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Ems performance improvement

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https://www.readbyqxmd.com/read/29703811/relationship-between-emergency-medical-services-response-time-and-bystander-intervention-in-patients-with-out-of-hospital-cardiac-arrest
#1
Yoshikazu Goto, Akira Funada, Yumiko Goto
BACKGROUND: The response time of emergency medical services (EMS) is an important determinant of survival after out-of-hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. METHODS AND RESULTS: We analyzed the records of 553 426 patients with out-of-hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2)...
April 27, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29703219/primary-mass-casualty-incident-triage-evidence-for-the-benefit-of-yearly-brief-re-training-from-a-simulation-study
#2
Michael S Dittmar, Philipp Wolf, Marc Bigalke, Bernhard M Graf, Torsten Birkholz
BACKGROUND: Triage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed...
April 27, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29689354/timing-of-advanced-airway-management-by-emergency-medical-services-personnel-following-out-of-hospital-cardiac-arrest-a-population-based-cohort-study
#3
Junichi Izawa, Taku Iwami, Koichiro Gibo, Masashi Okubo, Kentaro Kajino, Kousuke Kiyohara, Chika Nishiyama, Tatsuya Nishiuchi, Yasuyuki Hayashi, Takeyuki Kiguchi, Daisuke Kobayashi, Sho Komukai, Takashi Kawamura, Clifton W Callaway, Tetsuhisa Kitamura
BACKGROUND: Early prehospital advanced airway management (AAM) by emergency medical services (EMS) personnel has been intended to improve patient outcomes from out-of-hospital cardiac arrest (OHCA). However, few studies examine the effectiveness of early prehospital AAM. We investigated whether early prehospital AAM was associated with functionally favourable survival after adult OHCA. METHODS: We conducted a population-based cohort study of OHCA in Osaka, Japan, between 2005 and 2012...
April 21, 2018: Resuscitation
https://www.readbyqxmd.com/read/29656835/trauma-quality-improvement-reducing-triage-errors-by-automating-the-level-assignment-process
#4
David P Stonko, Dillon C O Neill, Bradley M Dennis, Melissa Smith, Jeffrey Gray, Oscar D Guillamondegui
BACKGROUND: Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error...
April 12, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29624088/intrastate-variation-in-treatment-and-outcomes-of-out-of-hospital-cardiac-arrest
#5
Ryan A Coute, Theresa A Shields, James A Cranford, Sardar Ansari, Mahshid Abir, M Hakam Tiba, Robert Dunne, Brian O'Neil, Robert Swor, Robert W Neumar
OBJECTIVE: Our objective was to analyze and compare out-of-hospital cardiac arrest (OHCA) system of care performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan. We hypothesized that clinically and statistically significant variations in treatment and outcomes of OHCA exists within a single U.S. state. METHODS: We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014-2015...
April 6, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29604728/development-of-an-electron-momentum-spectrometer-for-time-resolved-experiments-employing-nanosecond-pulsed-electron-beam
#6
Yaguo Tang, Xu Shan, Zhaohui Liu, Shanshan Niu, Enliang Wang, Xiangjun Chen
The low count rate of (e, 2e) electron momentum spectroscopy (EMS) has long been a major limitation of its application to the investigation of molecular dynamics. Here we report a new EMS apparatus developed for time-resolved experiments in the nanosecond time scale, in which a double toroidal energy analyzer is utilized to improve the sensitivity of the spectrometer and a nanosecond pulsed electron gun with a repetition rate of 10 kHz is used to obtain an average beam current up to nA. Meanwhile, a picosecond ultraviolet laser with a repetition rate of 5 kHz is introduced to pump the sample target...
March 2018: Review of Scientific Instruments
https://www.readbyqxmd.com/read/29572947/metabolic-perturbations-in-welsh-ponies-with-insulin-dysregulation-obesity-and-laminitis
#7
Sarah I Jacob, Kevin J Murray, Aaron K Rendahl, Raymond J Geor, Nichol E Schultz, Molly E McCue
BACKGROUND: Metabolomics, the study of small-molecule metabolites, has increased understanding of human metabolic diseases, but has not been used to study equine metabolic syndrome (EMS). OBJECTIVES: (1) To examine the serum metabolome of Welsh Ponies with and without insulin dysregulation before and during an oral sugar test (OST). (2) To identify differences in metabolites in ponies with insulin dysregulation, obesity, or history of laminitis. ANIMALS: Twenty Welsh Ponies (mean ± SD; 13...
