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https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#1
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29070716/plumber-study-prevalence-of-large-vessel-occlusion-strokes-in-mecklenburg-county-emergency-response
#2
Adeline Dozois, Lorrie Hampton, Carlene W Kingston, Gwen Lambert, Thomas J Porcelli, Denise Sorenson, Megan Templin, Shellie VonCannon, Andrew W Asimos
BACKGROUND AND PURPOSE: The recently proposed American Heart Association/American Stroke Association EMS triage algorithm endorses routing patients with suspected large vessel occlusion (LVO) acute ischemic strokes directly to endovascular centers based on a stroke severity score. The predictive value of this algorithm for identifying LVO is dependent on the overall prevalence of LVO acute ischemic stroke in the EMS population screened for stroke, which has not been reported. METHODS: We performed a cross-sectional study of patients transported by our county's EMS agency who were dispatched as a possible stroke or had a primary impression of stroke by paramedics...
October 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29033297/no-easy-way-out-a-case-of-physician-assisted-dying-in-the-emergency-department
#3
David H Wang
Currently, 1 out of 6 Americans lives within a jurisdiction in which physician-assisted dying is legally authorized. In most cases, patients ingest lethal physician-assisted dying medications at home without involvement of emergency medical services (EMS) or the emergency department (ED). However, occasionally the dying process is interrupted as a result of incomplete ingestion or vomiting of medications, confusion about timing of dying trajectory, familial emotional distress, and other variables. A case is presented here of a patient who arrived by ambulance to an urban ED after ingesting physician-assisted dying medication...
October 12, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29023167/state-regulation-of-community-paramedicine-programs-a-national-analysis
#4
Melody Glenn, Olivia Zoph, Kim Weidenaar, Leila Barraza, Warren Greco, Kylie Jenkins, Pooja Paode, Jonathan Fisher
BACKGROUND: Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs. OBJECTIVE: To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29019350/influenece-of-the-cprmeter-on-angular-position-of-elbows-and-generated-forces-during-cardiopulmonary-resuscitation
#5
Karolina Kopacz, Magdalena Fronczek-Wojciechowska, Anna Jaźwińska, Gianluca Padula, Dariusz Nowak, Tomasz Gaszyński
OBJECTIVES: It is commonly known that ergonomics in emergency medical services (EMS) is very important. Emergency medical services workers are exposed to different conditions and they should perform a variety of tasks. MATERIAL AND METHODS: The aim of the work has been to analyze the angular position of elbows and forces generated by the upper limbs during cardiopulmonary resuscitation with and without the CPRmeter based on feedback technology. Ten male paramedics and 10 male non-paramedics, in a kneeling position, performed cardiopulmonary resuscitation (CPR) on an Ambu Megacode manikin placed on the ground...
October 6, 2017: International Journal of Occupational Medicine and Environmental Health
https://www.readbyqxmd.com/read/28910212/feasibility-of-paramedic-performed-prehospital-lung-ultrasound-in-medical-patients-with-respiratory-distress
#6
Torben K Becker, Christian Martin-Gill, Clifton W Callaway, Francis X Guyette, Christopher Schott
OBJECTIVE: Prehospital ultrasound is not yet widely implemented. Most studies report on convenience samples and trauma patients, often by prehospital physicians or critical care clinicians. We assessed the feasibility of paramedic performed prehospital lung ultrasound in medical patients with respiratory distress. METHODS: Paramedics at 2 ambulance stations in the city of Pittsburgh, Pennsylvania, USA underwent a 2-hour training session in prehospital lung ultrasound using the SonoSite iViz, a handheld ultrasound device...
September 14, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28841102/association-of-burnout-with-workforce-reducing-factors-among-ems-professionals
#7
Remle P Crowe, Julie K Bower, Rebecca E Cash, Ashish R Panchal, Severo A Rodriguez, Susan E Olivo-Marston
OBJECTIVES: Emergency medical services (EMS) professionals often work long hours at multiple jobs and endure frequent exposure to traumatic events. The stressors inherent to the prehospital setting may increase the likelihood of experiencing burnout and lead providers to exit the profession, representing a serious workforce and public health concern. Our objectives were to estimate the prevalence of burnout, identify characteristics associated with experiencing burnout, and quantify its relationship with factors that negatively impact EMS workforce stability, namely sickness absence and turnover intentions...
