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Prehospital life support

Mark Froats, Andrew Reed, Richard Dionne, Justin Maloney, Susan Duncan, Rob Burns, Julie Sinclair, Michael Austin
BACKGROUND: Most patients transferred from a non-percutaneous coronary intervention (PCI) facility for primary PCI do not meet target reperfusion times. Direct transportation of patients with ST-elevation myocardial infarction (STEMI) from the scene by advanced life support (ALS) paramedics has been shown to improve reperfusion times and outcomes. OBJECTIVE: The aim of this study was to determine whether it is safe to bypass the closest hospital and transport by basic life support (BLS) provider to a PCI facility...
October 9, 2018: Journal of Emergency Medicine
J G Ten Brinke, S R Groen, M Dehnad, T P Saltzherr, M Hogervorst, J C Goslings
PURPOSE: The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization. METHODS: An extensive search throughout historical literature and recent evidence based studies was conducted...
September 15, 2018: European Spine Journal
Michael Parenteau, Zsolt Stockinger, Stephen Hughes, Brad Hickey, James Mucciarone, Christopher Manganello, Andrew Beeghly
Highly skilled swimmers and aquatically adaptable service members such as U.S. Navy Divers, Sea, Air and Land (SEAL) Teams, and Explosive Ordnance Disposal (EOD) technicians, die every year from drowning. Drowning is the cause of over 500,000 deaths annually across the globe. This Clinical Practice Guideline (CPG) provides an overview of drowning and associated conditions based on the best available current medical evidence. Unlike basic life support and advanced cardiac life support protocols, rescue breathing should be initiated prior to chest compressions to re-expand water-filled alveoli...
September 1, 2018: Military Medicine
Deborah P Waldrop, Jacqueline M McGinley, Michael W Dailey, Brian Clemency
BACKGROUND: The primary charge of Emergency Medical Services (EMS) is to save lives. However, EMS personnel are frequently called to scenes where prolonging life may not be the primary goal. When someone is nearing death, family members may feel compelled to call 9-1-1 because they are feeling uncertain about how to manage symptoms at the end of life. OBJECTIVE: We sought to explore prehospital providers' perspectives on how the awareness of dying and documentation of end-of-life wishes influence decision-making on emergency calls near the end of life...
October 11, 2018: Prehospital Emergency Care
Seyyed Mohammad Reza Hosseini, Mohammadreza Maleki, Hasan Abolghasem Gorji, Davoud Khorasani-Zavareh, Masoud Roudbari
Introduction: Prehospital emergency medical service dispatchers should make prompt and appropriate decisions to save the life of victims. The complexity of timely and reasonable decision-making in life-threatening conditions has driven researchers to investigate varying aspects of the emergency medical dispatch (EMD) process. The purpose of this study was to explore the contributors to appropriate and prompt decision-making among dispatchers. Methods: A qualitative study through thematic analysis was designed...
2018: Journal of Multidisciplinary Healthcare
Ithan D Peltan, Kristina H Mitchell, Kristina E Rudd, Blake A Mann, David J Carlbom, Thomas D Rea, Allison M Butler, Catherine L Hough, Samuel M Brown
RATIONALE: Early antibiotics improve outcomes for septic patients. Factors influencing antibiotic timing in emergency department (ED) sepsis remain unclear. OBJECTIVE: Determine the relationship between septic patients' prehospital level of care and ED door-to-antibiotic time. METHODS: This retrospective cohort study comprised patients admitted from the community to an academic ED June 2009 to February 2015 with fluid-refractory sepsis or septic shock...
August 28, 2018: Annals of the American Thoracic Society
G Anthony Fidacaro, Christopher W Jones, Lisa A Drago
OBJECTIVE: There are nearly 1000 annual ambulance crashes within the United States involving pediatric patients. In 2012 National Highway Traffic Safety Administration/US Department of Transportation released Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances. The aim of our study was to measure emergency medical services (EMS) providers' knowledge and opinions of how to safely transport pediatric patients. In addition, we aimed to gather information on barriers to safe pediatric transport...
August 13, 2018: Pediatric Emergency Care
Elizabeth Brown, Teresa A Williams, Hideo Tohira, Paul Bailey, Judith Finn
OBJECTIVE: The aim of the study was to describe the epidemiology of trauma in adult patients attended by ambulance paramedics in Perth, Western Australia. METHODS: A retrospective cohort study of trauma patients aged ≥16 years attended by St John Ambulance Western Australia (SJA-WA) paramedics in greater metropolitan Perth between 2013 and 2016 using the SJA-WA database and WA death data. Incidence and 30 day mortality rates were calculated. Patients who died prehospital (immediate deaths), on the day of injury (early deaths), within 30 days (late deaths) and those who survived longer than 30 days (survivors) were compared for age, sex, mechanism of injury and acuity level...
July 25, 2018: Emergency Medicine Australasia: EMA
Changsun Kim, Hyuk Joong Choi, Hyungjun Moon, Giwoon Kim, Choungah Lee, Jin Sung Cho, Seongjung Kim, Kyoungmi Lee, Hanjoo Choi, Wonjung Jeong
OBJECTIVE: To compare the survival to discharge between nursing home (NH) cardiac arrest patients receiving smartphone-based advanced cardiac life support (SALS) and basic life support (BLS). METHODS: The SALS registry includes data on cardiac arrest from 7 urban and suburban areas in Korea between July 2015 and December 2016. We include adult patients (>18) with out-of-hospital cardiac arrest (OHCA) of medical causes and EMS attended and dispatched in. SALS is an advanced field resuscitation including drug administration by paramedics with video communication-based direct medical direction...
