Read by QxMD icon Read

Paramedic prehospital out of hospital emergency

Todd Chassee, Diann Reischmann, Michael Mancera, John D Hoyle
BACKGROUND: Prehospital pediatric drug dosing errors affect 56,000 U.S. children annually. An accurate weight is the first step in accurate dosing. To date, the accuracy of Emergency Medical Dispatcher (EMD) obtained weights has not been evaluated. We hypothesized that EMD could obtain accurate pediatric weights. METHODS: We used a convenience sample of patients 12 years and younger that were transported by EMS to one children's hospital. EMD obtained patient weight (DW) from the 9-1-1 caller...
September 30, 2016: Prehospital Emergency Care
Martin Johnston, Sheldon Cheskes, Garry Ross, P Richard Verbeek
BACKGROUND: Patients who present in ventricular fibrillation are typically treated with cardiopulmonary resuscitation (CPR), epinephrine, antiarrhythmic medications, and defibrillation. Although these therapies have shown to be effective, some patients remain in a shockable rhythm. Double sequential external defibrillation has been described as a viable option for patients in refractory ventricular fibrillation. OBJECTIVE: To describe the innovative use of two defibrillators used to deliver double sequential external defibrillation by paramedics in a case of refractory ventricular fibrillation resulting in prehospital return of spontaneous circulation and survival to hospital discharge with good neurologic function...
September 2016: Prehospital Emergency Care
Z Nehme, E Andrew, S Bernard, K Smith
BACKGROUND: Resuscitation guidelines often recommend ongoing cardiopulmonary resuscitation (CPR) efforts to hospital for out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) personnel. In this study, we examine the relationship between EMS CPR duration and survival to hospital discharge in EMS witnessed OHCA patients. METHODS: Between January 2003 and December 2011, 1035 adult EMS witnessed arrests of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry...
March 2016: Resuscitation
Justin A Ezekowitz, Robert C Welsh, Dale Weiss, Michael Chan, William Keeble, Fadi Khadour, Sanjay Sharma, Wayne Tymchak, Sunil Sookram, Neil Brass, Darren Knapp, Thomas L Koshy, Yinggan Zheng, Paul W Armstrong
BACKGROUND: Whether prehospital point-of-care (POC) troponin further accelerates the time to diagnosis in patients with chest pain (CP) is unknown. We conducted a randomized trial of POC-Troponin testing in the ambulance. METHODS AND RESULTS: Patients with chest pain presenting by ambulance were randomized to usual care (UC) or POC-Troponin; ST-elevation myocardial infarction patients or those with noncardiovascular symptoms were excluded. Pre-hospital high-sensitivity troponin was analyzed on a POC device and available to the paramedic and emergency department (ED) staff...
December 2015: Journal of the American Heart Association
Justin Mausz, Sheldon Cheskes
Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care...
September 2015: CJEM
Alan A Garner, Kristy P Mann, Elwyn Poynter, Andrew Weatherall, Susan Dashey, Michael Puntis, Val Gebski
BACKGROUND: It has been suggested that prehospital care teams that can provide advanced prehospital interventions may decrease the transit time through the ED to CT scan and subsequent surgery. This study is an exploratory analysis of data from the Head Injury Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and ED phases of management. METHODS: Three prehospital care models were compared; road paramedics, and two physician staffed Helicopter Emergency Medical Services (HEMS) - HIRT HEMS and the Greater Sydney Area (GSA) HEMS...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Søren Mikkelsen, Andreas J Krüger, Stine T Zwisler, Anne C Brøchner
BACKGROUND: Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus to investigate ambulance runs initially assigned 'life-saving missions' with emphasis on long-term outcome in patients treated by the Mobile Emergency Care Unit (MECU) in Odense, Denmark METHODS: All MECU runs are registered in a database by the attending physician, stating, among other parameters, the treatment given, outcome of the treatment and the patient's diagnosis...
2015: BMJ Open
Corey S Davis, Jessica K Southwell, Virginia Radford Niehaus, Alexander Y Walley, Michael W Dailey
OBJECTIVES: Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out-of-hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal...
October 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
François Réminiac, Youenn Jouan, Xavier Cazals, Jean-François Bodin, Pierre-François Dequin, Antoine Guillon
The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries...
October 2014: Prehospital Emergency Care
Andrew W Asimos, Shana Ward, Jane H Brice, Wayne D Rosamond, Larry B Goldstein, Jonathan Studnek
STUDY OBJECTIVE: Emergency medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. METHODS: We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching...
November 2014: Annals of Emergency Medicine
Pe Jacobs, A Grabinsky
Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome...
