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Critical care paramedic

Alex J Fraess-Phillips
OBJECTIVE: The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients. METHODS: A narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA). RESULTS: Only 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients...
September 19, 2016: Prehospital and Disaster Medicine
Susan R Wilcox, Michael Ries, Ted A Bouthiller, E Dean Berry, Travis L Dowdy, Sharon DeGrace
Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team...
September 13, 2016: Journal of Intensive Care Medicine
Jason J Bischof, Ashish R Panchal, Geoffrey I Finnegan, Thomas E Terndrup
UNLABELLED: Introduction Endotracheal intubation (ETI) is a complex clinical skill complicated by the inherent challenge of providing care in the prehospital setting. Literature reports a low success rate of prehospital ETI attempts, partly due to the care environment and partly to the lack of consistent standardized training opportunities of prehospital providers in ETI. Hypothesis/Problem The availability of a mobile simulation laboratory (MSL) to study clinically critical interventions is needed in the prehospital setting to enhance instruction and maintain proficiency...
October 2016: Prehospital and Disaster Medicine
Jeffrey M Singh, Anna C Gunz, Sonny Dhanani, Mahvareh Aghari, Russell D MacDonald
OBJECTIVES: Transport of pediatric patients is common due to healthcare regionalization. We set out to determine the frequency of in-transit critical events during pediatric critical care transport and identify factors associated with these events. DESIGN: Retrospective cohort study using administrative and clinical data. SETTING: Single pediatric critical care transport provider in Ontario, Canada. PATIENTS: All pediatric care transports between January 1, 2005, and December 31, 2010...
October 2016: Pediatric Critical Care Medicine
Gary H Belt, Robert A Felberg, Jane Rubin, John J Halperin
BACKGROUND AND PURPOSE: Time to treatment is critically important in ischemic stroke. We compared the efficacy and cost of teleneurology evaluation during patient transport with that of mobile stroke transport units. METHODS: Using cellular-connected telemedicine devices, we assessed 89 presumptive stroke patients in ambulances in transit. Paramedics assisted remote teleneurologists in obtaining a simplified history and examination, then coordinating care with the receiving emergency department...
September 2016: Stroke; a Journal of Cerebral Circulation
Scott A Goldberg, Avital Porat, Christopher G Strother, Nadine Q Lim, H R Sagara Wijeratne, Greisy Sanchez, Kevin G Munjal
OBJECTIVES: Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is transferred from one healthcare professional to another. Patient handoff is an integral component of quality patient care and is increasingly identified as a potential source of medical error. However, evaluation of handoff from field providers to ED personnel is limited. We here present a quantitative analysis of the information transferred from EMS providers to ED physicians during handoff of critically ill and injured patients...
July 15, 2016: Prehospital Emergency Care
Russell D MacDonald, Felipe Allendes
OBJECTIVE: Transport of intra-aortic balloon pump (IABP)-dependent patients between hospitals is increasingly common. The transports are typically time-sensitive and require personnel familiar with IABP operation and management of a potentially unstable patient. This study examined transports performed by specially trained critical care paramedics in a large air medical and land critical care transport service. METHODS: This retrospective, descriptive review prospectively collected data for IABP-dependent patient transports in Ontario, Canada in a 10-year interval beginning September 2003...
July 2016: Air Medical Journal
Michele L Kuszajewski, John M O'Donnell, Paul E Phrampus, Walter C Robey, Patricia K Tuite
OBJECTIVE: Airway assessment and management are vital skills for the critical care transport provider. Nurses and paramedics often enter a transport program with limited or no exposure to airway management. Many programs lack a structured curriculum to show skill competence. Optimal methods in the development of airway management competence and the frequency of training needed to maintain skills have not been clearly defined. Because of this lack of standardization, the actual level of competence in both new and experienced critical care transport providers is unknown...
May 2016: Air Medical Journal
Neil B Davids
Over the past 14 years of conflict, the Department of Defense medical community has made significant strides in patient care. As the conflicts developed, many sources identified a critical gap in en route care, specifically the need for critical care trained personnel for point of injury and intrahospital transfers, as well as improved outcomes for patients who received care from critical care trained providers. As stopgap measures were implemented, the US Army instituted the Critical Care Flight Paramedic Program in order to meet this need of life saving critical care transport...
April 2016: U.S. Army Medical Department Journal
Erik Jan van Lieshout, Jan Binnekade, Elmer Reussien, Dave Dongelmans, Nicole P Juffermans, Rob J de Haan, Marcus J Schultz, Margreeth B Vroom
PURPOSE: Regionalization and concentration of critical care increases the need for interhospital transport. However, optimal staffing of ground critical care transport has not been evaluated. METHODS: In this prospective, randomized, open-label, blinded-endpoint non-inferiority trial, critically ill patients on mechanical ventilation transported by interhospital ground critical care transport were randomized between transport staffed by a dedicated team comprising a critical care nurse and paramedic (nurses group) or a dedicated team including a critical care physician (nurses + physician group)...
