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Prehospital mental health

Thomas R Scaggs, David M Glass, Megan Gleason Hutchcraft, William B Weir
Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics)...
October 2016: Prehospital and Disaster Medicine
Amy R Knowlton, Brian Weir, Julie Fields, Gerald Cochran, Junette McWilliams, Lawrence Wissow, Benjamin J Lawner
OBJECTIVE: The increasing use of prehospital emergency medical services (EMS) and its contribution to rising emergency department use and healthcare costs point to the need for better understanding factors associated with EMS use to inform preventive interventions. Understanding patient factors associated with pediatric use of EMS will inform pediatric-specific intervention. We examined pediatric patient demographic and health factors associated with one-time and repeat use of EMS. METHODS: We reviewed data from Baltimore City Fire Department EMS patient records over a 23-month period (2008-10) for patients under 21 years of age (n = 24,760)...
May 2016: Prehospital Emergency Care
Derek L Isenberg, Dorian Jacobs
INTRODUCTION: Violent patients in the prehospital environment pose a threat to health care workers tasked with managing their medical conditions. While research has focused on methods to control the agitated patient in the emergency department (ED), there is a paucity of data looking at the optimal approach to subdue these patients safely in the prehospital setting. Hypothesis This study evaluated the efficacy of two different intramuscular medications, midazolam and haloperidol, to determine their efficacy in sedating agitated patients in the prehospital setting...
October 2015: Prehospital and Disaster Medicine
Christopher Prener, Alisa K Lincoln
Emergency medical technicians and paramedics form the backbone of the United States' Emergency Medical Service (EMS) system. Despite the frequent involvement of EMS with people with mental health and substance abuse problems, the nature and content of this work, as well as how EMS providers think about this work, have not been fully explored. Using data obtained through observations and interviews with providers at an urban American EMS agency, this paper provides an analysis of the ways in which EMS providers interact with people with mental illness and substance abuse problems, as well as providers' experiences with the mental health care system...
November 2015: American Journal of Orthopsychiatry
Jahan Fahimi, Adrian Aurrecoechea, Erik Anderson, Andrew Herring, Harrison Alter
OBJECTIVES: The objectives of the study were to identify factors associated with adolescent emergency department (ED) visits for substance abuse, including those complicated by mental health (dual diagnosis), and to analyze their effect on ED length of stay (LOS) and disposition. METHODS: We performed a secondary analysis of ED visits by adolescents (age, 11-24) using the National Hospital Ambulatory Medical Care Survey (1997-2010) to identify visits for mental health, substance use, and dual diagnosis...
May 2015: Pediatric Emergency Care
Jon Femling, Steven Weiss, Eric Hauswald, David Tarby
OBJECTIVES: Sepsis is a significant problem. The differences between patients with sepsis who walk into the emergency department (ED) and those who are transported via emergency medical services (EMS) have not been clarified. The aim of the study was to determine whether there was a difference in outcome between patients arriving by EMS and those presenting directly to the ED. METHODS: We prospectively collected and reviewed a cohort of all cases of severe sepsis and septic shock admitted to the medical intensive care unit from the ED from November 2009 to March 2012...
December 2014: Southern Medical Journal
Elizabeth L Seaman, Mathew J Levy, J Lee Jenkins, Cassandra Chiras Godar, Kevin G Seaman
INTRODUCTION: Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited. HYPOTHESIS/PROBLEM: This study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age...
October 2014: Prehospital and Disaster Medicine
Jennifer F Anders, Kathleen Adelgais, John D Hoyle, Cody Olsen, David M Jaffe, Julie C Leonard
BACKGROUND: Pediatric cervical spine injury is rare. As a result, evidence-based guidance for prehospital triage of children with suspected cervical spine injuries is limited. The effects of transport time and secondary transfer for specialty care have not previously been examined in the subset of children with cervical spine injuries. OBJECTIVES: The primary objective was to determine if prehospital destination choice affects outcomes for children with cervical spine injuries...
January 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Sharon McKinley, Mary Fien, Rosalind Elliott, Doug Elliott
INTRODUCTION: Intensive care patients often report sleep disruption in ICU and during recovery from critical illness. OBJECTIVES: To assess: (i) patients' self-reported sleep quality in ICU, on the hospital ward after transfer from ICU and two and six months after hospital discharge; (ii) whether patients who report sleep disruption in ICU continue to report sleep disruption in recovery and (iii) whether prehospital insomnia, experiences in intensive care, quality of life and psychological health are associated with sleep disruption six months after hospital discharge...
December 2013: Journal of Psychosomatic Research
John T Street, Vanessa K Noonan, Antoinette Cheung, Charles G Fisher, Marcel F Dvorak
BACKGROUND CONTEXT: Adverse events (AEs) with significant resultant morbidity are common during the acute hospital care of patients with traumatic spinal cord injury (TSCI). The Rick Hansen SCI Registry (RHSCIR) collects Canada-wide data on patients with TSCI, such as sociodemographic, injury, diagnosis, intervention, and health outcome details. These data contribute to an evidence base for informing best practice and improving SCI care. As the RHSCIR captures data on patients from prehospital to community phases of care, it is an invaluable resource for providing information on health outcomes resulting from TSCI, including outcomes related to AEs...
May 1, 2015: Spine Journal: Official Journal of the North American Spine Society
Charilaos Lygidakis, Stella Argyriadou, Anastasia Lygera
OBJECTIVE: The authors aimed at reporting on whether or not primary care doctors follow atrial fibrillation (AF) treatment protocols, and on the mental distress of such patients. METHODS: A total of 138 patients with first detected or recurrent AF were examined in a health center. Demographic data were collected and their lifestyle and medical history for rhythm-related pathologies and chronic medication were investigated. Physical examination, electrocardiogram (EKG), and in selected cases, lab analysis were carried-out...
