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https://www.readbyqxmd.com/read/27913657/cost-benefit-analysis-of-telehealth-in-pre-hospital-care
#1
James R Langabeer, Tiffany Champagne-Langabeer, Diaa Alqusairi, Junghyun Kim, Adria Jackson, David Persse, Michael Gonzalez
OBJECTIVE: There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. METHODS: Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention...
December 2, 2016: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/27797986/ambulance-smartphone-tool-for-field-triage-of-ruptured-aortic-aneurysms-filtr-study-protocol-for-a-prospective-observational-validation-of-diagnostic-accuracy
#2
Thomas L Lewis, Rachael T Fothergill, Alan Karthikesalingam
INTRODUCTION: Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre...
October 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27747560/the-epidemiology-of-pre-hospital-potential-spinal-cord-injuries-in-victoria-australia-a-six-year-retrospective-cohort-study
#3
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, Shelley Cox, James W Middleton, Paul A Jennings
BACKGROUND: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. METHODS: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI...
December 2016: Injury Epidemiology
https://www.readbyqxmd.com/read/27688259/pre-hospital-identification-and-post-recovery-challenges-of-intoxication-with-synthetic-cannabinoid-containing-legal-high-products-such-as-exodus-damnation
#4
David Fitzpatrick, Patrick O'Meara, Andrew Cunningham
This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported...
November 2016: Scottish Medical Journal
https://www.readbyqxmd.com/read/27650864/pre-hospital-assessment-of-the-role-of-adrenaline-measuring-the-effectiveness-of-drug-administration-in-cardiac-arrest-paramedic-2-trial-protocol
#5
Gavin D Perkins, Tom Quinn, Charles D Deakin, Jerry P Nolan, Ranjit Lall, Anne-Marie Slowther, Matthew Cooke, Sarah E Lamb, Stavros Petrou, Felix Achana, Judith Finn, Ian G Jacobs, Andrew Carson, Mike Smyth, Kyee Han, Sonia Byers, Nigel Rees, Richard Whitfield, Fionna Moore, Rachael Fothergill, Nigel Stallard, John Long, Susie Hennings, Jessica Horton, Charlotte Kaye, Simon Gates
Despite its use since the 1960s, the safety or effectiveness of adrenaline as a treatment for cardiac arrest has never been comprehensively evaluated in a clinical trial. Although most studies have found that adrenaline increases the chance of return of spontaneous circulation for short periods, many studies found harmful effects on the brain and raise concern that adrenaline may reduce overall survival and/or good neurological outcome. The PARAMEDIC-2 trial seeks to determine if adrenaline is safe and effective in out-of-hospital cardiac arrest...
November 2016: Resuscitation
https://www.readbyqxmd.com/read/27625737/the-medical-duty-officer-an-attempt-to-mitigate-the-ambulance-at-hospital-interval
#6
Megan H Halliday, Andrew J Bouland, Benjamin J Lawner, Angela C Comer, Daniel C Ramos, Mark Fletcher
INTRODUCTION: A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time...
September 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27465304/epidemiology-and-outcomes-of-out-of-hospital-cardiac-arrest-in-a-developing-country-a-multicenter-cohort-study
#7
Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam, Amber Mehmood, Bryan McNally, Kent Stevens, Rozina Nuruddin, Mohammad Ishaq, Junaid Abdul Razzak
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country. METHODS: We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013...
July 28, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27411494/pre-hospital-delay-and-its-associated-factors-in-first-ever-stroke-registered-in-communities-from-three-cities-in-china
#8
Bin Jiang, Xiaojuan Ru, Haixin Sun, Hongmei Liu, Dongling Sun, Yunhai Liu, Jiuyi Huang, Li He, Wenzhi Wang
This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27224447/prolonged-cardiopulmonary-resuscitation-and-outcomes-after-out-of-hospital-cardiac-arrest
#9
Shahzleen Rajan, Fredrik Folke, Kristian Kragholm, Carolina Malta Hansen, Christopher B Granger, Steen Møller Hansen, Eric D Peterson, Freddy K Lippert, Kathrine B Søndergaard, Lars Køber, Gunnar H Gislason, Christian Torp-Pedersen, Mads Wissenberg
AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC). METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark...