March 23, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29560052/variations-in-cardiac-arrest-regionalization-in-california
#8
Brian L Chang, Mary P Mercer, Nichole Bosson, Karl A Sporer
Introduction: The development of cardiac arrest centers and regionalization of systems of care may improve survival of patients with out-of-hospital cardiac arrest (OHCA). This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California. Methods: We surveyed all of the 33 LEMSA in California regarding the treatment and routing of OHCA patients according to the current recommendations for OHCA management...
March 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29549460/success-rates-of-pre-hospital-difficult-airway-management-a-quality-control-study-evaluating-an-in-hospital-training-program
#9
Helmut Trimmel, Christoph Beywinkler, Sonja Hornung, Janett Kreutziger, Wolfgang G Voelckel
BACKGROUND: Competence in emergency airway management is key in order to improve patient safety and outcome. The scope of compulsory training for emergency physicians or paramedics is quite limited, especially in Austria. The purpose of this study was to review the difficult airway management performance of an emergency medical service (EMS) in a region that has implemented a more thorough training program than current regulations require, comprising 3 months of initial training and supervised emergency practice and 3 days/month of on-going in-hospital training as previously reported...
March 16, 2018: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29511001/time-to-epinephrine-administration-and-survival-from-nonshockable-out-of-hospital-cardiac-arrest-among-children-and-adults
#10
Matthew Hansen, Robert H Schmicker, Craig D Newgard, Brian Grunau, Frank Scheuermeyer, Sheldon Cheskes, Veer Vithalani, Fuad Alnaji, Thomas Rea, Ahamed H Idris, Heather Herren, Jamie Hutchison, Mike Austin, Debra Egan, Mohamud Daya
BACKGROUND: Previous studies have demonstrated that earlier epinephrine administration is associated with improved survival from out-of-hospital cardiac arrest (OHCA) with shockable initial rhythms. However, the effect of epinephrine timing on patients with nonshockable initial rhythms is unclear. The objective of this study was to measure the association between time to epinephrine administration and survival in adults and children with emergency medical services (EMS)-treated OHCA with nonshockable initial rhythms...
May 8, 2018: Circulation
https://www.readbyqxmd.com/read/29499230/regional-variation-in-the-characteristics-incidence-and-outcomes-of-out-of-hospital-cardiac-arrest-in-australia-and-new-zealand-results-from-the-aus-roc-epistry
#11
Ben Beck, Janet Bray, Peter Cameron, Karen Smith, Tony Walker, Hugh Grantham, Cindy Hein, Melanie Thorrowgood, Anthony Smith, Madoka Inoue, Tony Smith, Bridget Dicker, Andy Swain, Emma Bosley, Katherine Pemberton, Michael McKay, Malcolm Johnston-Leek, Gavin D Perkins, Graham Nichol, Judith Finn
INTRODUCTION: The aim of this study was to investigate regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. METHODS: This was a population-based cohort study of OHCA using data from the Aus-ROC Australian and New Zealand OHCA Epistry over the period of 01 January 2015-31 December 2015. Seven ambulance services contributed data to the Epistry with a capture population of 19.8 million people...
May 2018: Resuscitation
https://www.readbyqxmd.com/read/29412043/acute-crisis-care-for-patients-with-mental-health-crises-initial-assessment-of-an-innovative-prehospital-alternative-destination-program-in-north-carolina
#12
Jamie O Creed, Julianne M Cyr, Hillary Owino, Shannen E Box, Mia Ives-Rublee, Brian B Sheitman, Beat D Steiner, Jefferson G Williams, Michael W Bachman, Jose G Cabanas, J Brent Myers, Seth W Glickman
OBJECTIVE: Emergency Departments (ED) are overburdened with patients experiencing acute mental health crises. Pre-hospital transport by Emergency Medical Services (EMS) to community mental health and substance abuse treatment facilities could reduce ED utilization and costs. Our objective was to describe characteristics, treatment, and outcomes of acute mental health crises patients who were transported by EMS to an acute crisis unit at WakeBrook, a North Carolina community mental health center...
February 7, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29408717/a-smartphone-application-for-dispatch-of-lay-responders-to-out-of-hospital-cardiac-arrests
#13
Ellinor Berglund, Andreas Claesson, Per Nordberg, Therese Djärv, Peter Lundgren, Fredrik Folke, Sune Forsberg, Gabriel Riva, Mattias Ringh
BACKGROUND: Dispatch of lay volunteers trained in cardiopulmonary resuscitation (CPR) and equipped with automated external defibrillators (AEDs) may improve survival in cases of out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the functionality and performance of a smartphone application for locating and alerting nearby trained laymen/women in cases of OHCA. METHODS: A system using a smartphone application activated by Emergency Dispatch Centres was used to locate and alert laymen/women to nearby suspected OHCAs...
