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Prehospital emergency care

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https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#1
Jason P Stopyra, William S Harper, Tyson J Higgins, Julia V Prokesova, James E Winslow, Robert D Nelson, Roy L Alson, Christopher A Davis, Gregory B Russell, Chadwick D Miller, Simon A Mahler
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29310618/epidemiology-of-unplanned-out-of-hospital-births-attended-by-paramedics
#2
Gayle McLelland, Lisa McKenna, Amee Morgans, Karen Smith
BACKGROUND: Over the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia...
January 8, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29297735/national-assessment-of-quality-programs-in-emergency-medical-services
#3
Michael Redlener, Patrick Olivieri, George T Loo, Kevin Munjal, Michael T Hilton, Katya Trudeau Potkin, Michael Levy, Jeffrey Rabrich, Michael R Gunderson, Sabina A Braithwaite
OBJECTIVE: This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. METHODS: A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29297718/evaluation-of-physiologic-alterations-during-prehospital-paramedic-performed-rapid-sequence-intubation
#4
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29291175/factors-delaying-management-of-acute-stroke-an-indian-scenario
#5
Siju V Abraham, S Vimal Krishnan, Fazil Thaha, Jayaraj Mymbilly Balakrishnan, Tom Thomas, Babu Urumese Palatty
Background and Purpose: The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India. Methods: All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected...
October 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29285622/effects-of-the-intensity-of-prehospital-treatment-on-short-term-outcomes-in-patients-with-acute-heart-failure-the-semica-2-study
#6
Òscar Miró, Melissa Hazlitt, Xavier Escalada, Pere Llorens, Víctor Gil, Francisco Javier Martín-Sánchez, Pia Harjola, Verónica Rico, Pablo Herrero-Puente, Javier Jacob, David C Cone, Martin Möckel, Michael Christ, Yonathan Freund, Salvatore di Somma, Said Laribi, Alexandre Mebazaa, Veli-Pekka Harjola
OBJECTIVE: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF...
December 28, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29278996/a-systematic-review-of-prehospital-telehealth-utilization
#7
Andrew S Winburn, Juliana J Brixey, James Langabeer, Tiffany Champagne-Langabeer
Objective There has been moderate evidence of telehealth utilization in the field of emergency medicine, but less is known about telehealth in prehospital emergency medical services (EMS). The objective of this study is to explore the extent, focus, and utilization of telehealth for prehospital emergency care through the analysis of published research. Methods The authors conducted a systematic literature review by extracting data from multiple research databases (including MEDLINE/PubMed, CINAHL Complete, and Google Scholar) published since 2000...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/29251708/speed-isn-t-everything-identifying-patients-who-may-benefit-from-helicopter-transport-despite-faster-ground-transport
#8
Xilin Chen, Mark L Gestring, Matthew R Rosengart, Timothy R Billiar, Andrew B Peitzman, Jason L Sperry, Joshua B Brown
BACKGROUND: Helicopter emergency medical services (HEMS) have demonstrated survival benefits over ground emergency medical services (GEMS) for trauma patient transport. While HEMS speed is often-cited, factors such as provider experience and level of care may also play a role. Our objective was to identify patient groups that may benefit from HEMS even when prehospital time for helicopter utilization is longer than GEMS transport. METHODS: Adult patients transported by HEMS or GEMS from the scene of injury in the Pennsylvania State Trauma Registry were included...
December 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29234837/injury-severity-in-polytrauma-patients-is-underestimated-using-the-injury-severity-score-a-single-center-correlation-study-in-air-rescue
#9
C Schröter, F Urbanek, C Frömke, M Winkelmann, P Mommsen, C Krettek, C Zeckey
PURPOSE: Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. METHODS: In this prospective study, the ISS was determined prehospital by emergency physicians...
December 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29229538/association-of-prehospital-intubation-with-decreased-survival-among-pediatric-trauma-patients-in-iraq-and-afghanistan
#10
Steven G Schauer, Jason F Naylor, Guyon J Hill, Allyson A Arana, Jamie L Roper, Michael D April
INTRODUCTION: Airway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016...
December 1, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29223194/hospital-confirmed-acute-myocardial-infarction-prehospital-identification-using-the-medical-priority-dispatch-system
#11
Jeff J Clawson, Isabel Gardett, Greg Scott, Conrad Fivaz, Tracey Barron, Meghan Broadbent, Christopher Olola
Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender. Hypothesis/Problem No studies currently exist that describe the EMD's ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers...
December 10, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29223193/quality-indicators-for-evaluating-prehospital-emergency-care-a-scoping-review
#12
Ian Howard, Peter Cameron, Lee Wallis, Maaret Castren, Veronica Lindstrom
Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC...
