved over the past 40 years...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
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