May 2018: Resuscitation
https://www.readbyqxmd.com/read/29395772/effectiveness-of-prehospital-trauma-triage-systems-in-selecting-severely-injured-patients-is-comparative-analysis-possible
#14
REVIEW
Eveline A J van Rein, Rogier van der Sluijs, R Marijn Houwert, Amy C Gunning, Rob A Lichtveld, Luke P H Leenen, Mark van Heijl
INTRODUCTION: In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for trauma patients. METHODS: A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms...
January 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29367992/predicted-detonation-properties-at-the-chapman-jouguet-state-for-proposed-energetic-materials-mto-and-mto3n-from-combined-reaxff-and-quantum-mechanics-reactive-dynamics
#15
Tingting Zhou, Sergey V Zybin, William A Goddard, Tao Cheng, Saber Naserifar, Andres Jaramillo-Botero, Fenglei Huang
The development of new energetic materials (EMs) with improved detonation performance but low sensitivity and environmental impact is of considerable importance for applications in civilian and military fields. Often new designs are difficult to synthesize so predictions of performance in advance is most valuable. Examples include MTO (2,4,6-triamino-1,3,5-triazine-1,3,5-trioxide) and MTO3N (2,4,6-trinitro-1,3,5-triazine-1,3,5-trioxide) suggested by Klapötke as candidate EMs but not yet successfully synthesized...
January 25, 2018: Physical Chemistry Chemical Physics: PCCP
https://www.readbyqxmd.com/read/29352616/assessing-advanced-airway-management-performance-in-a-national-cohort-of-emergency-medical-services-agencies
#16
Henry E Wang, John P Donnelly, Dustin Barton, Jeffrey L Jarvis
STUDY OBJECTIVE: Although often the focus of quality improvement efforts, emergency medical services (EMS) advanced airway management performance has few national comparisons, nor are there many assessments with benchmarks accounting for differences in agency volume or patient mix. We seek to assess variations in advanced airway management and conventional intubation performance in a national cohort of EMS agencies. METHODS: We used EMS data from ESO Solutions, a national EMS electronic health record system...
January 15, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29345513/no-benefit-in-neurologic-outcomes-of-survivors-of-out-of-hospital-cardiac-arrest-with-mechanical-compression-device
#17
Ryan Newberry, Ted Redman, Elliot Ross, Rachel Ely, Clayton Saidler, Allyson Arana, David Wampler, David Miramontes
INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a major cause of death and morbidity in the United States. Quality cardiopulmonary resuscitation (CPR) has proven to be a key factor in improving survival. The aim of our study was to investigate the outcomes of OHCA when mechanical CPR (LUCAS 2 Chest Compression System™) was utilized compared to conventional CPR. Although controlled trials have not demonstrated a survival benefit to the routine use of mechanical CPR devices, there continues to be an interest for their use in OHCA...
May 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29336652/detection-of-stemi-using-prehospital-serial-12-lead-electrocardiograms
#18
Alain Tanguay, Johann Lebon, Lorraine Lau, Denise Hébert, François Bégin
OBJECTIVE: Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction...
January 16, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29330570/open-door-laminoplasty-what-can-the-unilateral-approach-offer
#19
REVIEW
R Kothe, G Schmeiser, L Papavero
OBJECTIVE: Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach. INDICATIONS: Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis. CONTRAINDICATIONS: Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement of C2 or C7. SURGICAL TECHNIQUE: Unilateral subaxial approach with detachment of muscles only on one side...
February 2018: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/29327141/theoretical-study-on-benzoheterocycle-based-energetic-materials-effect-of-heterocyclic-fused-conjugation-hydrogen-bond-and-substitutional-group-on-the-detonation-performance
#20
Cheng Shen, Pengcheng Wang, Ming Lu
In this paper, four series of benzoheterocycle based energetic materials (EMs) have been designed to plan out a strategy to improve the density and safety of EMs, such as combining the insensitive group with aminobenzene ring and the high energetic nitramine explosives, benzo-heterocycle mother ring, designing multi-nitrogen heterocycles with a conjugated system containing N-N and C-N high energy bonds, and hydrogen bonding. Their optimized structure and detonation properties were first calculated and discussed using DFT methods...
January 11, 2018: Journal of Molecular Modeling
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