August 2016: Resuscitation
https://www.readbyqxmd.com/read/27154472/does-the-norwegian-emergency-medical-dispatch-classification-as-non-urgent-predict-no-need-for-pre-hospital-medical-treatment-an-observational-study
#10
Eystein Grusd, Jo Kramer-Johansen
BACKGROUND: The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27130277/the-effect-of-pre-existing-health-conditions-on-the-cost-of-recovery-from-road-traffic-injury-insights-from-data-linkage-of-medicare-and-compensable-injury-claims-in-victoria-australia
#11
Behrooz Hassani-Mahmooei, Janneke Berecki-Gisolf, Youjin Hahn, Roderick J McClure
BACKGROUND: Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury. METHODS: Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis...
2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27027598/paramedic-checklists-do-not-accurately-identify-post-ictal-or-hypoglycaemic-patients-suitable-for-discharge-at-the-scene
#12
Hideo Tohira, Daniel Fatovich, Teresa A Williams, Alexandra Bremner, Glenn Arendts, Ian R Rogers, Antonio Celenza, David Mountain, Peter Cameron, Peter Sprivulis, Tony Ahern, Judith Finn
OBJECTIVES: The objective of this study was to assess the accuracy and safety of two pre-defined checklists to identify prehospital post-ictal or hypoglycemic patients who could be discharged at the scene. METHODS: A retrospective cohort study of lower acuity, adult patients attended by paramedics in 2013, and who were either post-ictal or hypoglycemic, was conducted. Two self-care pathway assessment checklists (one each for post-ictal and hypoglycemia) designed as clinical decision tools for paramedics to identify patients suitable for discharge at the scene were used...
June 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/26968133/ethnicity-and-pre-hospital-care-for-people-with-suspected-cardiac-pain-cross-sectional-study
#13
Zahid Asghar, Viet-Hai Phung, Aloysius Niroshan Siriwardena
OBJECTIVES: Few studies have investigated the quality of pre-hospital care by ethnicity. We aimed to investigate ethnic differences in pre-hospital ambulance care of patients with suspected cardiac pain. METHODS: We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with suspected cardiac pain over one year (August 2011 to July 2012) extracted from a single regional ambulance service. This included patient demographic data, clinical measurements, drugs administered and outcomes, such as transportation to hospital or referral to primary care...
October 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/26948870/paramedics-involvement-in-planned-home-birth-a-one-year-case-study
#14
Gayle McLelland, Lisa McKenna, Amee Morgans, Karen Smith
OBJECTIVE: to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice. METHODS: retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service...
July 2016: Midwifery
https://www.readbyqxmd.com/read/26944389/ease-and-difficulty-of-pre-hospital-airway-management-in-425-paediatric-patients-treated-by-a-helicopter-emergency-medical-service-a-retrospective-analysis
#15
Alexander R Schmidt, Lea Ulrich, Burkhardt Seifert, Roland Albrecht, Donat R Spahn, Philipp Stein
BACKGROUND: Pre-hospital paediatric airway management is complex. A variety of pitfalls need prompt response to establish and maintain adequate ventilation and oxygenation. Anatomical disparity render laryngoscopy different compared to the adult. The correct choice of endotracheal tube size and depth of insertion is not trivial and often challenged due to the initially unknown age of child. METHODS: Data from 425 paediatric patients (<17 years of age) with any airway manipulation treated by a Swiss Air-Ambulance crew between June 2010 and December 2013 were retrospectively analysed...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/26901259/-strategies-for-reducing-door-to-balloon-time-in-patients-with-acute-myocardial-infarction-undergoing-primary-angioplasty-the-pavia-experience
#16
Marco Ferlini, Gaetano Maria De Ferrari, Giuseppe Moroni, Paolo Roversi, Antonella Potenza, Sergio Leonardi, Alessandra Repetto, Rita Camporotondo, Giuseppe Alessandrino, Massimiliano Gnecchi, Barbara Marinoni, Manuela Guerci, Gabriele Crimi, Maurizio Ferrario, Maria Antonietta Bressan, Maurizio Raimondi, Stefano De Servi, Luigi Oltrona Visconti
BACKGROUND: Primary percutaneous coronary intervention (pPCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) if performed by an experienced team within 120 min of first medical contact. The door to balloon time (DTB) has become a performance measure and is the focus of local, regional and national quality improvement initiatives. The primary objective of the present study was to evaluate whether the implementation of reperfusion strategies could result in shorter DTB times...
