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Emergency AND Prehospital

Xavier R J Moors, Stef J M Bouman, Joost H Peters, Pascal Smulders, Michelle B Oude Alink, Dennis Den Hartog, Robert Jan Stolker
OBJECTIVE: In the prehospital setting, the Nijmegen and Rotterdam helicopter emergency medical services administer packed red blood cells to critically ill or injured pediatric patients. Blood is given on scene or during transport and is derived from nearby hospitals. We summarize our experience with prehospital blood use in pediatric patients. METHODS: The databases from both the Nijmegen and Rotterdam helicopter emergency medical services were reviewed for all pediatric (< 18 years) patients who received packed red blood cells on scene or during transport to the hospital...
September 2018: Air Medical Journal
Kathleen M Adelgais, Matthew Hansen, Brooke Lerner, J Joelle Donofrio, Kabir Yadav, Kathleen Brown, Yiju T Liu, Paula Denslow, Kurt Denninghoff, Paul Ishimine, Lenora M Olson
The evidence supporting best practices when treating children in the prehospital setting or even the effect Emergency Medical Services (EMS) has on patient outcomes is limited. Standardizing the critical outcomes for EMS research will allow for focused and comparable effort among the small but growing group of pediatric EMS investigators on specific topics. Standardized outcomes will also provide the opportunity to collectively advance the science of EMS for children and demonstrate the effect of EMS on patient outcomes...
October 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Vincent Darioli, Patrick Taffé, Pierre-Nicolas Carron, Fabrice Dami, Laurent Vallotton, Bertrand Yersin, Patrick Schoettker, Mathieu Pasquier
OBJECTIVE: The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. PARTICIPANTS AND METHODS: We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services. We excluded uninjured or dead-on-scene patients. Primary outcome was assessment of the discriminative performance of the NACA score to classify the 48-h vital status of patients...
October 10, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Frederik Geisler, Syed F Ali, Martin Ebinger, Alexander Kunz, Michal Rozanski, Carolin Waldschmidt, Joachim E Weber, Matthias Wendt, Benjamin Winter, Lee H Schwamm, Heinrich J Audebert
Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany...
October 10, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Abdallah Rebeiz, Roula Sasso, Rana Bachir, Zeina Mneimneh, Rima Jabbour, Mazen El Sayed
BACKGROUND: Arrival of patients with ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) results in shorter reperfusion times and lower mortality in developed countries. OBJECTIVES: This study examines EMS use by STEMI patients in Lebanon and associated clinical outcomes. METHODS: A retrospective observational study with chart review was carried out for STEMI patients arriving to the Emergency Department of a tertiary care center in Lebanon between January 1, 2013 and August 31, 2016...
October 6, 2018: Journal of Emergency Medicine
José-Gabriel Sato Folatre, Per Arnell, Mari Henning, Kristina Josefsson, Gabriel Skallsjö, Sven-Erik Ricksten
In 2016, physician staffed helicopter emergency medical service (VGR HEMS) became the first Swedish prehospital service to routinely carry and transfuse red blood cells. In this report we describe our implementation and present our results, with preliminary analysis of our data. Out of 1 336 patients a total of 34 patients (2,5 %) were transfused without any adverse events. Our demography is predominantly male and the most common mechanism of injury is trauma. Amongst the most common interventions were endotracheal intubation, thoracostomy and CPR...
October 2, 2018: Läkartidningen
Mark Schieren, Andreas B Böhmer, Rolf Lefering, Thomas Paffrath, Frank Wappler, Jerome Defosse
INTRODUCTION: Chest trauma and obesity are both associated with increased risks for respiratory complications (e.g. hypoxia, hypercarbia, pneumonia), which are frequent causes of posttraumatic morbidity and mortality. However, as there is only limited and inconsistent evidence, the aim of our study was to analyse the effect of body mass index (BMI) on patient outcomes after thoracic trauma. PATIENTS AND METHODS: We screened 50.519 patients entered in TraumaRegister DGU® , between 2004-2009, when the BMI was part of the standardized dataset...