July 9, 2018: American Journal of Emergency Medicine
Maximilian Scharonow, Christian Weilbach
BACKGROUND: In the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated...
June 18, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Janosch Dahmen, Marko Brade, Christian Gerach, Martin Glombitza, Jan Schmitz, Simon Zeitter, Eva Steinhausen
BACKGROUND: The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE: The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest...
June 5, 2018: Der Unfallchirurg
Sylvain Bussières, François Bégin, Pierre-Alexandre Leblanc, Alain Tanguay, Jean-Michel Paradis, Denise Hébert, Richard Fleet
CLINICIAN'S CAPSULE What is known about the topic? ST-elevation myocardial infarction (STEMI) patients transported by ambulance are at risk for adverse events. What did this study ask? What is the impact of transport time on the occurrence of adverse events in the presence of basic life support paramedics? What did this study find? Transport time is not associated with a higher risk of adverse events. Why does this study matter to clinicians? Largest investigation of adverse events in a Canadian cohort of STEMI patients transported by ambulance...
June 5, 2018: CJEM
Maryse C Cnossen, Ruben van der Brande, Hester F Lingsma, Suzanne Polinder, Fiona Lecky, Andrew I R Maas
The first hour following traumatic brain injury (TBI) is considered crucial to prevent death and disability. It is, however, not established yet how the prehospital care should be organized to optimize recovery during the first hour. The objective of the current study was to examine variation in prehospital trauma care across Europe aiming to inform comparative effectiveness analyses on care for neurotrauma patients. A survey on prehospital trauma care was sent to 68 neurotrauma centers from 20 European countries participating in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study...
July 24, 2018: Journal of Neurotrauma
Mark Levitan, Madelyn P Law, Richard Ferron, Karen Lutz-Graul
IntroductionAccording to Ontario, Canada's Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features...
June 2018: Prehospital and Disaster Medicine
Sandra DiBrito, Elliott R Haut
No abstract text is available yet for this article.
June 20, 2018: JAMA Surgery
Tatsuma Fukuda, Naoko Ohashi-Fukuda, Yutaka Kondo, Kei Hayashida, Ichiro Kukita
Importance: Controversy remains as to whether advanced life support (ALS) or basic life support (BLS) is superior for critically ill and injured patients, including out-of-hospital cardiac arrest (OHCA) and major trauma, in the prehospital setting. Objective: To assess whether prehospital ALS should be provided for traumatic OHCA and who should perform it. Design, Setting, and Participants: Japanese government-managed nationwide population-based registry data of patients with OHCA transported to an emergency hospital were analyzed...
June 20, 2018: JAMA Surgery
Elina U Wells, Courtney P Williams, Richard E Kennedy, Patricia Sawyer, Cynthia J Brown
This study aimed to determine the proportion of older adults who recovered community mobility after hospitalization and identify factors associated with recovery. Using a random sample of 1,000 Medicare beneficiaries ≥65 years of age, we identified individuals with at least one hospitalization over 8.5 years of follow-up. Data were collected at baseline and every 6 months, including demographics, function, social support, community mobility measured by the UAB Life-Space Assessment (LSA), and overnight hospital admissions...
April 1, 2018: Journal of Applied Gerontology: the Official Journal of the Southern Gerontological Society
Bradley S Marino, Sarah Tabbutt, Graeme MacLaren, Mary Fran Hazinski, Ian Adatia, Dianne L Atkins, Paul A Checchia, Allan DeCaen, Ericka L Fink, George M Hoffman, John L Jefferies, Monica Kleinman, Catherine D Krawczeski, Daniel J Licht, Duncan Macrae, Chitra Ravishankar, Ricardo A Samson, Ravi R Thiagarajan, Rune Toms, James Tweddell, Peter C Laussen
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms...
May 29, 2018: Circulation
Felicia M Mix, Martin D Zielinski, Lucas A Myers, Kathy S Berns, Anurahda Luke, James R Stubbs, Scott P Zietlow, Donald H Jenkins, Matthew D Sztajnkrycer
IntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS). METHODS: This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90)...
June 2018: Prehospital and Disaster Medicine
Kenton L Anderson, Kristin C Fiala, Maria G Castaneda, Susan M Boudreau, Allyson A Araña, Vikhyat S Bebarta
BACKGROUND: Prehospital cardiopulmonary resuscitation, including closed chest compressions, has commonly been considered ineffective in traumatic cardiopulmonary arrest (TCPA) because traditional chest compressions do not produce substantial cardiac output. However, recent evidence suggests that chest compressions located over the left ventricle (LV) produce greater hemodynamics when compared to traditional compressions. We hypothesized that chest compressions located directly over the LV would improve return of spontaneous circulation (ROSC) and hemodynamics when compared with traditional chest compressions, in a swine model of TCPA...
August 2018: Journal of Trauma and Acute Care Surgery
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