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https://www.readbyqxmd.com/read/28538247/the-positive-predictive-value-of-an-ambulance-prealert-for-stroke-and-transient-ischaemic-attack
#1
Craig W Brown, Mary J Macleod
OBJECTIVE: Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times...
May 19, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28494638/an-environmental-scan-of-emergency-response-systems-and-services-in-remote-first-nations-communities-in-northern-ontario
#2
E J Mew, S D Ritchie, D VanderBurgh, J L Beardy, J Gordon, M Fortune, S Mamakwa, A M Orkin
BACKGROUND: Approximately 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada. Limited information is available regarding the status of emergency care in these communities. OBJECTIVE: We aimed to understand emergency response systems, services, and training in remote NAN communities. DESIGN: We used an environmental scan approach to compile information from multiple sources including community-based participatory research...
2017: International Journal of Circumpolar Health
https://www.readbyqxmd.com/read/28492165/-the-contribution-of-legal-medicine-in-child-protection-presentation-of-a-multidisciplinary-approach
#3
J Hiquet, E Christin, O Dubourg, J Fougas, C Baup, G Brunet, J Millington, N Grosleron, S Gromb-Monnoyeur
INTRODUCTION: Maltreatment is a complex issue and therefore, requires a multidisciplinary approach, which has been commonly used in North America since the 1980s but remains unsystematic in France. Since 1999, the Centre d'Accueil en Urgence des Victimes d'Agression (emergency unit for victims of assault) of the Bordeaux University Hospital has brought together various medical, paramedical, and social actors on this issue. A standardized psychosocial assessment procedure has been introduced and is detailed in this paper, and was consistently conducted in all cases of suspicion of abuse on a minor...
December 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28484212/quality-of-analgesia-in-physician-operated-telemedical-prehospital-emergency-care-is-comparable-to-physician-based-prehospital-care-a-retrospective-longitudinal-study
#4
Niklas Lenssen, Andreas Krockauer, Stefan K Beckers, Rolf Rossaint, Frederik Hirsch, Jörg C Brokmann, Sebastian Bergrath
Acute pain is a common reason for summoning emergency medical services (EMS). Yet in several countries the law restricts opioid-based analgesia administration to physicians. Telemedical support of paramedics is a novel approach to enable timely treatment under the guidance of a physician. In this retrospective observational study, conducted in the EMS of Aachen, Germany, the analgesic quality and occurrence of adverse events were compared between telemedically-supported paramedics (July-December, 2014) and a historical control group (conventional on-scene EMS physicians; January-March, 2014)...
May 8, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28483276/effectiveness-of-finger-marker-for-maintaining-the-correct-compression-point-during-paediatric-resuscitation-a-simulation-study
#5
Jae Yun Jung, Young Ho Kwak, Hyuksool Kwon, Yoo Jin Choi, Do Kyun Kim, Hee Chan Kim, Jung Chan Lee, Ji Heum Park, Hyungsoo Lim
OBJECTIVE: High-quality cardiopulmonary resuscitation is a significant factor for increasing the survival rate of paediatric patients. This study is to investigate the effectiveness of finger-marker stickers for maintaining the correct compression point during simulated infant cardiopulmonary resuscitation (CPR). METHODS: This crossover simulation study was conducted with 40 emergency physicians and paramedics at emergency departments of 2 tertiary hospitals. We used a remodeled infant CPR manikin developed to measure CPR quality indicators...
April 11, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28481722/ems-provider-perceptions-on-termination-of-resuscitation-in-a-large-urban-ems-system
#6
Katie L Tataris, Christopher T Richards, Leslee Stein-Spencer, Stephanie Ryan, Pete Lazzara, Joseph M Weber
OBJECTIVE: Despite the value of out-of-hospital Termination of Resuscitation (TOR) and the scientific evidence in favor of this practice, TOR has not been uniformly adopted or consistently practiced in EMS systems. Previous focus group studies have identified multiple barriers to implementation of out of hospital TOR but existing literature on EMS provider perceptions is limited. We sought to identify EMS providers' perceived barriers to performing out-of-hospital TOR in a large urban EMS system...