September 28, 2018: Injury
Dag Ståle Nystøyl, Steinar Hunskaar, Hans Johan Breidablik, Øyvind Østerås, Erik Zakariassen
OBJECTIVE: To examine handling of cancelled helicopter emergency medical services (HEMS) missions with a persisting medical indication. DESIGN: Retrospective observational study. SETTING AND SUBJECTS: Cancelled HEMS missions with persisting medical indication within Sogn og Fjordane county in Norway during the period of 2010-2013. Both primary and secondary missions were included. MAIN OUTCOME MEASURES: Primary care involvement, treatment and cooperation within the prehospital system...
October 8, 2018: Scandinavian Journal of Primary Health Care
Patrick A Eder, Birgit Reime, Thomas Wurmb, Uwe Kippnich, Layal Shammas, Asarnusch Rashid
BACKGROUND:  Trauma is a global burden. Emergency medical services (EMS) provide care for individuals who have serious injuries or suffered a major trauma. OBJECTIVE:  This paper provides a comprehensive overview of telemedicine applications in prehospital trauma care. METHODS:  We conducted a systematic review according to PRISMA guidelines. We identified articles by electronic database search (PubMed, EMBASE, the Cochrane Library, CINAHL, SpringerLink, LIVIVO, DARE, IEEE Xplore, Google Scholar and ScienceDirect) using keywords related to prehospital settings, ambulance, telemedicine and trauma...
October 8, 2018: Methods of Information in Medicine
Sean M Bell, David H Lam, Kathleen Kearney, Ravi S Hira
Ventricular fibrillation is a life-threatening cardiac arrhythmia that leads to a loss of cardiac function and sudden cardiac death. In this review, we summarize therapeutic interventions and guidelines for providers managing patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation in prehospital and emergency settings. Additionally, we review invasive management, including urgent coronary angiography, extracorporeal membrane oxygenation, and novel strategies for managing refractory ventricular fibrillation arrest...
August 2018: Cardiology Clinics
Eun Jin Kang, Sun Hyu Kim
Objectives This study evaluated unnecessary emergency medical services (EMS) transport for pediatric patients depending on whether they received emergency department (ED) treatment after EMS transport. Methods Pediatric patients were divided into two groups according to whether they received treatment at the ED (ED treatment) or did not receive treatment at the ED (non-ED treatment). Results The non-ED treatment group comprised 65 of the total 794 patients. The elapsed time from scene to arrival at the ED was longer in the non-ED treatment group than in the ED treatment group...
October 8, 2018: Journal of International Medical Research
Abdulrhman Alghamdi, Laura Howard, Charles Reynard, Philip Moss, Heather Jarman, Kevin Mackway-Jones, Simon Carley, Richard Body
OBJECTIVES: Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG. METHODS: We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain...
October 4, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Mat Goebel, Christopher Tainter, Christopher Kahn, James V Dunford, John Serra, Jodie Pierce, J Joelle Donofrio
BACKGROUND: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. METHODS: This is a retrospective chart review of known LVAD patients belonging to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's two emergency departments between January 2012 and December 2015...
October 4, 2018: Prehospital Emergency Care
Tanya L Medley, Christina Miteff, Ian Andrews, Tyson Ware, Michael Cheung, Paul Monagle, Simone Mandelstam, Alison Wray, Clair Pridmore, Christopher Troedson, Russell C Dale, Michael Fahey, Adriane Sinclair, Peter Walsh, Belinda Stojanovski, Mark T Mackay
Stroke is among the top 10 causes of death in children and survivors carry resulting disabilities for decades, at substantial cost to themselves and their families. Children are not currently able to access reperfusion therapies, due to limited evidence supporting safety and efficacy and long diagnostic delays. The Australian Clinical Consensus Guideline for the Diagnosis and Acute Management of Childhood Stroke was developed to minimize unwarranted variations in care and document best evidence on the risk factors, etiologies, and conditions mimicking stroke that differ from adults...
