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Emergency AND Prehospital

Steven G Schauer, Jason F Naylor, Joseph K Maddry, Denise M Beaumont, Cord W Cunningham, Megan B Blackburn, Michael D April
OBJECTIVES: Airway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management. METHODS: We used a series of emergency department procedure codes to identify patients within the Department of Defense Trauma Registry from January 2007 to August 2016. This is a subanalysis of those with a documented prehospital airway intervention...
December 2018: Southern Medical Journal
Ryan Brown, Alix Carter, Judah Goldstein, Jan L Jensen, Andrew H Travers
Introduction Hospitalization due to ambulatory care sensitive conditions (ACSC) is often used as a proxy measure for access to primary care. The prevalence of ACSC has not been measured in the prehospital setting. Emergency medical services (EMS) are being used by patients who lack access to primary care for ACSC. Many novel models of care have been implemented within Canada and internationally, utilizing paramedics to ease the burden of poor primary care access. Recently, a mobile care team (MCT) consisting of a paramedic/nurse configuration has been deployed in the community of New Waterford, Nova Scotia...
September 26, 2018: Curēus
Cody Vaughn Gibson
OBJECTIVES: The primary purpose of this study was to determine if methicillin-resistant Staphylococcus aureus (MRSA) was present on the surface of oxygen cylinders and regulators used in the prehospital setting and secondarily to assess other surfaces for MRSA within the ambulance compartment, as a comparison. METHODS: On 17 March 2018, the surface of oxygen cylinders and regulators located in ambulances at an emergency medical services (EMS) station in North Alabama (n=9) and at an offsite oxygen cylinder storage area (n=70) were swabbed using sterile cotton-tipped applicators saturated in an 0...
December 1, 2018: Emergency Medicine Journal: EMJ
Ryan M Boudreau, Keshav K Deshpande, Gregory M Day, William R Hinckley, Nicole Harger, Timothy A Pritts, Amy T Makley, Michael D Goodman
BACKGROUND: Tranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED). MATERIALS AND METHODS: We identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period...
January 2019: Journal of Surgical Research
Amy Gl Nuttall, Katie M Paton, Alison M Kemp
OBJECTIVE: To evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury. DESIGN: Cross sectional study. SETTING: UK hospital admissions: September 2009-February 2010. PATIENTS: <15 years with head injury. INTERVENTIONS: GCS and/or AVPU at injury scene and in emergency departments (ED). MAIN OUTCOME: Measures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type...
November 28, 2018: BMJ Open
Abdul Q Alarhayem, Stephen M Cohn, Oliver Cantu-Nunez, Brian J Eastridge, Todd E Rasmussen
BACKGROUND: Six hours has long been considered the threshold of ischemia after peripheral artery injury. However, there is a paucity of evidence regarding the impact of operative delays on morbidity and mortality in patients with lower extremity arterial injuries. METHODS: We analyzed the records of 3,441,259 injured patients entered into the National Trauma Data Bank Research Dataset from 2012 to 2015. Patients (≥16 years) with lower extremity arterial injuries were identified by International Classification of Diseases, Ninth Revision injury and procedure codes...
November 26, 2018: Journal of Vascular Surgery
Michael Ely, Elizabeth A Edgerton, Russell Telford, Kent Page, Craig Hemingway, Donald Vernon, Lenora M Olson
OBJECTIVES: Pediatric patients represent a small proportion of emergency medical services (EMS) calls, challenging providers in maintaining skills in treating children. Having structural capacity to appropriately diagnose and treat pediatric patients is critical. Our study measured the availability of off-line and on-line medical direction and recommended pediatric equipment at EMS agencies. METHODS: A Web-based survey was sent to EMS agencies in 2010 and 2013, and results were analyzed to determine availability of medical direction and equipment...
November 26, 2018: Pediatric Emergency Care
T Warnecke, M Dobbermann, T K Becker, M Bernhard, J Hinkelbein
No abstract text is available yet for this article.
November 28, 2018: Der Anaesthesist
Dominique Larouche, Marie Bellemare, Jérôme Prairie, Sandrine Hegg-Deloye, Philippe Corbeil
Few studies have quantified the risk of musculoskeletal disorders during patient transfers in total assistance mode in real-life prehospital emergency care situations. An index to assess the overall risk of patient transfers was created; it makes it possible to quantify risk based on the patient's position and the height of the patient's location. An analysis of 71 transfers executed by paramedics in actual work situations showed that moving a patient from the ground was characterized by acute sagittal flexions and axial rotations, respectively, 42% and 12% of the time...
January 2019: Applied Ergonomics
Jessica N Jeruzal, Lori L Boland, Monica S Frazer, Jonathan W Kamrud, Russell N Myers, Charles J Lick, Andrew C Stevens
OBJECTIVE: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted to increase understanding about the difficulties of responding to pediatric calls and to obtain information about how organizations can better support EMS providers in managing potentially difficult calls. METHODS: Paramedics and emergency medical technicians from a single US ambulance service were invited to participate in focus groups about responding to 9-1-1 calls involving pediatric patients...