May 8, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28476475/lower-chest-compression-fraction-associated-with-rosc-in-ohca-patients-with-longer-downtimes
#7
Milena Talikowska, Hideo Tohira, Madoka Inoue, Paul Bailey, Deon Brink, Judith Finn
AIM: To investigate the relationship between chest compression fraction (CCF) and survival outcomes in OHCA, including whether the relationship varied based upon downtime from onset of arrest to provision of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS). METHODS: Data from resuscitations performed by St John Ambulance Western Australia (SJA-WA) paramedics between July 2014 and June 2016 was captured using the Q-CPR feedback device. Logistic regression analysis was used to study the relationship between CCF and return of spontaneous circulation (ROSC)...
May 2, 2017: Resuscitation
https://www.readbyqxmd.com/read/28467124/building-capacity-in-healthcare-by-re-examining-clinical-services-in-paramedicine
#8
Walter Tavares, Ian Drennan, Kelly Van Diepen, Michael Abanil, Natalie Kedzierski, Chris Spearen, Norm Barrette, Mathew Mercuri
OBJECTIVES: Emergency departments (ED) continue to be overburdened, leading to crowding and elevated risk of negative clinical outcomes. Extending clinical services to paramedics may support efforts to improve ED burdens by promoting health care access and capacity during times of patient crisis. The objective of this study was to identify the clinical course and most responsible diagnosis of patients transported by paramedic services to local EDs to then evaluate impact of various augmented 9-1-1/paramedic clinical service models on the need for additional ED services...
May 3, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28460858/analysis-of-out-of-hospital-pediatric-intubation-by%C3%A2-an-australian-helicopter-emergency-medical%C3%A2-service
#9
Brian J Burns, Joanna B Watterson, Sandra Ware, Luke Regan, Cliff Reid
STUDY OBJECTIVE: We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS). METHODS: A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findings included patient demographics, operator background, airway intervention including intubation attempts, complications, and critical timings...
April 28, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28457576/effect-of-concentrated-psychiatric-education-on-perceived-competence-to-care-for-behavioral-health-patients
#10
Elizabeth J Winokur, Jeannine Loucks, Dana N Rutledge
Increasing numbers of behavioral patients are presenting to emergency departments, where competency of staff to care for this group is unknown. METHODS: This pre-post study measured the effects of a 7-hour conference on perceived competency of nurses and allied health professionals to care for behavioral health (BH) patients, as measured by the 23-item Behavioral Health Care Competency (BHCC) survey. RESULTS: Of 102 participants, most were emergency nurses (72%), acute care nurses and case managers (20%), and allied health personnel (trauma technicians and paramedics) (8%)...
April 27, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28445653/describing-the-mental-health-profile-of-first-responders-a-systematic-review-formula-see-text
#11
Sara Jones
BACKGROUND: First responders (FRs) are responsible for providing multiple services during various critical events. Considering the frequency, nature, and intensity of duty-related traumatic exposures, the cumulative impact on FRs' mental health is of paramount importance. OBJECTIVES: The purpose of this systematic review was to describe how duty-related trauma exposure can affect the comprehensive mental health profile of FRs, including firefighters, emergency medical technicians, and paramedics...
May 2017: Journal of the American Psychiatric Nurses Association
https://www.readbyqxmd.com/read/28440675/near-infrared-spectroscopy-nirs-to-detect-traumatic-intracranial-haematoma-a-systematic-review-and-meta-analysis
#12
Robert J Brogan, Vassilios Kontojannis, Bhavin Garara, Hani J Marcus, Mark H Wilson
OBJECTIVES AND METHODS: Head injury is the most common trauma presentation to UK emergency departments, with around 1.2 million patients each year. The key management principal for this time critical illness remains early surgical intervention. With the development of handheld near-infrared spectroscopy (NIRS) devices, there is now the possibility of triaging and diagnosing these patients immediately, where computed tomography (CT) scanner is unavailable. NIRS has two related but distinct potential uses within clinical medicine...
April 25, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28433454/a-randomized-comparison-of-three-chest-compression-techniques-and-associated-hemodynamic-effect-during-infant-cpr-a-randomized-manikin-study
#13
Jacek Smereka, Lukasz Szarpak, Antonio Rodríguez-Núñez, Jerzy R Ladny, Steve Leung, Kurt Ruetzler
INTRODUCTION: Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28431536/-popping-nana-back-into-bed-a-qualitative-exploration-of-paramedic-decision-making-when-caring-for-older-people-who-have-fallen
#14
Paul Simpson, Ric Thomas, Jason Bendall, Bill Lord, Stephen Lord, Jacqueline Close
BACKGROUND: Older fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to explore the decision making process used by paramedics when caring for older fallers. METHODS: A qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups...
