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Prehospital, out-of-hospital, EMS, paramedic

Joshua Pound, P Richard Verbeek, Sheldon Cheskes
BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers...
March 2017: Prehospital Emergency Care
Todd Chassee, Diann Reischmann, Michael Mancera, John D Hoyle
BACKGROUND: Prehospital pediatric drug dosing errors affect 56,000 U.S. children annually. An accurate weight is the first step in accurate dosing. To date, the accuracy of Emergency Medical Dispatcher (EMD) obtained weights has not been evaluated. We hypothesized that EMD could obtain accurate pediatric weights. METHODS: We used a convenience sample of patients 12 years and younger that were transported by EMS to one children's hospital. EMD obtained patient weight (DW) from the 9-1-1 caller...
November 2016: Prehospital Emergency Care
Z Nehme, E Andrew, S Bernard, K Smith
BACKGROUND: Resuscitation guidelines often recommend ongoing cardiopulmonary resuscitation (CPR) efforts to hospital for out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) personnel. In this study, we examine the relationship between EMS CPR duration and survival to hospital discharge in EMS witnessed OHCA patients. METHODS: Between January 2003 and December 2011, 1035 adult EMS witnessed arrests of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry...
March 2016: Resuscitation
Justin Mausz, Sheldon Cheskes
Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care...
September 2015: CJEM
Corey S Davis, Jessica K Southwell, Virginia Radford Niehaus, Alexander Y Walley, Michael W Dailey
OBJECTIVES: Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out-of-hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal...
October 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Andrew W Asimos, Shana Ward, Jane H Brice, Wayne D Rosamond, Larry B Goldstein, Jonathan Studnek
STUDY OBJECTIVE: Emergency medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. METHODS: We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching...
November 2014: Annals of Emergency Medicine
Pe Jacobs, A Grabinsky
Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome...
January 2014: International Journal of Critical Illness and Injury Science
Matthew V Kiefer, H Gene Hern, Harrison J Alter, Joseph B Barger
INTRODUCTION: Prehospital first responders historically have treated hypoglycemia in the field with an IV bolus of 50 mL of 50% dextrose solution (D50). The California Contra Costa County Emergency Medical Services (EMS) system recently adopted a protocol of IV 10% dextrose solution (D10), due to frequent shortages and relatively high cost of D50. The feasibility, safety, and efficacy of this approach are reported using the experience of this EMS system. METHODS: Over the course of 18 weeks, paramedics treated 239 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes...
April 2014: Prehospital and Disaster Medicine
Keith Wesley, Karen Wesley
BACKGROUND: Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. OBJECTIVES: We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED)...
October 2013: JEMS: a Journal of Emergency Medical Services
Damien Ryan, Alan M Craig, Linda Turner, P Richard Verbeek
BACKGROUND: Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. OBJECTIVES: We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED)...
April 2013: Prehospital Emergency Care
Amado Alejandro Báez, Priscilla Hanudel, Maria Teresa Perez, Ediza M Giraldez, Susan R Wilcox
INTRODUCTION: Severe sepsis and septic shock are common and often fatal medical problems. The Prehospital Sepsis Project is a multifaceted study that aims to improve the out-of-hospital care of patients with sepsis by means of education and enhancement of skills. The objective of this Project was to assess the knowledge and attitudes in the principles of diagnosis and management of sepsis in a cohort of United States out-of-hospital care providers. METHODS: This was cross-sectional study...
April 2013: Prehospital and Disaster Medicine
Michael G Tunik, Neal Richmond, Marsha Treiber, Andrew Skomorowsky, Sandro Galea, David Vlahov, Shannon Blaney, Monique Kusick, Robert Silverman, George L Foltin
OBJECTIVE: The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area. METHODS: A prospective observational cohort of consecutive children younger than 18 years with OOHRA cared for by the New York City 911 emergency medical services (EMS) system from April 12, 2002, to March 31, 2003...
September 2012: Pediatric Emergency Care
G Franschman, N Verburg, V Brens-Heldens, T M J C Andriessen, J Van der Naalt, S M Peerdeman, J P Valk, N Hoogerwerf, S Greuters, P Schober, P E Vos, H M T Christiaans, C Boer
INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch on prehospital run time and outcome in severe TBI. METHODS: Prehospital run times of 497 patients with severe TBI who were solely treated by a paramedic EMS (n = 125) or an EMS/P-HEMS combination (n = 372) were retrospectively analyzed...
