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Emergency paramedic

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https://www.readbyqxmd.com/read/29158691/project-for-the-introduction-of-prehospital-analgesia-with-fentanyl-and-morphine-administered-by-specially-trained-paramedics-in-a-rural-service-area-in-germany
#1
Maximilian Scharonow, Timo Alberding, Wolfgang Oltmanns, Christian Weilbach
Background: In patients with serious illness or trauma, reduction of severe pain is a key therapeutic goal of emergency medical service (EMS) teams. In Germany, only physicians are allowed to use opioid analgesics. In the rural EMS area studied, the mean arrival time for paramedics is 8 minutes, 23 seconds, and for the rescue physician between 10 minutes, 30 seconds and 16 minutes, 59 seconds, depending on EMS site. In cases of parallel callouts, rescue-physician arrival times may be considerably longer...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29151401/evaluation-of-a-primary-care-paramedic-stemi-bypass-guideline
#2
Jonathan L Kwong, Garry Ross, Linda Turner, Chris Olynyk, Sheldon Cheskes, Adam Thurston, P Richard Verbeek
OBJECTIVE: Limited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline. METHODS: We reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria...
November 20, 2017: CJEM
https://www.readbyqxmd.com/read/29148174/prehospital-transfusion-of-red-cell-concentrates-in-a-paramedic-staffed-helicopter-emergency-medical-service
#3
Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen Bernard, Marcus Kennedy, Karen Smith
OBJECTIVE: The optimal volume and type of intravenous fluid for the treatment of blood loss in the prehospital setting is controversial. The use of red cell concentrates (RCCs) may be associated with improved outcomes; however, the administration of blood products is limited to physicians in many jurisdictions. We sought to describe the characteristics of RCC transfusions in a paramedic-staffed helicopter emergency medical system in Victoria, Australia. METHODS: We performed a retrospective analysis of all cases where paramedics consulted the responsible physician for approval of RCC transfusion between July 2011 and December 2015 in Victoria, Australia...
November 17, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29140748/paramedic-initiated-home-care-referrals-and-use-of-home-care-and-emergency-medical-services
#4
Amol A Verma, John Klich, Adam Thurston, Jordan Scantlebury, Alex Kiss, Gayle Seddon, Samir K Sinha
OBJECTIVE: We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. METHODS: This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral...
November 15, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29139599/adherence-to-a-multifactorial-fall-prevention-program-following-paramedic-care-predictors-and-impact-on-falls-and-health-service-use-results-from-an-rct-a-priori-subgroup-analysis
#5
A Stefanie Mikolaizak, Stephen R Lord, Anne Tiedemann, Paul Simpson, Gideon Caplan, Jason C Bendall, Kirsten Howard, Jacqueline Close
OBJECTIVE: To identify predictors and impact of adherence to a multifactorial fall-prevention program on falls and health service utilisation. METHODS: Randomised controlled trial with a priori subgroup analysis within intervention group according to adherence. Participants were community dwelling, (≥65 years), not transported to hospital following fall-related paramedic care. The Attitudes to Falls-Related Interventions Scale (AFRIS) was completed at baseline, adherence levels were measured (three-point scale) at six months, and falls and health service utilisation were recorded for 12 months...
November 15, 2017: Australasian Journal on Ageing
https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#6
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29130627/temporal-trends-2002-2014-of-incidence-and-shockable-status-of-adult-emergency-medical-service-attended-out-of-hospital-cardiac-arrest-of-presumed-cardiac-aetiology-in-queensland
#7
Katherine Pemberton, Emma Bosley
OBJECTIVE: To describe trends in incidence and shockable status of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014. METHODS: The QAS cardiac arrest registry was used to collect data. Analyses included age-standardised rates by gender for all adults and older adults only (65 years+); age-specific incidence rates of young adults (18-49), middle age adults (50-64) and five groups of older adults (65-69, 70-74, 75-79, 80-84 and 85+); and proportions of shockable versus non-shockable initial rhythm together and by age group (young, middle age and older adults)...