January 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/26857556/envenomation-by-the-invasive-pterois-volitans-species-lionfish-in-the-french-west-indies-a-two-year-prospective-study-in-martinique
#17
Dabor Resiere, Laura Cerland, Luc De Haro, Ruddy Valentino, Anne Criquet-Hayot, Cyrille Chabartier, Stephane Kaidomar, Yanick Brouste, Bruno Mégarbane, Hossein Mehdaoui
CONTEXT: The invasion of the lionfish (Pterois volitans) in the French West Indies represents one of the most important marine invasions by alien species in history. Since its first recognition in Martinique in February 2011, the lionfish presence has strongly progressed, resulting in increasing envenomation cases. Our objective was to report features of lionfish envenomation and outcome. METHODS: A prospective study conducted at the Martinique University Hospital by the emergency departments, general practitioners, and the pre-hospital emergency ambulance service included all the patients referred from November 2011 to February 2014 for one or several stings by lionfish, as strongly suggested by the fish description and the association with marked local pain and edema...
2016: Clinical Toxicology
https://www.readbyqxmd.com/read/26847874/effect-of-emergency-medical-services-use-on-hospital-outcomes-of-acute-hemorrhagic-stroke
#18
Sola Kim, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Yu Jin Lee, Eui Jung Lee, Ki Ok Ahn, Taeyun Kim, Ki Jeong Hong, Yu Jin Kim
BACKGROUND: It is unclear whether the use of emergency medical services (EMS) is associated with enhanced survival and decreased disability after hemorrhagic stroke and whether the effect size of EMS use differs according to the length of stay (LOS) in emergency department (ED). METHODS: Adult patients (19 years and older) with acute hemorrhagic stroke who survived to admission at 29 hospitals between 2008 and 2011 were analyzed, excluding those who had symptom-to-ED arrival time of 3 h or greater, received thrombolysis or craniotomy before inter-hospital transfer, or had experienced cardiac arrest, had unknown information about ambulance use and outcomes...
May 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/26739767/operational-implementation-and-lessons-learned-from-haiti-s-first-helicopter-air-ambulance
#19
Vincent DeGennaro, Jordan Owen, Jerry Chandler, Ralph McDaniel
Critical-care helicopter transport has demonstrated improvements in morbidity and mortality to those patients who utilise the service, but this has largely excluded developing country populations due to set up costs. Haiti Air Ambulance is the first completely publicly-available helicopter ambulance service in a developing country. US standards were adopted for both aviation and aeromedical care in Haiti due to proximity and relationships. In order to implement properly, standards for aviation, critical care, and insurance reimbursement had to be put in place with local authorities...
May 2016: Injury
https://www.readbyqxmd.com/read/26587098/hand-washing-practices-among-emergency-medical-services-providers
#20
Joshua Bucher, Colleen Donovan, Pamela Ohman-Strickland, Jonathan McCoy
INTRODUCTION: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. METHODS: We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables...
September 2015: Western Journal of Emergency Medicine
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