July 2016: Intensive Care Medicine
Kim De Vasconcellos, David Lee Skinner, Dhivendra Singh
BACKGROUND: Transport of the critically ill patient poses the risk of numerous complications. Hypoxaemia is one such serious adverse event and is associated with potential morbidity and mortality. It is, however, potentially preventable. OBJECTIVE: To determine the incidence of hypoxaemia on arrival in a tertiary multidisciplinary intensive care unit (ICU) and to identify risk factors for this complication. METHOD: A retrospective observational study was conducted at King Edward VIII Hospital, Durban, South Africa, from May 2013 to February 2014...
May 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Marc Felzen, Jörg C Brokmann, Stefan K Beckers, Michael Czaplik, Frederik Hirsch, Miriam Tamm, Rolf Rossaint, Sebastian Bergrath
INTRODUCTION: Telemedical concepts in emergency medical services (EMS) lead to improved process times and patient outcomes, but their technical performance has thus far been insufficient; nevertheless, the concept was transferred into EMS routine care in Aachen, Germany. This study evaluated the system's technical performance and compared it to a precursor system. METHODS: The telemedicine system was implemented on seven ambulances and a teleconsultation centre staffed with experienced EMS physicians was established in April 2014...
April 13, 2016: Journal of Telemedicine and Telecare
Jonathan Lu, Akshay Bagai, Chris Buller, Asim Cheema, John Graham, Michael Kutryk, Jo-Ann Christie, Neil Fam
BACKGROUND: The implementation of regional primary percutaneous coronary intervention (PCI) programs has been critical in achieving timely intervention in patients with ST-segment elevation myocardial infarction (STEMI). However, 1 consequence has been inappropriate and false-positive cardiac catheterization laboratory (CCL) activations where either angiography is cancelled or no culprit lesion is found, respectively. METHODS: We performed a retrospective cohort study of 1,391 patients referred for primary PCI to a single academic center from November 2007 to August 2013...
March 2016: American Heart Journal
Syeda Fauzia Hasan, Mohammad Hamid
BACKGROUND AND AIMS: Incident reporting is a reliable and inexpensive tool used in anaesthesia to identify errors in patient management. A hospital incident reporting system was already present in our hospital, but we were unable to find any incident related to acute pain management. Hence, acute pain service (APS) was started for voluntary incident reporting in post-operative patients to identify critical incidents, review the root cause and suggest remedial measures. METHODS: All post-operative patients managed by APS were included in this observational study...
December 2015: Indian Journal of Anaesthesia
Aditya Mantha, Nathaniel L Coggins, Aditya Mahadevan, Rebecca N Strehlow, Matthew C Strehlow, S V Mahadevan
BACKGROUND: Paramedic trainees in developing countries face complex and chaotic clinical environments that demand effective leadership, communication, and teamwork. Providers must rely on non-technical skills (NTS) to manage bystanders and attendees, collaborate with other emergency professionals, and safely and appropriately treat patients. The authors designed a NTS curriculum for paramedic trainees focused on adaptive leadership, teamwork, and communication skills critical to the Indian prehospital environment...
December 2016: International Journal of Emergency Medicine
(no author information available yet)
A clinical team from The Valley Hospital in Ridgewood, NJ, visit at-risk patients at home after discharge if the patients don't qualify for or refuse home health services. A mobile team that includes a paramedic, a critical care nurse, and an emergency medical technician visits patients who have been referred by the case managers after a risk assessment. The team performs a comprehensive assessment of the patients and their home situations and reinforces the discharge teaching they received in the hospital...
February 2016: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
Nancy A Haug, Jennifer Bielenberg, Steven H Linder, Anna Lembke
BACKGROUND: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. METHODS: Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months...
2016: Substance Abuse
Christopher W C Lee, Shelley L McLeod, Kristine Van Aarsen, Michelle Klingel, Jeffrey M Franc, Michael B Peddle
INTRODUCTION: During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport. HYPOTHESIS: Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm...
April 2016: Prehospital and Disaster Medicine
Lara D Rappaport, Lina Brou, Tim Givens, Maria Mandt, Ashley Balakas, Kelley Roswell, Jason Kotas, Kathleen M Adelgais
BACKGROUND: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. OBJECTIVE: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. METHODS: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy)...
July 2016: Prehospital Emergency Care
Christopher W C Lee, Shelley L McLeod, Michael B Peddle
BACKGROUND: Mass-casualty incidents (MCIs) present a unique challenge with regards to triage as patient volume often outweighs the number of available Emergency Medical Services (EMS) providers. A possible strategy to optimize existing triage systems includes the use of other first responder groups, namely fire and police, to decrease the triage time during MCIs, allowing for more rapid initiation of life-saving treatment and prioritization of patient transport. Hypothesis First-year primary care paramedic (PCP), fire, and police trainees can apply with similar accuracy an internationally recognized MCI triage tool, Sort, Assess, Life-saving interventions, Treatment/transport (SALT), immediately following a brief training session, and again three months later...
October 2015: Prehospital and Disaster Medicine
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