November 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29127541/the-bargaining-of-professionalism-in-emergency-care-practice-nhs-paramedics-and-higher-education
#8
Assaf Givati, Chris Markham, Ken Street
Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals' education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal-political circumstances affecting its provision and demand...
November 10, 2017: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/29121819/ethical-decision-making-based-on-field-assessment-the-experiences-of-prehospital-personnel
#9
Mohammad Torabi, Fariba Borhani, Abbas Abbaszadeh, Foroozan Atashzadeh-Shoorideh
INTRODUCTION: Due to the stressful nature of prehospital emergency providers' duties, as well as difficulties such as distance to information resources and insufficient time to analyze situations, ethical decision-making in prehospital services is a daily challenge. OBJECTIVES: This study aimed to describe the experiences of Iranian prehospital emergency personnel in the field of ethical decision-making. METHODS: The data were collected by semi-structured interviews (n = 15) in Iran and analyzed using the content analysis approach...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/29108791/improvement-of-blood-loss-volume-estimation-by-paramedics-using-a-pictorial-nomogram-a-developmental-study
#10
Chun Yu Yeung, Wai Wa Yim, Suet Yi Chan, Ronson Sze Long Lo, Ling Yan Leung, Kevin Kei Ching Hung, Colin A Graham
INTRODUCTION: To propose and evaluate a nomogram to assist paramedics to visually estimate the external blood loss on a non-absorbent surface and to identify whether the nomogram improves visual estimation. METHODS: The study was a prospective, paired-control design (pre-training control group & post-training group), utilizing Emergency Medical Assistant (EMA) I and II trainees from the Hong Kong Fire Services Ambulance Command Training School. A nomogram (blood loss volume to area on a non-absorbent surface) was prepared to aid blood loss estimation...
October 31, 2017: Injury
https://www.readbyqxmd.com/read/29103361/titrating-the-rig-how-paramedics-work-in-and-on-their-ambulance
#11
Michael K Corman
In this article, I take readers inside of an ambulance and explore how paramedics work in and on their "apparatus unit" to make it a workable fit. This taken-for-granted work is important because much is at stake in the back of the ambulance, particularly in relation to quality of care and safety. I draw on data from an institutional ethnography into the socially organized work and work settings of paramedics, which included more than 200 hr of observations and more than 100 interviews with paramedics. The findings shed light on the situated work processes of paramedics as they orient and respond to their "apparatus unit" and enact quality and safety in practice...
November 1, 2017: Qualitative Health Research
https://www.readbyqxmd.com/read/29095286/clinical-predictors-of-outcomes-in-patients-undergoing-emergency-air-medical-transport-from-kinmen-to-taiwan
#12
Julia Chia-Yu Chang, Hsien-Hao Huang, Shu-Hua Chang, Yin-Ru Chen, Ju-Shin Fan, Yen-Chia Chen, David Hung-Tsang Yen
Emergency air medical transport (EAMT) is indispensable for acutely or critically ill patients in remote areas. We determined patient-level and transport-specific factors associated with all-cause mortality after EAMT.We conducted a population-based, retrospective cohort study using a prospective registry consisting of clinical/medical records. Study inclusion criteria consisted of all adults undergoing EAMT from Kinmen hospital to the ED of Taipei Veterans General Hospital (TVGH) between January 1, 2006 and December 31, 2012...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29076236/choosing-public-or-private-emergency-departments-in-australia
#13
Katherine Walker, Michael Ben-Meir
Emergency medicine was once exclusively provided in public hospitals in Australia, but now over half a million consultations per annum are in private (7% total emergency consultations). Private EDs have excess capacity and are staffed by senior doctors (majority FACEM) with open access to investigations and broad specialist inpatient services. Public EDs struggle with rising attendances and overcapacity. Private hospitals have high levels of patient satisfaction and aim to optimise service provision. A major barrier to private ED attendances is out-of-pocket costs...