January 2014: International Journal of Critical Illness and Injury Science
Matthew V Kiefer, H Gene Hern, Harrison J Alter, Joseph B Barger
INTRODUCTION: Prehospital first responders historically have treated hypoglycemia in the field with an IV bolus of 50 mL of 50% dextrose solution (D50). The California Contra Costa County Emergency Medical Services (EMS) system recently adopted a protocol of IV 10% dextrose solution (D10), due to frequent shortages and relatively high cost of D50. The feasibility, safety, and efficacy of this approach are reported using the experience of this EMS system. METHODS: Over the course of 18 weeks, paramedics treated 239 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes...
April 2014: Prehospital and Disaster Medicine
T Chaudhary, C Hohenstein, O Bayer
BACKGROUND: Sepsis is a common, time-urgent emergency that is still associated with a high mortality and morbidity rate. A strong correlation between the onset of therapy and survival has been shown. With every hour of delay, survival decreases by 7.6 %. In 2001, four treatment goals that should be performed in the first 6 h of treatment were developed. These form the basis of early goal-directed therapy (EDGT) which is accepted as the standard of treatment for sepsis in the emergency department...
March 2014: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Keith Wesley, Karen Wesley
BACKGROUND: Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. OBJECTIVES: We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED)...
October 2013: JEMS: a Journal of Emergency Medical Services
Richard L Lammers, Maria Willoughby-Byrwa, William D Fales
INTRODUCTION: Management of pediatric cardiac arrest challenges the skills of prehospital care providers. Errors and error-producing conditions are difficult to identify from retrospective records. The objective of this study was to identify errors committed by prehospital care providers and the underlying causes of those errors during a simulated pediatric cardiopulmonary arrest followed by a structured debriefing. METHODS: Performance criteria were defined prospectively by an advisory panel...
June 2014: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Francis Kim, Graham Nichol, Charles Maynard, Al Hallstrom, Peter J Kudenchuk, Thomas Rea, Michael K Copass, David Carlbom, Steven Deem, W T Longstreth, Michele Olsufka, Leonard A Cobb
IMPORTANCE: Hospital cooling improves outcome after cardiac arrest, but prehospital cooling immediately after return of spontaneous circulation may result in better outcomes. OBJECTIVE: To determine whether prehospital cooling improves outcomes after resuscitation from cardiac arrest in patients with ventricular fibrillation (VF) and without VF. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial that assigned adults with prehospital cardiac arrest to standard care with or without prehospital cooling, accomplished by infusing up to 2 L of 4°C normal saline as soon as possible following return of spontaneous circulation...
January 1, 2014: JAMA: the Journal of the American Medical Association
Lionel Lamhaut, Romain Jouffroy, Michaela Soldan, Pascal Phillipe, Thibaut Deluze, Murielle Jaffry, Christelle Dagron, Benoit Vivien, Christian Spaulding, Kim An, Pierre Carli
BACKGROUND: Extra corporeal life support (ECLS) has been recently introduced in the treatment of refractory cardiac arrest (CA). Several studies have assessed the use of ECLS in refractory CA once the patients reach hospital. The time between CA and the implementation of ECLS is a major prognostic factor for survival. The main predictive factor for survival is ECLS access time. Pre hospital ECLS implementation could reduce access time. We therefore decided to assess the feasibility and safety of prehospital ECLS implementation (PH-ECLS) in a pilot study...
November 2013: Resuscitation
J Bosch, J de Nooij, M de Visser, S C Cannegieter, N J Terpstra, C Heringhaus, J Burggraaf
BACKGROUND: In Dutch ambulance practice, failure or inability to intubate patients with altered oxygenation and/or ventilation leaves bag-valve mask ventilation as the only alternative, which is undesirable for patient outcome. A novel Laryngeal Mask Airway Supreme (LMA-S) device may be a suitable alternative. AIM: To evaluate the effectiveness and suitability of the LMA-S for emergency medical services in daily out-of-hospital emergency practice. METHODS: After a period of theoretical and practical training of ambulance paramedics in the use of the LMA-S, prospective data were collected on the utilisation of LMA-S in an observational study...
September 2014: Emergency Medicine Journal: EMJ
Eva Eiske Spijker, Maarten de Bont, Matthijs Bax, Maro Sandel
BACKGROUND: Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a large urban region. This study evaluates the implementation, practical use and complications of this prehospital treatment. METHODS: This was a retrospective case series study. The study was carried out in a period shortly after the implementation of the BCPAP system on all EMS ambulances in the The Hague region...
2013: International Journal of Emergency Medicine
Christoph Hr Wiese, Christoph L Lassen, Utz E Bartels, Mahmoud Taghavi, Saleem Elhabash, Bernhard M Graf, Gerd G Hanekop
BACKGROUND: To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. METHODS: One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical ...
2013: BMC Palliative Care
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"