August 25, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28822212/comparison-of-start-and-salt-triage-methodologies-to-reference-standard-definitions-and-to-a-field-mass-casualty-simulation
#8
COMPARATIVE STUDY
Salvatore Silvestri, Adam Field, Neal Mangalat, Tory Weatherford, Christopher Hunter, Zoe McGowan, Zachary Stamile, Trevor Mattox, Tanner Barfield, Aarian Afshari, George Ralls, Linda Papa
OBJECTIVES: We compared Sort, Assess, Lifesaving Intervention, Treatment/Transport (SALT) and Simple Triage and Rapid Treatment (START) triage methodologies to a published reference standard, and evaluated the accuracy of the START method applied by emergency medical services (EMS) personnel in a field simulation. DESIGN: Simulated mass casualty incident (MCI). Paramedics trained in START triage assigned each victim to green (minimal), yellow (delayed), red (immediate), or black (dead) categories...
2017: American Journal of Disaster Medicine
https://www.readbyqxmd.com/read/28771639/utilisation-of-prehospital-emergency-medical-services-for-hyperglycaemia-a-community-based-observational-study
#9
Melanie Villani, Natalie Nanayakkara, Sanjeeva Ranasinha, Arul Earnest, Karen Smith, Georgia Soldatos, Helena Teede, Sophia Zoungas
AIMS: This study examines prehospital Emergency Medical Service (EMS) utilisation and patterns of demand for hyperglycaemia management, including characteristics of individuals and factors related to hospital transport. MATERIALS AND METHODS: A state-wide, community-based observational study of all patients requiring prehospital EMS for hyperglycaemia during a 7 year study period (Jan 2009-Dec 2015) using electronic data from the Ambulance Victoria data warehouse was conducted...
2017: PloS One
https://www.readbyqxmd.com/read/28657809/medical-oversight-educational-core-content-and-proposed-scopes-of-practice-of-wilderness-ems-providers-a-joint-project-developed-by-wilderness-ems-educators-medical-directors-and-regulators-using-a-delphi-approach
#10
Michael G Millin, David E Johnson, Tod Schimelpfenig, Keith Conover, Matthew Sholl, Jonnathan Busko, Rachael Alter, Will Smith, Jennifer Symonds, Peter Taillac, Seth C Hawkins
INTRODUCTION: A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. METHODS: Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content...
November 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28622155/triad-ix-can-a-patient-testimonial-safely-help-ensure-prehospital-appropriate-critical-versus-end-of-life-care
#11
Ferdinando Mirarchi, Christopher Cammarata, Timothy E Cooney, Kristin Juhasz, Stanley A Terman
OBJECTIVE: The present study sought to assess the clarity of Physician Orders for Life-Sustaining Treatment (POLST) or Living Will (LW) documents alone or in combination with a video message/testimonial (VM). METHODS: Emergency medical services (EMS) personnel responded to survey questions about the meaning of stand-alone POLST and LW documents and those used in conjunction with emergent care scenarios. Personnel were randomized to receive documents only or documents with VM...
June 16, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28611884/emergency-medical-services-professionals-attitudes-about-community-paramedic-programs
#12
Robert J Steeps, Denise A Wilfong, Michael W Hubble, Daniel L Bercher
INTRODUCTION: The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. METHODS: We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28484212/quality-of-analgesia-in-physician-operated-telemedical-prehospital-emergency-care-is-comparable-to-physician-based-prehospital-care-a-retrospective-longitudinal-study
#13
Niklas Lenssen, Andreas Krockauer, Stefan K Beckers, Rolf Rossaint, Frederik Hirsch, Jörg C Brokmann, Sebastian Bergrath
Acute pain is a common reason for summoning emergency medical services (EMS). Yet in several countries the law restricts opioid-based analgesia administration to physicians. Telemedical support of paramedics is a novel approach to enable timely treatment under the guidance of a physician. In this retrospective observational study, conducted in the EMS of Aachen, Germany, the analgesic quality and occurrence of adverse events were compared between telemedically-supported paramedics (July-December, 2014) and a historical control group (conventional on-scene EMS physicians; January-March, 2014)...
May 8, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28481722/ems-provider-perceptions-on-termination-of-resuscitation-in-a-large-urban-ems-system
#14
Katie L Tataris, Christopher T Richards, Leslee Stein-Spencer, Stephanie Ryan, Pete Lazzara, Joseph M Weber
OBJECTIVE: Despite the value of out-of-hospital Termination of Resuscitation (TOR) and the scientific evidence in favor of this practice, TOR has not been uniformly adopted or consistently practiced in EMS systems. Previous focus group studies have identified multiple barriers to implementation of out of hospital TOR but existing literature on EMS provider perceptions is limited. We sought to identify EMS providers' perceived barriers to performing out-of-hospital TOR in a large urban EMS system...
