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prehospital physician

Vibe Maria Laden Nielsen, Jacob Madsen, Anette Aasen, Anne Pernille Toft-Petersen, Kenneth Lübcke, Bodil Steen Rasmussen, Erika Frischknecht Christensen
BACKGROUND: Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory support with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the study is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care. METHODS: In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering from acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were treated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Katherine Remick, Christopher Redgate, Daniel Ostermayer, Amy H Kaji, Marianne Gausche-Hill
OBJECTIVE: Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED)...
September 16, 2016: Prehospital Emergency Care
A M K Harmsen, G F Giannakopoulos, M Terra, E S M de Lange de Klerk, F W Bloemers
PURPOSE: Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation. METHODS: A cohort comparison, between June 2004-July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome...
September 15, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Lucas A Myers, Charles G Gallet, Logan J Kolb, Christine M Lohse, Christopher S Russi
INTRODUCTION: This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. METHODS: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth)...
September 2016: Western Journal of Emergency Medicine
Jose V Nable, Benjamin J Lawner, William J Brady
In the daily practice of emergency medicine, physicians constantly interact with components of emergency medical services systems. The provision of high-quality care in the prehospital setting requires emergency physicians to remain abreast of recent literature that may inform the care of patients prior to their arrival at the emergency department. This literature review will examine some recent trends in the prehospital literature. In addition, the review will highlight important areas of clinical practice which represent some of the many intersections between emergency medicine and emergency medical services such as cardiac arrest and airway management...
July 19, 2016: American Journal of Emergency Medicine
Annika Hamilton, Jacob Steinmetz, Mads Wissenberg, Christian Torp-Pedersen, Freddy K Lippert, Lars Hove, Nicolai Lohse
AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician involvement and 30-day survival. METHODS: Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012...
August 23, 2016: Resuscitation
Benjamin Lindquist, Matthew C Strehlow, G V Ramana Rao, Jennifer A Newberry
BACKGROUND: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care...
2016: Curēus
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
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
Charlotte Loumann Krogh, Jacob Steinmetz, Søren Steemann Rudolph, Rasmus Hesselfeldt, Freddy K Lippert, Peter A Berlac, Lars S Rasmussen
BACKGROUND: Advances in technology have made ultrasound (US) devices smaller and portable, hence accessible for prehospital care providers. This study aims to evaluate the effect of a four-hour, hands-on US training course for physicians working in the prehospital setting. The primary outcome measure was US performance assessed by the total score in a modified version of the Objective Structured Assessment of Ultrasound Skills scale (mOSAUS). METHODS: Prehospital physicians participated in a four-hour US course consisting of both hands-on training and e-learning including a pre- and a post-learning test...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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
Christian B Laursen, Anja Hänselmann, Stefan Posth, Søren Mikkelsen, Lars Videbæk, Henrik Berg
BACKGROUND: An improved prehospital diagnostic accuracy of cardiogenic pulmonary oedema could potentially improve initial treatment, triage, and outcome. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema. METHODS: A prospective observational study was conducted in a prehospital setting. Patients were included if the physician based prehospital mobile emergency care unit was activated and one or more of the following two were present: respiratory rate >30/min...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Domhnall O'Dochartaigh, Matthew Douma, Mark MacKenzie
OBJECTIVE: To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). METHODS: A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s)...
July 19, 2016: Prehospital Emergency Care
Lorin R Browne, Manish I Shah, Jonathan R Studnek, Daniel G Ostermayer, Stacy Reynolds, Clare E Guse, David C Brousseau, E Brooke Lerner
BACKGROUND: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed...
July 13, 2016: Prehospital Emergency Care
Whitney Jones Rhodes, David Steinbruner, Lani Finck, Kathleen Flarity
OBJECTIVE: The purpose of this study was to qualitatively describe the underpinnings of the successful implementation of a collaborative prehospital spinal immobilization guideline throughout the emergency medical services (EMS) community in two counties in Colorado. We also describe lessons learned that may be beneficial to other communities considering similar initiatives. METHODS: Qualitative data were collected from key informants who were directly involved in the implementation of a new prehospital spinal immobilization guideline among four community hospitals in two different hospital systems and the associated EMS providers within the two counties...
July 13, 2016: Prehospital Emergency Care
Yann Daniel, Sébastien Habas, Maximilien Cruc
BACKGROUND: Out-of-hospital endotracheal intubation is a frequent procedure for trauma care. Nevertheless, in warm climates, sunlight and heat can interfere with the flow of the usual procedure. They can affect the equipment and hinder the operator. There are few data on this issue. The presentation of this case highlights three common complications that may occur when intubating under a hot and bright sun. CASE REPORT: A 23-year-old man had a car accident in Djibouti, at 11:00 a...
September 2016: Journal of Emergency Medicine
Stefan Taubenböck, Wolfgang Lederer, Marc Kaufmann, Gunnar Kroesen
OBJECTIVE: The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. METHODS: Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. RESULTS: Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8...
September 2016: Wilderness & Environmental Medicine
Misgav Rottenstreich, Yuval Glick, Ofer Natan Gofrit
BACKGROUND: Acute scrotal pain (ASP) is a common symptom of young adults. Testicular torsion is the most important diagnosis in these cases. It is a medical emergency in which the diagnosis must be made rapidly to prevent testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. This study was conducted to examine the spectrum of diagnoses in young man with ASP in a prehospital setting, the frequency of significant diagnoses, and their outcomes...
October 2016: American Journal of Emergency Medicine
Glenn Larsson, Anders Holmén, Kristina Ziegert
The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medical condition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition...
2016: Studies in Health Technology and Informatics
Matthew Hansen, Garth Meckler, Kerth OʼBrien, Phillip Engle, Caitlin Dickinson, Kathryn Dickinson, Jonathan Jui, William Lambert, Erika Cottrell, Jeanne-Marie Guise
OBJECTIVE: The objective of this study was to determine what aspects of prehospital pediatric airway management may contribute to patient safety events. METHODS: We conducted a 3-phase Delphi survey in prehospital professionals across the United States to identify potential contributors to patient safety events. Respondents ranked how likely factors were to contribute on a 9-point Likert-type scale and were allowed to elaborate through open-ended questions. Analysis was conducted using a mixed-methods approach, including Likert-type responses and open-ended questions which were analyzed for specific themes...
September 2016: Pediatric Emergency Care
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