April 1, 2010: Journal of Primary Care & Community Health
Karine Price, Stéphane Perron, Norman King
OBJECTIVES: The objective of this paper is to describe Montreal's heat response plan and its application during the July 2010 heat wave. PARTICIPANTS AND SETTING: The Montreal heat response plan is designed to ensure the surveillance of weather and health indicators during the summer season and to coordinate actions to be undertaken during this period to reduce morbidity and mortality due to heat, particularly when weather thresholds are reached or an increase in health indicators is observed...
March 2013: Canadian Journal of Public Health. Revue Canadienne de Santé Publique
Toshikazu Abe, Shinichi Ishimatsu, Yasuharu Tokuda
INTRODUCTION: Few studies are available on the clinical characteristics of patients using emergency medical transports in Japan. In this study, we aimed to investigate reasons for emergency medical transports and their relation to clinical severity. METHODS: We conducted a 3-year population-based observational study of patients transported by ambulance to emergency departments (ED) in the capital of Japan, Tokyo, which has a population of about 13 million. Demographic data, reasons for transport, and the severity of initial assessment at ED were recorded...
2013: PloS One
Julia K Fuzak, Jennifer Trainor
BACKGROUND: Failure to promptly recognize and treat anaphylaxis can result in death. Understanding the incidence, etiology, and management is imperative. A previous pediatric study identified latex as the most common anaphylaxis allergen. We aim to describe the incidence, etiology, and management of anaphylaxis prelatex and postlatex-precaution implementation. METHODS: Retrospective review of inpatient and emergency department (ED) records of pediatric anaphylaxis patients seen at 1 institution between 1986 and 1990 or 2002 and 2006 was performed...
February 2013: Pediatric Emergency Care
Dominic Aldington
PURPOSE OF REVIEW: The purpose of this review is to look at the options available for the management of pain in victims of conflict, from the point of wounding, through a chain of evacuation, to rehabilitation in the home country. This is relevant for all healthcare workers as any could find themselves treating veterans and having a clear understanding of what occurred will help. RECENT FINDINGS: The article will discuss developments in the prehospital environment, the field hospital, during repatriation and back in the home country to include neurostimulation in cases of refractory pain...
June 2012: Current Opinion in Supportive and Palliative Care
Richard Lammers, Maria Byrwa, William Fales
OBJECTIVES: Systematic evaluation of prehospital provider performance during actual resuscitations is difficult. Although prior studies reported pediatric drug-dosing mistakes and other types of management errors, the underlying causes of those errors were not investigated. The objective of this study was to identify causes of errors during a simulated, prehospital pediatric emergency. METHODS: Two-person emergency medical services (EMS) crews from five geographically diverse agencies participated in a validated simulation of an infant with altered mental status, seizures, and respiratory arrest using their own equipment and drugs...
January 2012: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Marc Arial, Pascal Wild, Damien Benoit, Dominique Chouaniere, Brigitta Danuser
BACKGROUND: The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers. METHODS: 333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment...
November 2011: American Journal of Industrial Medicine
Victor D Dinglas, Jonathan Gellar, Elizabeth Colantuoni, Vanessa A Stan, Pedro A Mendez-Tellez, Peter J Pronovost, Dale M Needham
PURPOSE: The aim of this study is to evaluate if severity of illness in the intensive care unit influences patients' retrospective recall of their baseline physical function from before hospital admission. MATERIALS AND METHODS: This is a prospective cohort study of 193 acute lung injury survivors who, before hospital discharge, retrospectively reported their prehospitalization physical function using the Short Form 36 quality of life survey. RESULTS: Four measures were used to evaluate intensive care unit (ICU) severity of illness: (1) Acute Physiology and Chronic Health Evaluation II Acute Physiologic Score at ICU admission, (2) Lung Injury Score at acute lung injury diagnosis, (3) Sequential Organ Failure Assessment score at study enrollment, and (4) maximum daily Sequential Organ Failure Assessment score during the entire ICU stay...
December 2011: Journal of Critical Care
Brian Suffoletto, Adam Frisch, Arjun Prabhu, Jeffrey Kristan, Francis X Guyette, Clifton W Callaway
BACKGROUND: Regionalization of emergency care for patients with serious infections has the potential to improve outcomes, but is not feasible without accurate identification of patients in the prehospital environment. OBJECTIVE: To determine the incremental predictive value of provider judgment in addition to prehospital physiologic variables for identifying patients who have serious infections. METHODS: We conducted a prospective study at a single teaching tertiary-care emergency department (ED) where a convenience sample of emergency medical services (EMS) providers and ED clinicians completed a questionnaire about the same patients...
July 2011: Prehospital Emergency Care
P Daniel Patterson, Brian P Suffoletto, Douglas F Kupas, Matthew D Weaver, David Hostler
BACKGROUND: Fatigue is common among medical professionals and has been linked to poor performance and medical error. Objective. To characterize sleep quality and its association with severe fatigue in emergency medical services (EMS) providers. METHODS: We studied a convenience sample of EMS providers who completed three surveys: the Pittsburgh Sleep Quality Index (PSQI), the Chalder Fatigue Questionnaire (CFQ), and a demographic survey. We used established measures to examine survey psychometrics and performed t-tests, analysis of variance (ANOVA), and chi-square tests to identify differences in PSQI and CFQ scores...
April 2010: Prehospital Emergency Care
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