April 21, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28429117/a-comparison-of-mcgrath-mac%C3%A2-and-standard-direct-laryngoscopy-in-simulated-immobilized-cervical-spine-pediatric-intubation-a-manikin-study
#15
Marcin Madziala, Jacek Smereka, Marek Dabrowski, Steve Leung, Kurt Ruetzler, Lukasz Szarpak
Emergency airway management in children is generally considered to be challenging, and endotracheal intubation requires a high level of personal skills and experience. Immobilization of the cervical spine is indicated in all patients with the risk of any cervical spine injury but significantly aggravates endotracheal intubation. The best airway device in this setting has not been established yet, although the use of videolaryngoscopes is generally promising. Seventy-five moderately experienced paramedics of the Emergency Medical Service of Poland performed endotracheal intubations in a pediatric manikin in three airway scenarios: (A) normal airway, (B) manual in-line cervical immobilization, and (C) cervical immobilization using a Patriot cervical extrication collar and using two airway techniques: (1) McGrath videolaryngoscope and (2) Macintosh blade in a randomized sequence...
April 21, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28420688/can-a-partnership-between-general-practitioners-and-ambulance-services-reduce-conveyance-to-emergency-care
#16
Manuel Villarreal, Jonathan Leach, Kandala Ngianga-Bakwin, Jeremy Dale
BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department (ED). METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28411738/implementing-powered-stretcher-and-load-systems-was-a-cost-effective-intervention-to-reduce-the-incidence-rates-of-stretcher-related-injuries-in-a-paramedic-service
#17
Daniel P Armstrong, Richard Ferron, Cindi Taylor, Brent McLeod, Steve Fletcher, Renée S MacPhee, Steven L Fischer
Paramedic services are considering moving towards the use of powered stretcher and load systems to reduce stretcher related injuries, but cost is perceived as a barrier. This study compared injury incidence rates, days lost, and compensation costs between Niagara Emergency Medical Service (NEMS) and Hamilton Paramedic Service (HPS) pre- (four years) and post- (one year) implementation of powered stretcher and load systems in NEMS. Prior to the intervention stretcher related musculoskeletal disorder (MSD) incidence rates averaged 20...
July 2017: Applied Ergonomics
https://www.readbyqxmd.com/read/28401616/searching-for-staircases-strengthening-the-connections-between-the-emergency-department-and-the-intensive-care-unit
#18
James M Walter, James J Walter
On a fall day in Chicago, a middle-aged man stepped out of a northbound train, appeared to choke, and collapsed. Paramedics arrived within minutes and administered several rounds of defibrillation and intravenous epinephrine. The patient was rapidly transported to an academic medical center, resuscitated in the Emergency Department (ED), and was soon surrounded by a multidisciplinary team of doctors, nurses, and respiratory therapists in the Intensive Care Unit (ICU). This article is protected by copyright...
April 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28399219/a-multidisciplinary-intervention-to-prevent-subsequent-falls-and-health-service-use-following-fall-related-paramedic-care-a-randomised-controlled-trial
#19
A Stefanie Mikolaizak, Stephen R Lord, Anne Tiedemann, Paul Simpson, Gideon A Caplan, Jason Bendall, Kirsten Howard, Lyndell Webster, Narelle Payne, Sarah Hamilton, Joanne Lo, Elisabeth Ramsay, Sandra O'Rourke, Linda Roylance, J C Close
Background: approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes. Objective: to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use. Design, setting, participants: Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia...
March 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28397649/support-and-assessment-for-fall-emergency-referrals-safer-2-a-cluster-randomised-trial-and-systematic-review-of-clinical-effectiveness-and-cost-effectiveness-of-new-protocols-for-emergency-ambulance-paramedics-to-assess-older-people-following-a-fall-with-referral
#20
Helen A Snooks, Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill, Sarah Gaze, Mary Halter, Ioan Humphreys, Marina Koniotou, Phillipa Logan, Ronan Lyons, Suzanne Mason, Jon Nicholl, Julie Peconi, Ceri Phillips, Judith Phillips, Alison Porter, A Niroshan Siriwardena, Graham Smith, Alun Toghill, Mushtaq Wani, Alan Watkins, Richard Whitfield, Lynsey Wilson, Ian T Russell
BACKGROUND: Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES: To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use...
March 2017: Health Technology Assessment: HTA
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