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https://www.readbyqxmd.com/read/28340247/usability-testing-of-the-iphone-app-to-improve-pain-assessment-for-older-adults-with-cognitive-impairment-prehospital-setting-a-qualitative-study
#1
Rachael E Docking, Matthew Lane, Pat A Schofield
Objectives. : Pain assessment in older adults with cognitive impairment is often challenging, and paramedics are not given sufficient tools/training to assess pain. The development of a mobile app may improve pain assessment and management in this vulnerable population. We conducted usability testing of a newly developed iPhone pain assessment application with potential users, in this case as a tool for clinical paramedic practice to improve pain assessment of older adults with cognitive impairment...
March 15, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339314/an-analysis-of-ems-and-ed-detection-of-stroke
#2
Ian Medoro, David C Cone
BACKGROUND AND PURPOSE: Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify the ED of a "stroke alert" from the field. However, there are few data on the accuracy of these EMS stroke alerts. The goal of this study was to examine diagnostic test performance of EMS and ED stroke alerts and related process measures. METHODS: The EMS and ED records of all stroke alerts in a large tertiary ED from August 2013-January 2014 were examined and data abstracted by one trained investigator, with data accuracy confirmed by a second investigator for 15% of cases...
March 24, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28338599/volumetric-control-of-whole-blood-collection-in-austere-environments
#3
Michael A Meledeo, Andrew D Fisher, Grantham C Peltier, Ethan A Miles, William B Muse, Win B Kerr, Shawn C Nessen, Andrew P Cap
INTRODUCTION: Fresh whole blood transfusions are a powerful tool in prehospital care; however, the lack of equipment such as a scale in field situations frequently leads to collections being under- or overfilled, leading to complications for both patient and donor. This study describes two methods for simple, rapid control of collection bag volume: (1) a length of material to constrict the bag, and (2) folding/clamping the bag. METHOD: Whole blood collection bags were allowed to fill with saline via gravity...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28336412/a-pilot-prospective-randomized-trial-of-video-versus-direct-laryngoscopy-for-paramedic-endotracheal-intubation
#4
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)...
March 20, 2017: Resuscitation
https://www.readbyqxmd.com/read/28333837/leadership-lessons-learned-in-tactical-combat-casualty-care
#5
Frank K Butler
The US Military has achieved remarkable success in improving survival for our nation's combat wounded throughout the 14 years of conflict in Iraq and Afghanistan. For the prehospital phase of care, where most combat fatalities occur, these advances have been embodied in Tactical Combat Casualty Care (TCCC.) TCCC is a set of evidence-based, best-practice, prehospital trauma care guidelines that are customized for use on the battlefield. The TCCC Guidelines have been updated on an ongoing basis over the last 15 years through the work of the Committee on TCCC and the TCCC Working Group...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333833/leadership-and-a-casualty-response-system-for-eliminating-preventable-death
#6
Russ S Kotwal, Harold R Montgomery, Ethan A Miles, Curtis C Conklin, Michael T Hall, Stanley A McChrystal
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are non-survivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, in order to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by non-medical combatant leaders within the 75th Ranger Regiment, U...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333828/prehospital-blood-transfusion-programs-capabilities-and-lessons-learned
#7
Martin D Zielinski, James R Stubbs, Kathleen S Berns, Elon Glassberg, Alan D Murdock, Eilat Shinar, Geir Arne Sunde, Steve Williams, Mark H Yazer, Scott Zietlow, Donald H Jenkins
The Trauma and Hemostasis Oxygenation Research (THOR) network has met in Bergen, Norway every summer over the past six years in an effort to have experts in transfusion, blood banking, military medicine, and trauma surgery exchange ideas, share their experiences, and set an agenda to move the science of remote damage control resuscitation forward. In this manuscript, we supply the lessons shared from the authors/speakers to the reader. These lessons include the experiences of the Norwegian Military with freeze dried plasma and whole blood resuscitation, lessons from extreme remote damage control resuscitation situations on oceanic cruises, and remote blood product resuscitation techniques at Mayo Clinic and the University of Pittsburgh...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28328673/remote-damage-control-during-the-attacks-on-paris-lessons-learned-by-the-paris-fire-brigade-and-evolutions-in-the-rescue-system
#8
Xavier Lesaffre, Jean-Pierre Tourtier, Yann Violin, Benoit Frattini, Catherine Rivet, Olivier Stibbe, Florian Faure, Anne Godefroy, Jean-Claude Gallet, Sylvain Ausset
On November 13, 2015, in 40 minutes, Paris suffered 4 suicide bombers attacks, shootings at 3 different restaurant terraces and an attack on the Bataclan concert hall resulting in 130 dead and 495 wounded. How did the Parisian rescue system respond and how did it evolve since?We proved we could deploy quickly wide prehospital and hospital resources and teams' equipment and preparedness is being further developed. In order to secure a swifter initial response we need a better integration of the operators of the rescue chain with a simpler and more robust organization as well as improved communications channels...
