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Ems performance improvement

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 non-shockable 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 EMS-treated OHCA with non-shockable initial rhythms. Methods -We performed a secondary analysis of OHCAs prospectively identified by the Resuscitation Outcomes Consortium (ROC) network from June 4, 2011 to June 30, 2015...
March 6, 2018: Circulation
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 to 31 December 2015. Seven ambulance services contributed data to the Epistry with a capture population of 19.8 million people...
February 27, 2018: Resuscitation
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
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...
January 31, 2018: Resuscitation
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
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
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
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...
January 18, 2018: Prehospital Emergency Care
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
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...
January 12, 2018: Operative Orthopädie und Traumatologie
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
Christian Martin-Gill, Laura K Barger, Charity G Moore, J Stephen Higgins, Ellen M Teasley, Patricia M Weiss, Joseph P Condle, Katharyn L Flickinger, Patrick J Coppler, Denisse J Sequeira, Ayushi A Divecha, Margaret E Matthews, Eddy S Lang, P Daniel Patterson
BACKGROUND: Scheduled napping during work shifts may be an effective way to mitigate fatigue-related risk. This study aimed to critically review and synthesize existing literature on the impact of scheduled naps on fatigue-related outcomes for EMS personnel and similar shift worker groups. METHODS: A systematic literature review was performed of the impact of a scheduled nap during shift work on EMS personnel or similar shift workers. The primary (critical) outcome of interest was EMS personnel safety...
January 11, 2018: Prehospital Emergency Care
Jonathan R Studnek, Allison E Infinger, Megan L Renn, Patricia M Weiss, Joseph P Condle, Katharyn L Flickinger, Andrew J Kroemer, Brett R Curtis, Xiaoshuang Xun, Ayushi A Divecha, Patrick J Coppler, Zhadyra Bizhanova, Denisse J Sequeira, Eddy Lang, J Stephen Higgins, P Daniel Patterson
BACKGROUND: Modifying the task load of Emergency Medical Services (EMS) personnel may mitigate fatigue, sleep quality and fatigue related risks. A review of the literature addressing task load interventions may benefit EMS administrators as they craft policies related to mitigating fatigue. We conducted a systematic review of the peer-reviewed literature to address the following question: "In EMS personnel, do task load interventions mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?" (PROSPERO 2016:CRD42016040114)...
January 11, 2018: Prehospital Emergency Care
Jennifer L Temple, David Hostler, Christian Martin-Gill, Charity G Moore, Patricia M Weiss, Denisse J Sequeira, Joseph P Condle, Eddy S Lang, J Stephen Higgins, P Daniel Patterson
BACKGROUND: Emergency Medical Services (EMS) workers may experience fatigue as a consequence of shift work. We reviewed the literature to determine the impact of caffeine as a countermeasure to fatigue in EMS personnel and related shift workers. METHODS: We employed the GRADE methodology to perform a systematic literature review and search multiple databases for research that examined the impact of caffeine on outcomes of interest, such as patient and EMS personnel safety...
January 11, 2018: Prehospital Emergency Care
Laura K Barger, Michael S Runyon, Megan L Renn, Charity G Moore, Patricia M Weiss, Joseph P Condle, Katharyn L Flickinger, Ayushi A Divecha, Patrick J Coppler, Denisse J Sequeira, Eddy S Lang, J Stephen Higgins, P Daniel Patterson
BACKGROUND: Fatigue training may be an effective way to mitigate fatigue-related risk. We aimed to critically review and synthesize existing literature on the impact of fatigue training on fatigue-related outcomes for Emergency Medical Services (EMS) personnel and similar shift worker groups. METHODS: We performed a systematic literature review for studies that tested the impact of fatigue training of EMS personnel or similar shift workers. Outcomes of interest included personnel safety, patient safety, personnel performance, acute fatigue, indicators of sleep duration and quality, indicators of long-term health (e...
January 11, 2018: Prehospital Emergency Care
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
January 3, 2018: Prehospital Emergency Care
Wing-Hoi Cheung, Wan-Yiu Shen, David Lok-Kwan Dai, Kin Bong Lee, Tracy Y Zhu, Ronald Man-Yeung Wong, Kwok-Sui Leung
OBJECTIVE: To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) for fragility hip fracture patients. DESIGN: Prospective cohort study. PATIENTS: Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care...
December 20, 2017: Journal of Rehabilitation Medicine
Jamshed Haneef, Renu Chadha
The present research work highlights the development of multicomponent solid form of the antihypertensive drug irbesartan (IRB) to improve its biopharmaceutical attributes. Mechanochemical synthesis of a new solid form of IRB with coformers having antioxidant properties (syringic acid, nicotinic acid, and ascorbic acid) resulted into three eutectic mixtures (EMs). Formation of eutectic was ascertained by differential scanning calorimetry whereas exact stoichiometry (50/50% w/w) was established by phase diagram and Tamman's triangle...
December 15, 2017: AAPS PharmSciTech
Jiri Knor, Roman Skulec, Dominika Seblova, Malek Jiri
BACKGROUND: The presence of gasping in out-of-hospital cardiac arrest (OHCA) patients predicts short-term prognosis. We performed a retrospective study to evaluate whether the presence of gasping at the time of Emergency Medical Service (EMS) arrival in the case OHCA patients of presumed cardian origin has any impact on six-month survival and/or sustained return of spontaneous circulation (ROSC). METHODS: We collected and analyzed Utstein Style data for all patients resuscitated for OHCA of presumed cardiac origin by the EMS of the Central Bohemian Region from July 1st, 2013 to June 30th, 2014...
December 13, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
Wolfgang Kemmler, Anja Weissenfels, Michael Bebenek, Michael Fröhlich, Heinz Kleinöder, Matthias Kohl, Simon von Stengel
In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16-25 min/session, 85 Hz, 350 μ s, and 4-6 s impulse/4 s impulse-break) and used the same pain questionnaire...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
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