December 10, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29217362/rethinking-prehospital-stroke-notification-assessing-utility-of-emergency-medical-services-impression-and-cincinnati-prehospital-stroke-scale
#13
Stephen W English, Alejandro A Rabinstein, Jay Mandrekar, James P Klaas
BACKGROUND AND PURPOSE: Although prehospital stroke notification has improved stroke treatment, incorporation of these systems into existing infrastructure has resulted in new challenges. The goal of our study was to design an effective prehospital notification system that allows for early and accurate identification of patients presenting with acute stroke. METHODS: We conducted a retrospective single-center cohort study of patients presenting with suspicion of acute stroke from 2014 to 2015...
December 5, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29217178/factors-associated-with-advanced-cardiac-care-in-prehospital-chest-pain-patients
#14
Adam Frisch, Kenneth J Heidle, Stephanie O Frisch, Ashar Ata, Brandon Kramer, Caroline Colleran, Jestin N Carlson
INTRODUCTION: Many patients transported by emergency medical services (EMS) may require advanced cardiac care but do not have ST-segment elevation (STEMI) on the initial prehospital EKG. We sought to identify factors associated with the need for advanced cardiac care in undifferentiated EMS patients reporting chest pain in the absence of STEMI on EKG. METHODS: We performed a retrospective analysis of all adult patients, reporting atraumatic chest pain from a single EMS agency, presenting to a single, urban hospital over a 10-year period...
December 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29209788/-reform-of-emergency-physician-training-in-austria-finally-up-to-date
#15
REVIEW
H Trimmel, M Baubin, J Kreutziger, G Frank, G Prause
During the last 20 years Austrian prehospital emergency medical services (EMS) have significantly improved. The structure and organization of Austrian EMS comply with European standards but training requirements for prehospital EMS physicians are insufficient when compared with other countries. Although some EMS systems follow the German or Swiss postgraduate training concepts, the legal requirements in Austria defining the scope of mandatory training for physicians in the prehospital setting are only minimal...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209787/-different-levels-of-experience-with-anesthetic-agents-of-german-emergency-physicians-results-of-an-online-survey
#16
A Luckscheiter, M Fischer, W Zink
BACKGROUND AND OBJECTIVE: In 2015 practice management guidelines on prehospital emergency anesthesia in adults were published in Germany. The aim of the present study was to evaluate whether emergency physicians follow these guidelines in daily practice and to assess their level of experience with the use of anesthetic agents. MATERIAL AND METHODS: In an online survey the way of induction of preclinical anesthesia (including preoxygenation time and applied monitoring techniques) was assessed with the help of virtual scenarios based on the guidelines...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29208018/noise-exposure-during-prehospital-emergency-physicians-work-on-mobile-emergency-care-units-and-helicopter-emergency-medical-services
#17
Mads Christian Tofte Hansen, Jesper Hvass Schmidt, Anne C Brøchner, Jakob Kjersgaard Johansen, Stine Zwisler, Søren Mikkelsen
BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS). A second objective was to identify any occupational hearing loss amongst prehospital personnel. METHODS: Noise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet...
December 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29199427/predictive-value-of-routine-point-of-care-cardiac-troponin-t-measurement-for-prehospital-diagnosis-and-risk-stratification-in-patients-with-suspected-acute-myocardial-infarction
#18
Martin B Rasmussen, Carsten Stengaard, Jacob T Sørensen, Ingunn S Riddervold, Troels M Hansen, Matthias Giebner, Claus-Henrik Rasmussen, Hans E Bøtker, Christian J Terkelsen
OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. METHODS AND RESULTS: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction...
December 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29198373/the-development-and-implementation-of-a-layperson-trauma-first-responder-course-in-la-paz-bolivia-a-pilot-study
#19
Marissa A Boeck, Tyler E Callese, Sarah K Nelson, Steven J Schuetz, Christian Fuentes Bazan, Juan Mauricio P Saavedra Laguna, Michael B Shapiro, Nabil M Issa, Mamta Swaroop
BACKGROUND: Ninety percent of nearly five million annual global injury deaths occur in low- and middle-income countries (LMICs), where prehospital care systems are frequently rudimentary or nonexistent. The World Health Organization considers layperson first-responders as essential for emergency medical services in low-resource settings lacking more formalized systems. This study sought to develop and implement a layperson trauma first responder course (TFRC) in Bolivia. MATERIALS AND METHODS: In March and April 2013 nine sessions of the eight-hour TFRC were held in La Paz, Bolivia...
November 22, 2017: Injury
https://www.readbyqxmd.com/read/29198239/medical-response-to-the-tianjin-explosions-lessons-learned
#20
Jin-Jun Zhang, Tian-Bing Wang, Da Fan, Jun Zhang, Bao-Guo Jiang
BACKGROUND: On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned. METHODS: This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals...
December 4, 2017: Disaster Medicine and Public Health Preparedness
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