March 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28328647/pressure-injury-in-a-community-population-a-descriptive-study
#9
Lisa Q Corbett, Marjorie Funk, Gilbert Fortunato, David M OʼSullivan
PURPOSE: The purpose of this study was to describe present-on-admission pressure injuries (POA-PIs) in community-dwelling adults admitted to acute care. The specific aims of the study were to (1) measure the prevalence of POA-PIs during a 1-year period; (2) determine prehospital location of patients with POA-PIs; and (3) describe demographics, pressure injury (PI) characteristics, risk factors, and posthospital outcome of community-dwelling adults with PIs admitted to hospital. DESIGN: Retrospective descriptive study...
March 21, 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28325485/the-effects-of-interprofessional-education-self-reported-professional-competence-among-prehospital-emergency-care-nursing-students-on-the-point-of-graduation-a-cross-sectional-study
#10
M Castrèn, M Mäkinen, J Nilsson, V Lindström
The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses' (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC...
March 16, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28320917/predictors-of-massive-blood-transfusion-a-delphi-study-to-examine-the-views-of-experts
#11
Jacqueline V Mclennan, K C Mackway-Jones, S T Horne, R Body
BACKGROUND: Trauma patients requiring massive blood transfusion (MBT) have high morbidity and mortality: early and aggressive use of blood products during immediate resuscitation may improve survival. There is currently a lack of evidence to guide initial identification of these patients which is especially important in areas where plasma may need to be thawed. In the absence of this evidence, this study aimed to robustly evaluate expert opinion by using a Delphi process to identify predictors of massive transfusion...
March 20, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28318991/bleeding-control-using-hemostatic-dressings-lessons-learned
#12
REVIEW
Brad L Bennett
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#13
REVIEW
Russ S Kotwal, Frank K Butler
During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28318455/airway-management-in-disaster-response-a-manikin-study-comparing-direct-and-video-laryngoscopy-for-endotracheal-intubation-by-prehospital-providers-in-level-c-personal-protective-equipment
#14
Sami Yousif, Jason T Machan, Yasser Alaska, Selim Suner
Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE. METHODS: In this prospective, randomized, crossover study, a convenience sample of practicing prehospital providers were recruited...
March 20, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28316308/where-we-fail-location-and-timing-of-failure-to-rescue-in-trauma
#15
Jennifer J Chung, Emily C Earl-Royal, M Kit Delgado, Jose L Pascual, Patrick M Reilly, Douglas J Wiebe, Daniel N Holena
Failure to rescue (FTR) is an outcome metric that reflects a center's ability to prevent mortality after a major complication. Identifying the timing and location of FTR events could help target efforts to reduce FTR rates. We sought to characterize the timing and location of FTR occurrences at our center, hypothesizing that FTR rates would be highest early after injury and in settings of lower intensity of care. We used data, prospectively collected from 2009 to 2013, on patients ≥16 years old with minimum Abbreviated Injury Score ≥2 from a single institution...
March 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28314465/data-capture-and-communication-during-transfers-to-definitive-care-in-an-inclusive-trauma-system
#16
Nori L Bradley, Naisan Garraway, Nathaniel Bell, Nasira Lakha, S Morad Hameed
INTRODUCTION: Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. PATIENTS AND METHODS: We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243)...
November 5, 2016: Injury
https://www.readbyqxmd.com/read/28306741/pre-hospital-midazolam-for-benzodiazepine-treated-seizures-before-and-after-the-rapid-anticonvulsant-medication-prior-to-arrival-trial-a-national-observational-cohort-study
#17
Eytan Shtull-Leber, Robert Silbergleit, William J Meurer
BACKGROUND: Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. METHODS AND FINDINGS: This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28296638/complete-versus-incomplete-angiography-prior-to-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction
#18
Kevin Stiver, Xu Gao, Satya Shreenivas, Konstantinos Dean Boudoulas, Ernie Mazzaferri, Nader Makki, Scott M Lilly
OBJECTIVES: Shorter reperfusion times in ST-elevation myocardial infarction (STEMI) are associated with improved survival. Prehospital strategies have been developed to minimize door-to-balloon (DTB) time, but few strategies within the catheterization laboratory itself have been evaluated. Incomplete angiography (IA) prior to percutaneous coronary intervention (PCI) is undertaken in clinical practice as a means to further reduce DTB time. We sought to determine whether or not those with STEMI who underwent IA prior to PCI had different preprocedural characteristics or post-PCI outcomes...
March 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28294854/-registry-of-acute-coronary-syndromes-record-3-characteristics-of-patients-and-treatment-during-initial-hospitalization
#19
A D Erlikh, N A Gratsiansky On Behalf Of Record-Participants
Acute Coronary Syndrome (ACS) Registries RECORD 1-2 (2007-2001) gave valuable information on management of ACS patients in Russia. RECORD-3 was carried out in March-April, 2015. Here we present characteristics of included patients (pts) and data on their treatment during initial hospitalization. MATERIAL AND METHODS: RECORD-3 recruited pts with suspected ACS consecutively hospitalized in participating hospitals (n=47, 55% "invasive") during 1 month. RESULTS: Number of included pts was 2370 (39% women, mean age 64...
April 2016: Kardiologiia
https://www.readbyqxmd.com/read/28291697/early-prehospital-assessment-of-non-urgent-patients-and-outcomes-at-the-appropriate-level-of-care-a-prospective-exploratory-study
#20
Glenn Larsson, Anders Holmén, Kristina Ziegert
INTRODUCTION: The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. METHODS: The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000...
March 10, 2017: International Emergency Nursing
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