October 4, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Rebecca M Hirschhorn, Zachary Y Kerr, Erin B Wasserman, Melissa C Kay, Daniel R Clifton, Thomas P Dompier, Susan W Yeargin
CONTEXT:  Data regarding the epidemiology of emergency transport incidents (ETIs) of patients with sport-related injuries are lacking. Understanding the use of emergency services by athletic trainers can help improve emergency preparedness and prehospital care for injured student-athletes. OBJECTIVE:  To determine the frequency and type of ETIs resulting from athletic participation. DESIGN:  Descriptive epidemiology study. SETTING:  Participating high schools and colleges during 2011-2012 to 2013-2014 and 2009-2010 to 2014-2015, respectively...
October 4, 2018: Journal of Athletic Training
Christina Conrad, Parita Soni, Vasanth Coorg, Benjamin Thompson, Jared Muenzer, Zebulon Timmons, Blake Bulloch
PURPOSE: Undertreatment of pain by caregivers before presentation to the pediatric emergency department (ED) has been well documented. What has yet to be elucidated are the reasons why caregivers fail to adequately treat pain before arrival in the ED and whether there are differences based on ethnic background or age of the child. The objectives of this study were to determine the barriers to giving pain medication for injuries before ED arrival and to determine if there are any ethnic- or age-related variations to giving pain relief at home...
October 2, 2018: Pediatric Emergency Care
Christopher L Hunter, Salvatore Silvestri, Amanda Stone, Anne Shaughnessy, Stacie Miller, Alexa Rodriguez, Linda Papa
OBJECTIVE: To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes. METHODS: We conducted a retrospective cohort study among septic patients who were identified as "sepsis alerts" in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not...
September 22, 2018: American Journal of Emergency Medicine
Jean-Christophe Dubus, Marie-Sophie Lê, Joana Vitte, Philippe Minodier, Aurélie Boutin, Ania Carsin, Gilles Viudes, Guilhem Noel
Despite multiple recommendations, intramuscular epinephrine is poorly prescribed in emergency department receiving pediatric anaphylaxis. To evaluate the role of severity symptoms on this use, we included all admissions for a diagnosis linked to possible allergy in the two pediatric emergency departments of our institution between January 2010 and December 2015. Selection and analysis were restricted to children under 18 years fulfilling Sampson's criteria for anaphylaxis. We retrospectively ranked these admissions with the Ring and Messmer anaphylaxis severity score and compared the use of epinephrine according to this classification...
September 29, 2018: European Journal of Pediatrics
Emilie Gregers, Jesper Kjærgaard, Freddy Lippert, Jakob H Thomsen, Lars Køber, Michael Wanscher, Christian Hassager, Helle Søholm
BACKGROUND: The prognosis in refractory out-of-hospital cardiac arrest (OHCA) with ongoing cardiopulmonary resuscitation (CPR) at hospital arrival is often considered dismal. The use of extracorporeal cardiopulmonary resuscitation (eCPR) for perfusion enhancement during resuscitation has shown variable results. We aimed to investigate outcome in refractory OHCA patients managed conservatively without use of eCPR. METHODS: We included consecutive OHCA patients with refractory arrest or prehospital return of spontaneous circulation (ROSC) in the Copenhagen area in 2002-2011...
September 29, 2018: Critical Care: the Official Journal of the Critical Care Forum
K S Cheung, L P Leung, Y C Siu, T C Tsang, M Sh Tsui, C C Tam, R Hw Chan
INTRODUCTION: After ST-segment elevation myocardial infarction (STEMI), it is vital to shorten reperfusion time. This study examined data from a pilot project to shorten the door-to-balloon (D2B) time by using prehospital 12-lead electrocardiogram (ECG). METHODS: Fifteen ambulances equipped with X Series® Monitor/Defibrillator (Zoll Medical Corporation) were deployed to the catchment area of Queen Mary Hospital, Hong Kong, from November 2015 to December 2016. For patients with chest pain, prehospital 12-lead ECG was performed and tele-transmitted to attending physicians at the accident and emergency department for immediate interpretation...
October 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
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