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Emergency AND Prehospital

Brian D Sumner, Emily A Grimsley, Niall H Cochrane, Ryan R Keane, Alexis B Sandler, Paul C Mullan, Karen J O'Connell
BACKGROUND: The National Association of EMS Physicians emphasizes the importance of high quality communication between emergency medical services (EMS) providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration. OBJECTIVE: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations...
August 17, 2018: Prehospital Emergency Care
David Pickham, André Valdez, Jelle Demeestere, Robin Lemmens, Linda Diaz, Sherril Hopper, Karen de la Cuesta, Fannie Rackover, Kenneth Miller, Maarten Lansberg
BACKGROUND: Use of prehospital stroke scales may enhance stroke detection and improve treatment rates and delays. Current scales, however, may lack detection accuracy. As such, we examined if coordination and diplopia (Balance and Eyes) assessments increase the accuracy of the Face-Arms-Speech-Time (FAST) scale in a multi-site prospective study of emergency response activations for presumed stroke. METHODS: This was a prospective study of emergency response activations for presumed stroke in Santa Clara County, California...
August 17, 2018: Prehospital Emergency Care
Kathleen M Adelgais, J Matthew Sholl, Rachael Alter, Kristin Lauria Gurley, Camille Broadwater-Hollifield, Peter Taillac
BACKGROUND: Individual states, regions, and local emergency medical service (EMS) agencies are responsible for the development and implementation of prehospital patient care protocols. Many states lack model prehospital guidelines for managing common conditions. Recently developed national evidence-based guidelines (EBGs) may address this gap. Barriers to statewide dissemination and implementation of model guidelines have not been studied. The objective of this study was to examine barriers and enablers to dissemination and implementation of an evidence-based guideline for traumatic pain management across 5 states...
August 17, 2018: Prehospital Emergency Care
Chien-Hao Lin, Chih-Hao Lin, Chih-Yi Tai, Yu-You Lin, Frank Fuh-Yuan Shih
OBJECTIVE: A burn mass casualty incident (BMCI) involving 499 patients occurred at a "color party" in Taiwan in June 27, 2015. We implemented a study to identify critical challenges regarding the prehospital emergency care in BMCIs. METHODS: A three-stage, mixed methods study was conducted in 2016. First, a statistical analysis of prehospital management using the data retrieved from the Emergency Medical Management System of the Ministry of Health and Welfare, Taiwan was performed...
August 17, 2018: Prehospital Emergency Care
Laurel O'Connor, Matthew Rebesco, Conor Robinson, Karen Gross, Andrew Castellana, Mark J O'Connor, Marc Restuccia
OBJECTIVE: The goal of this study is to describe complications and outcomes of prehospital ketamine use for agitation as compared to other methods of physical or chemical restraint such as haloperidol plus benzodiazepine or physical restraint only. METHODS: We conducted a single-center retrospective review of patient encounters in which restraint was administered in the prehospital setting. At the beginning of our study window, only physical restraint was available to paramedics managing agitated patients, but subsequently, haloperidol and benzodiazepines were introduced, followed by ketamine two years later...
August 17, 2018: Prehospital Emergency Care
Osamu Kitahara, Kei Nishiyama, Bunsei Yamamoto, Shigeaki Inoue, Sadaki Inokuchi
This study aimed to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting mortality among prehospital patients with and without infection. This single-center, retrospective, cross-sectional study was conducted among patients who arrived via the emergency medical services (EMS). We calculated the qSOFA score and Modified Early Warning Score (MEWS) from prehospital records. We identified patients as infected if they received intravenous antibiotics at the emergency department or within the first 24 hours...
2018: PloS One
Julie E Sinclair, Mike Austin, Mark Froats, Shannon Leduc, Justin Maloney, Richard Dionne, Andy Reed, Christian Vaillancourt
BACKGROUND: In Ontario, Canada, there currently are no prehospital treat-and-release protocols and the safety of this practice remains unclear. We sought to describe the characteristics, management, and outcomes of patients with hypoglycemia treated by paramedics, and to determine the predictors of repeat access to prehospital or emergency department (ED) care within 72 hours of initial paramedic assessment. METHODS: We performed a health record review of paramedic call reports and ED records over a 12-month period...
August 15, 2018: Prehospital Emergency Care
Peter O'Meara, Gary Wingrove, Michael Nolan
INTRODUCTION: For the past 50 years paramedic services and paramedic roles in high-income nations have evolved in response to changes in community needs and expectations. The aim of this article is to review paramedic models of service delivery, with an emphasis on models that have the potential to improve the health and wellbeing of frontier and remote populations. METHODS: Paramedic models of relevance to rural and frontier settings were identified from searches of CINHAL and Medline, while key paramedic-specific journals were individualy searched in the event that they were not indexed...