November 2012: Injury
Harry P Selker, Joni R Beshansky, Patricia R Sheehan, Joseph M Massaro, John L Griffith, Ralph B D'Agostino, Robin Ruthazer, James M Atkins, Assaad J Sayah, Michael K Levy, Michael E Richards, Tom P Aufderheide, Darren A Braude, Ronald G Pirrallo, Delanor D Doyle, Ralph J Frascone, Donald J Kosiak, James M Leaming, Carin M Van Gelder, Gert-Paul Walter, Marvin A Wayne, Robert H Woolard, Lionel H Opie, Charles E Rackley, Carl S Apstein, James E Udelson
CONTEXT: Laboratory studies suggest that in the setting of cardiac ischemia, immediate intravenous glucose-insulin-potassium (GIK) reduces ischemia-related arrhythmias and myocardial injury. Clinical trials have not consistently shown these benefits, possibly due to delayed administration. OBJECTIVE: To test out-of hospital emergency medical service (EMS) administration of GIK in the first hours of suspected acute coronary syndromes (ACS). DESIGN, SETTING, AND PARTICIPANTS: Randomized, placebo-controlled, double-blind effectiveness trial in 13 US cities (36 EMS agencies), from December 2006 through July 31, 2011, in which paramedics, aided by electrocardiograph (ECG)-based decision support, randomized 911 (871 enrolled) patients (mean age, 63...
May 9, 2012: JAMA: the Journal of the American Medical Association
Christian Winship, Brett Williams, Malcolm J Boyle
BACKGROUND: Many studies over the past decade have investigated delaying initial defibrillation to perform cardiopulmonary resuscitation (CPR), as it has been associated with increased rates of restoration of spontaneous circulation and/or survival. Since 2006, a number of studies have investigated these procedures. The objective of this study was to undertake a literature review examining the commencement of CPR before defibrillation in the out-of-hospital setting. METHODS: A literature review was undertaken using the electronic medical databases Ovid Medline, EMBASE, CINHAL Plus, Cochrane Systematic Review and Meditext, from their commencement to the end of June 2011...
October 2012: Emergency Medicine Journal: EMJ
Corita R Grudzen, Lynne D Richardson, William J Koenig, Jerome R Hoffman, Karl A Lorenz, Steven M Asch
OBJECTIVE: To translate a set of evidence-based clinical standards designed to allow paramedics to forego unnecessary and potentially harmful resuscitation attempts into a feasible new policy. DATA SOURCES/SETTING: Policy documents, meeting minutes, and personal communications between a large urban Emergency Medical Services (EMS) agency serving all of Los Angeles County (LAC) and a research group were reviewed over 12 months. STUDY DESIGN: LAC EMS and University of California, Los Angeles (UCLA) formed a partnership (the EMS-UCLA Collaborative) to develop and translate the standards into new EMS protocols...
February 2012: Health Services Research
Jason S Haukoos, Gary Witt, Craig Gravitz, Julianne Dean, David M Jackson, Thomas Candlin, Peter Vellman, John Riccio, Kennon Heard, Tom Kazutomi, Dylan Luyten, Gilbert Pineda, Jeff Gunter, Jennifer Biltoft, Christopher Colwell
OBJECTIVES: The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between fire-based basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system...
April 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Christian Martin-Gill, Francis X Guyette, Jon C Rittenberger
BACKGROUND: There is no consensus among emergency medical services (EMS) systems as to the optimal numbers and training of EMS providers who respond to the scene of prehospital cardiac arrests. Increased numbers of providers may improve the performance of cardiopulmonary resuscitation (CPR), but this has not been studied as part of a comprehensive resuscitation scenario. OBJECTIVE: To compare different all-paramedic crew size configurations on objective measures of patient resuscitation using a high-fidelity human simulator...
April 2010: Prehospital Emergency Care
C Vaillancourt, A Lui, V J De Maio, G A Wells, I G Stiell
OBJECTIVES: While lower socioeconomic status is associated with lower level of education and increased incidence of cardiovascular diseases, the impact of socioeconomic status on out-of-hospital cardiac arrest outcomes is unclear. We used residential property values as a proxy for socioeconomic status to determine if there was an association with: (1) bystander CPR rates and (2) survival to hospital discharge for out-of-hospital cardiac arrest. METHODS: We performed a secondary data analysis of cardiac arrest cases prospectively collected as part of the Ontario Prehospital Advanced Life Support study, conducted in 20 cities with ALS and BLS-D paramedics...
December 2008: Resuscitation
Robert A Swor, Scott Compton, Robert Domeier, Nika Harmon, Kevin Chu
OBJECTIVE: We sought to characterize the collapse-to-9-1-1 call interval, to evaluate the frequency of pre-9-1-1 delay, and to assess whether delay is associated with decreased survival after out-of-hospital cardiac arrest (OHCA). METHODS: This was a five-year prospective survey of bystanders to adult OHCA cases in which the victims were transported to seven local teaching hospitals in Michigan. Bystander data were obtained by telephone interview beginning two weeks after the event, and through review of emergency medical services (EMS) documents...
July 2008: Prehospital Emergency Care
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