September 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28476475/lower-chest-compression-fraction-associated-with-rosc-in-ohca-patients-with-longer-downtimes
#15
Milena Talikowska, Hideo Tohira, Madoka Inoue, Paul Bailey, Deon Brink, Judith Finn
AIM: To investigate the relationship between chest compression fraction (CCF) and survival outcomes in OHCA, including whether the relationship varied based upon downtime from onset of arrest to provision of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS). METHODS: Data from resuscitations performed by St John Ambulance Western Australia (SJA-WA) paramedics between July 2014 and June 2016 was captured using the Q-CPR feedback device. Logistic regression analysis was used to study the relationship between CCF and return of spontaneous circulation (ROSC)...
July 2017: Resuscitation
https://www.readbyqxmd.com/read/28460858/analysis-of-out-of-hospital-pediatric-intubation-by%C3%A2-an-australian-helicopter-emergency-medical%C3%A2-service
#16
Brian J Burns, Joanna B Watterson, Sandra Ware, Luke Regan, Cliff Reid
STUDY OBJECTIVE: We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS). METHODS: A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findings included patient demographics, operator background, airway intervention including intubation attempts, complications, and critical timings...
April 28, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28366241/teammate-familiarity-teamwork-and-risk-of-workplace-injury-in-emergency-medical-services-teams
#17
Ashley M Hughes, P Daniel Patterson, Matthew D Weaver, Megan E Gregory, Shirley C Sonesh, Douglas P Landsittel, David Krackhardt, David Hostler, Elizabeth H Lazzara, Xiao Wang, John E Vena, Eduardo Salas, Donald M Yealy
Increased teammate familiarity in emergency medical services (EMS) promotes development of positive teamwork and protects against workplace injury. METHODS: Measures were collected using archival shift records, workplace injury data, and cross-sectional surveys from a nationally representative sample of 14 EMS agencies employing paramedics, prehospital nurses, and other EMS clinicians. One thousand EMS clinicians were selected at random to complete a teamwork survey for each of their recent partnerships and tested the hypothesized role of teamwork as a mediator in the relationship between teammate familiarity and injury with the PROCESS macro...
March 30, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28356134/external-validation-of-the-rosc-after-cardiac-arrest-raca-score-in-a-physician-staffed-emergency-medical-service-system
#18
Petteri Kupari, Markus Skrifvars, Markku Kuisma
BACKGROUND: The return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score may have implications as a quality indicator for the emergency medical services (EMS) system. We aimed to validate this score externally in a physician staffed urban EMS system. METHODS: We conducted a retrospective cohort study. Data on resuscitation attempts from the Helsinki EMS cardiac arrest registry from 1.1.2008 to 31.12.2010 were collected and analyzed. For each attempted resuscitation the RACA score variables were collected and the score calculated...
March 29, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28336412/a-pilot-prospective-randomized-trial-of-video-versus-direct-laryngoscopy-for-paramedic-endotracheal-intubation
#19
RANDOMIZED CONTROLLED TRIAL
Scott Ducharme, Brandon Kramer, David Gelbart, Caroline Colleran, Brian Risavi, Jestin N Carlson
BACKGROUND: Prehospital intubation poses several unique challenges. Video assisted laryngoscopy has been shown to help increase intubation success in the hospital setting; however, little prospective data have examined video assisted laryngoscopy in traditional ground ambulance agencies. METHODS: We performed a randomized, cross-over, non-blinded trial in ground ambulances comparing first attempt success and overall intubation success between video assisted laryngoscopy using the King Video Laryngoscope (KVL) and direct laryngoscopy (DL)...
May 2017: Resuscitation
https://www.readbyqxmd.com/read/28274221/effectiveness-of-a-community-paramedic-led-health-assessment-and-education-initiative-in-a-seniors-residence-building-the-community-health-assessment-program-through-emergency-medical-services-chap-ems
#20
G Agarwal, R Angeles, M Pirrie, F Marzanek, B McLeod, J Parascandalo, L Dolovich
BACKGROUND: Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls. METHODS: Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior's apartment building in Hamilton, Ontario...
March 9, 2017: BMC Emergency Medicine
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