August 2018: Rural and Remote Health
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
F F Girrbach, F Hilbig, M Michael, M Bernhard
BACKGROUND: A myriad of publications have contributed to an evidence-based approach to airway management in emergency services and admissions in recent years; however, it remains unclear which international registries on airway management in emergency medicine currently exist and how they are characterized concerning inclusion criteria, patient characteristics and definition of complications. METHODS: A systematic literature research was carried out in PubMed with respect to publications from 2007-2017...
August 13, 2018: Der Anaesthesist
Paibul Suriyawongpaisal, Samrit Srithamrongsawad, Pongsakorn Atiksawedparit, Khanisthar Phooseemungkun, Krongkan Bunchaiyai, Thanita Thongtan
Introduction: Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems...
2018: Emergency Medicine International
Rein Ketelaars, Gabby Reijnders, Geert-Jan van Geffen, Gert Jan Scheffer, Nico Hoogerwerf
Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications...
August 8, 2018: Critical Ultrasound Journal
Silke Walter, Henry Zhao, Damien Easton, Cees Bil, Jonas Sauer, Yang Liu, Martin Lesmeister, Iris Q Grunwald, Geoffrey A Donnan, Stephen M Davis, Klaus Fassbender
Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites...
August 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Andrew H Travers
Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, patient homes, hospital settings). This article highlights (1) the reorganization of the emergency medical service system design, (2) the strategies enabling efficient operation of this design, and (3) resultant innovations evolving from both system redesign and strategy application...
August 2, 2018: Healthcare Management Forum
Theodore T Redman, Elliot M Ross
BACKGROUND: Cadaver training for prehospital surgical procedures is a valid training model. The limitation to date has been that perfused cadavers have only been used in wet laboratories in hospitals or university centers. We endeavor to describe a transportable central-perfused cadaver model suitable for training in the battlefield environment. Goals of design were to create a simple, easily reproducible, and realistic model to simulate procedures in field and austere conditions. METHODS: We conducted a review of the published literature on cadaver models, conducted virtual-reality simulator training, performed interviews with subject matter experts, and visited the laboratories at the Centre for Emergency Health Sciences in Spring Branch, TX, the Basic Endovascular Skills in Trauma laboratory in Baltimore, MD, and the Fresh Tissue Dissection Laboratory at Los Angeles County and University of Southern California, Keck School of Medicine, Los Angeles, CA...
July 28, 2018: Journal of Emergency Medicine
Carl O Eriksson, Nicole Ovregaard, Matthew Hansen, Garth Meckler, Barbara Skarica, Jeanne-Marie Guise
BACKGROUND AND OBJECTIVES: Although medical errors in the hospital are a recognized source of morbidity and mortality, less is known about safety events in the prehospital care of children. As part of a multiphase study, we developed and evaluated the reliability and usability of the pediatric prehospital safety event detection system (PEDS), a tool used to identify safety events in prehospital care. METHODS: The tool was based on hospital chart review tools, literature review, and results from focus groups and a national Delphi survey...
August 2018: Hospital Pediatrics
Kaitlyn Luckey-Smith, Kevin High
Malignant hyperthermia (MH) is a life-threatening hypermetabolic state that can occur following induction with depolarizing neuromuscular blockade and volatile anesthesia gases. Because succinylcholine is a common choice for prehospital and emergency department inductions, it is important for staff to be able to recognize and effectively treat an MH crisis. This case study highlights a 20-year-old male trauma patient who presented to a Level I trauma center and was intubated for declining mental status. He developed suspected MH following his anesthetic induction with succinylcholine...
July 2018: Advanced Emergency Nursing Journal
Kosuke Kiyohara, Masahiko Nitta, Yasuto Sato, Noriko Kojimahara, Naohito Yamaguchi, Taku Iwami, Tetsuhisa Kitamura
The effectiveness of dissemination of public-access automated external defibrillators (AEDs) has been well established for adults, but not for children at the population level. We obtained out-of-hospital cardiac arrest (OHCA) data between January 2005 and December 2014 from a nationwide OHCA registry of Japan. Our study subjects were OHCA cases aged 6 to 17, involving attempted resuscitation by emergency medical service personnel or by bystanders. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA...
June 5, 2018: American Journal of Cardiology
Matt Wilkes, Eleanor C Heath, Nicholas P Mason
Methoxyflurane is a volatile, fluorinated anesthetic agent with analgesic properties. Although no longer used as an anesthetic due to concerns regarding renal toxicity in high doses, it has enjoyed a resurgence as an inhaled analgesic in prehospital care and in the emergency department. The agent is nonflammable and leads to rapid, titratable analgesia without intravenous access. The Penthrox inhaler device is light, robust, and straightforward to administer. Consequently, it has been proposed as an ideal analgesic for the remote high altitude setting...
July 26, 2018: Wilderness & Environmental Medicine
Chen Ji, Tom Quinn, Lucia Gavalova, Ranjit Lall, Charlotte Scomparin, Jessica Horton, Charles D Deakin, Helen Pocock, Michael A Smyth, Nigel Rees, Samantha J Brace-McDonnell, Simon Gates, Gavin D Perkins
OBJECTIVES: There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest...
July 28, 2018: BMJ Open
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