October 26, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29070716/plumber-study-prevalence-of-large-vessel-occlusion-strokes-in-mecklenburg-county-emergency-response
#14
Adeline Dozois, Lorrie Hampton, Carlene W Kingston, Gwen Lambert, Thomas J Porcelli, Denise Sorenson, Megan Templin, Shellie VonCannon, Andrew W Asimos
BACKGROUND AND PURPOSE: The recently proposed American Heart Association/American Stroke Association EMS triage algorithm endorses routing patients with suspected large vessel occlusion (LVO) acute ischemic strokes directly to endovascular centers based on a stroke severity score. The predictive value of this algorithm for identifying LVO is dependent on the overall prevalence of LVO acute ischemic stroke in the EMS population screened for stroke, which has not been reported. METHODS: We performed a cross-sectional study of patients transported by our county's EMS agency who were dispatched as a possible stroke or had a primary impression of stroke by paramedics...
October 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29062596/exploring-the-psychological-health-of-emergency-dispatch-centre-operatives-a-systematic-review-and-narrative-synthesis
#15
Sarah E Golding, Claire Horsfield, Annette Davies, Bernadette Egan, Martyn Jones, Mary Raleigh, Patricia Schofield, Allison Squires, Kath Start, Tom Quinn, Mark Cropley
BACKGROUND: The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives. METHODS: Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set...
2017: PeerJ
https://www.readbyqxmd.com/read/29054574/concepts-antecedents-and-consequences-of-ambulance-ramping-in-the-emergency-department-a-scoping-review
#16
Chris Kingswell, Ramon Z Shaban, Julia Crilly
BACKGROUND: Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance Ramping', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping...
November 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/29049005/beliefs-attitudes-and-activities-of-healthcare-personnel-about-influenza-and-pneumococcal-vaccines
#17
Fatma Çiftci, Elif Şen, Nalan Demir, Orçun Çiftci, Serhat Erol, Oya Kayacan
OBJECTIVES: Vaccination of healthcare personnel (HCP) is an effective measure for preventing the spread of influenza among at-risk patients. This study was conducted to determine influenza vaccination rates and activities among HCP working at a tertiary healthcare setting. METHODS: This study included 470 HCP (85 physicians, 134 nurses, 53 healthcare assistants, 44 paramedics, 47 medical secretaries, and 107 auxillary staff members) working at the emergency, cardiology, chest diseases, and internal medicine departments with the largest volume of patients with vaccination indication of two large university hospitals with similar medical practices and work environment...
October 19, 2017: Human Vaccines & Immunotherapeutics
https://www.readbyqxmd.com/read/29033297/no-easy-way-out-a-case-of-physician-assisted-dying-in-the-emergency-department
#18
David H Wang
Currently, 1 out of 6 Americans lives within a jurisdiction in which physician-assisted dying is legally authorized. In most cases, patients ingest lethal physician-assisted dying medications at home without involvement of emergency medical services (EMS) or the emergency department (ED). However, occasionally the dying process is interrupted as a result of incomplete ingestion or vomiting of medications, confusion about timing of dying trajectory, familial emotional distress, and other variables. A case is presented here of a patient who arrived by ambulance to an urban ED after ingesting physician-assisted dying medication...
October 12, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29023167/state-regulation-of-community-paramedicine-programs-a-national-analysis
#19
Melody Glenn, Olivia Zoph, Kim Weidenaar, Leila Barraza, Warren Greco, Kylie Jenkins, Pooja Paode, Jonathan Fisher
BACKGROUND: Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs. OBJECTIVE: To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29021720/burn-injury-review-of-pathophysiology-and-therapeutic-modalities-in-major-burns
#20
I Kaddoura, G Abu-Sittah, A Ibrahim, R Karamanoukian, N Papazian
Despite a considerable decrease in their incidence worldwide, burn injuries remain one of the commonest forms of trauma and account for a weighty proportion of trauma cases in health-care emergencies around the globe. Although the latest data reveal a substantial decline in burn-related mortality and hospital admissions in the US over the past three decades, severe thermal injuries continue to trigger devastating morbidity and significant mortality while their management remains a dynamic challenge for the entire medical and paramedical community...
June 30, 2017: Annals of Burns and Fire Disasters
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