November 27, 2018: Prehospital Emergency Care
Remco H A Ebben, Flaka Siqeca, Ulla Riis Madsen, Lilian C M Vloet, Theo van Achterberg
OBJECTIVE: Guideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings. DESIGN: Systematic review. DATA SOURCES: PubMed (including MEDLINE), CINAHL, EMBASE and Cochrane. METHODS: We selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care...
November 25, 2018: BMJ Open
Ian Howard, Bernard Pillay, Nicholas Castle, Loua Al Shaikh, Robert Owen, David Williams
BACKGROUND: Emergency Care has previously been identified as an area of significant concern regarding the prevalence of Adverse Events (AEs). However, the majority of this focus has been on the in-hospital setting, with little understanding of the identification and incidence of AEs in the prehospital environment. METHOD: The early development and testing of Emergency Medical Services (EMS) specific triggers for the identification of AEs and Harm has been previously described...
November 26, 2018: BMC Emergency Medicine
Katya Evans, Heike Geduld, Willem Stassen
Background: Given the frequency of suicidal patients making attempts prior to a completed suicide, emergency access to mental health care services could lead to significant reduction in morbidity and mortality for these patients. Aim: To describe the attitudes of prehospital providers and describe transport decision-making around the management of patients with a suicide attempt. Setting: Cape Town Metropole. Methods: A cross-sectional, vignette-based survey was used to collect data related to training and knowledge of the Mental Health Care Act , prehospital transport decision-making and patient management...
2018: South African Journal of Psychiatry: SAJP: the Journal of the Society of Psychiatrists of South Africa
Francisco Martín-Rodríguez, Raúl López-Izquierdo, Miguel A Castro Villamor, Iratxe Moro Mangas, Pablo Del Brío Ibáñez, Juan F Delgado Benito, José L Martín Conty, Jesús Álvarez Manzanares, Agustín Mayo-Iscar, Carlos Del Pozo Vegas
BACKGROUND: Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making. STUDY DESIGN: We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018...
November 19, 2018: American Journal of Emergency Medicine
Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn
OBJECTIVE: To determine the association between prehospital time and outcomes in adult major trauma patients, transported by ambulance paramedics. METHODS: A retrospective cohort study of major trauma patients (Injury Severity Score >15) attended by St John Ambulance paramedics in Perth, Western Australia, who were transported to hospital between 1st January 2013 and 31st December 2016. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to limit selection bias and confounding...
November 21, 2018: Prehospital Emergency Care
Geiza Costa, Olavo Cabral, Eduardo Santana, Glaucia Lima, Israel Figueiredo
INTRODUCTION: Prehospital care is defined as any medical attention provided outside the hospital environment. This study aims to study the operation of a regional SAMU by assessing electronic records of cases managed and to evaluate demand patterns over time. METHODS: A retrospective, cross-sectional study was conducted through an analysis of emergency calls handled between the years of 2009 and 2013 by the SAMU Metropolitan 2 Region mobile emergency care service, located in Niterói, Brazil...
November 2018: International Emergency Nursing
Anders Möller, Luke Hunter, Lisa Kurland, Sa'ad Lahri, Daniël J van Hoving
Introduction: Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa. Methods: The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015...
September 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Bruna Dessena, Paul C Mullan
Introduction: Child abuse is a common condition in the emergency centres of South Africa. It is critical for both prehospital emergency care practitioners and emergency centre-based emergency medicine registrars to be competent in screening, diagnosing, treating, and documenting child abuse. Our goal was to assess the knowledge of child abuse management in a sample of prehospital emergency care practitioners and emergency medicine registrars in Cape Town, South Africa. Methods: A mixed-methods approach of quantitative and qualitative data was used to survey a sample of 120 participants (30 emergency medicine registrars and 90 prehospital emergency care practitioners: 30 Basic Life Support, 30 Intermediate Life Support, and 30 Advanced Life Support)...
June 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Mike Wells, Laurice Barnes, Craig Vincent-Lambert
Introduction: The choice of weight estimation method to use during prehospital paediatric emergency care is important because it needs to be both accurate and easy to use. Accuracy is important to ensure optimum drug dosing while ease-of-use is important to minimise user errors and the cognitive load experienced by healthcare providers. Little is known about which weight estimation systems are used in the prehospital environment anywhere in the world. This knowledge is important because if the use of inappropriate weight estimation practices is identified, it could be remedied through education and institutional policies...
June 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Tyron Maartens, Benjamin de Waal
Introduction: We compare the effectiveness of direct laryngoscopy (DL) to video laryngoscopy (VL) in simulated, difficult airway scenarios in a cohort of novice, prehospital, emergency care providers. Methods: Forty-five (45) students were randomised to DL or VL groups and then tasked to perform intubation on a manikin in three simulated airway scenarios. The scenarios included an uncomplicated intubation, intubation with manual in-line neck stabilisation (MILNS), and a simulated motor vehicle entrapment, with C-Spine held from behind, using a face-to-face intubation technique...
December 2017: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
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