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Critical thinking ambulance

Michael E Detsky, Michael O Harhay, Dominique F Bayard, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Elizabeth Cooney, Nicole B Gabler, Sarah J Ratcliffe, Mark E Mikkelsen, Scott D Halpern
Importance: Predictions of long-term survival and functional outcomes influence decision making for critically ill patients, yet little is known regarding their accuracy. Objective: To determine the discriminative accuracy of intensive care unit (ICU) physicians and nurses in predicting 6-month patient mortality and morbidity, including ambulation, toileting, and cognition. Design, Setting, and Participants: Prospective cohort study conducted in 5 ICUs in 3 hospitals in Philadelphia, Pennsylvania, and enrolling patients who spent at least 3 days in the ICU from October 2013 until May 2014 and required mechanical ventilation, vasopressors, or both...
June 6, 2017: JAMA: the Journal of the American Medical Association
Marina Buswell, Sarah Amado, Claire Goodman, Julia William, Jane Fleming, Phillip Lumbard, Larissa Prothero
BACKGROUND: Care for older people with dementia (OPWD) is a major concern across all care settings. Ambulance services are in the spotlight as pressures on emergency services and calls for admission avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a significant proportion of whom may have dementia. There is a perception that dementia may be an issue but we do not understand how much this affects use of emergency services. METHODS: We reviewed 358 ambulance service paper-based patient care records (PCRs) to test the feasibility of using them as a source of information about ambulance service use by OPWD and, conducted critical incident reviews of 999 callouts to understand factors associated with emergency ambulance call-outs...
June 2015: Emergency Medicine Journal: EMJ
Andrew H Westmoreland
BACKGROUND: Coronary emergencies at sea requiring air evacuation are not uncommon. On board a Nimitz-class aircraft carrier while in a remote location, an active duty sailor suffered a myocardial infarction. A medical evacuation by helicopter was necessary. Transfer proved difficult due to the ship's location, poor flying conditions, and the patient's deteriorating condition. This case stresses the importance of expeditious diagnosis, treatment, and air transfer to shore-based facilities capable of providing definitive coronary care...
January 2014: Aviation, Space, and Environmental Medicine
Di Lamb
OBJECTIVE: The Royal Air Force Critical Care Air Support Teams (CCASTs) have a philosophy to undertake transfers of critically ill patients from anywhere in the world back to a UK medical facility in a stable or improved clinical condition. The training they receive is primarily taught by traditional didactic methods, with no standardisation of education between teams that are expected to deliver care to the same standard. Notwithstanding there being no current compromise to patient care during air transfer, it was important to consider the benefits of an alternative experiential teaching modality...
February 2007: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Alan Garner
The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags...
October 2003: Emergency Medicine
S Clohessy, A Ehlers
OBJECTIVES: To examine the relationship of coping strategies and responses to intrusive memories with post-traumatic stress disorder (PTSD) and other psychiatric symptoms in ambulance service workers. METHOD: Fifty-six ambulance service workers describe the most distressing aspects of their work and completed questionnaires designed to measure their coping strategies in dealing with distressing incidents. They also described their intrusive memories of particularly distressing incidents and completed a questionnaire designed to measure their interpretation of these intrusions and their responses to them...
September 1999: British Journal of Clinical Psychology
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