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human factors in prehospital research:

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
Helen Pocock, Charles D Deakin, Tom Quinn, Gavin D Perkins, Jessica Horton, Simon Gates
BACKGROUND: There is an urgent need to develop prehospital research capability in order to improve the care of patients presenting to emergency medical services (EMS). The Prehospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest trial, a pragmatic cluster randomised trial evaluating the LUCAS-2 device, represents the largest randomised controlled trial conducted by UK ambulance services to date. The aim of this study was to identify and analyse factors that may influence paramedic attitudes to, and participation in, clinical trials...
August 2016: Emergency Medicine Journal: EMJ
Nerses Sanossian, David S Liebeskind, Marc Eckstein, Sidney Starkman, Samuel Stratton, Franklin D Pratt, William Koenig, Scott Hamilton, May Kim-Tenser, Robin Conwit, Jeffrey L Saver
BACKGROUND AND PURPOSE: Emergency medical services routing of patients with acute stroke to designated centers may increase the proportion of patients receiving care at facilities meeting national standards and augment recruitment for prehospital stroke research. METHODS: We analyzed consecutive patients enrolled within 2 hours of symptom onset in a prehospital stroke trial, before and after regional Los Angeles County Emergency Medical Services implementation of preferentially routing patients with acute stroke to approved stroke centers (ASCs)...
October 2015: Stroke; a Journal of Cerebral Circulation
Roy Nadler, Sami Gendler, Avi Benov, Avi Shina, Erez Baruch, Gilad Twig, Elon Glassberg
BACKGROUND: Intravenous (IV) access has an essential role in the care provided for trauma patients, allowing for transfusion of blood products, fluids, and drugs. Decisions should be made regarding the necessity of IV access while considering cost-benefit of the procedure in terms of delayed evacuation times. METHODS: A retrospective review of all trauma patients in whom at least one attempt at IV access was performed were reviewed. Data were abstracted from the Israeli Defense Force Trauma Registry...
August 2015: Journal of Trauma and Acute Care Surgery
Paul A Jennings, Bill Lord, Karen Smith
INTRODUCTION: Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. METHODS: An analysis of electronic patient care records of all patients younger than 15 years presenting with pain to the emergency medical service of Victoria, Australia, over a 4-year period (2008-2011)...
November 2015: American Journal of Emergency Medicine
Michael J Widener, Zac Ginsberg, Daniel Schleith, Douglas J Floccare, Jon Mark Hirshon, Samuel Galvagno
INTRODUCTION: We describe how geographic information systems (GIS) can be used to assess and compare estimated transport time for helicopter and ground emergency medical services. Recent research shows that while the odds of a trauma patient's survival increase with helicopter emergency medical services (HEMS), they may not increase to the extent necessary to make HEMS cost effective. This study offers an analytic tool to objectively quantify the patient travel time advantage that HEMS offers compared to ground emergency medical services (GEMS)...
July 2015: Aerospace Medicine and Human Performance
Iván Sánchez Fernández, Nicholas S Abend, Satish Agadi, Sookee An, Ravindra Arya, James Nicholas Brenton, Jessica L Carpenter, Kevin E Chapman, William D Gaillard, Tracy A Glauser, Howard P Goodkin, Kush Kapur, Mohamad A Mikati, Katrina Peariso, Margie Ream, James Riviello, Robert C Tasker, Tobias Loddenkemper
OBJECTIVE: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED). METHODS: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE...
June 9, 2015: Neurology
Gavin D Smith, Meagan M Fry, David Taylor, Amee Morgans, Kate Cantwell
BACKGROUND: People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of atrioventricular nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents, or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM)...
2015: Cochrane Database of Systematic Reviews
Riana R Pryor, Ronald N Roth, Joe Suyama, David Hostler
Exertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling...
June 2015: Prehospital and Disaster Medicine
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, James Middleton, Paul A Jennings
BACKGROUND: Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. OBJECTIVES: Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. METHODS: Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases...
April 2015: Injury
Teija Norri-Sederholm, Heikki Paakkonen, Jouni Kurola, Kaija Saranto
BACKGROUND: In prehospital emergency medical services, one of the key factors in the successful delivery of appropriate care is the efficient management and supervision of the area's emergency medical services units. Paramedic field supervisors have an important role in this task. One of the key factors in the daily work of paramedic field supervisors is ensuring that they have enough of the right type of information when co-operating with other authorities and making decisions. However, a gap in information sharing still exists especially due to information overload...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Martin Ebinger, Jochen B Fiebach, Heinrich J Audebert
PURPOSE OF REVIEW: Mobile computed tomography (CT) scanning in specialized ambulances has recently become feasible. Two randomized trials have used mobile CTs for prehospital thrombolysis. This short review summarizes the available literature on this topic and provides an outlook on potential future developments. RECENT FINDINGS: Mobile CT in acute suspected stoke is feasible and helps to diagnose, triage and treat patients. It is an integral component of a novel and promising stroke research platform in specialized ambulances with telemedicine connection and neurological expertise on board...
February 2015: Current Opinion in Neurology
Aaron M Burnett, Bjorn K Peterson, Samuel J Stellpflug, Kristin M Engebretsen, Katherine J Glasrud, Jordan Marks, Ralph J Frascone
INTRODUCTION: Intramuscular ketamine has become increasingly popular for prehospital chemical restraint of severely agitated or violent patients because of its favorable adverse effect profile, rapid onset, and wide therapeutic window. However, there is currently no literature quantifying the need for intubation or hospital admission for these patients once they reach the emergency department. METHODS: Medical records for patients receiving prehospital ketamine who were transported to a single level 1 trauma center were abstracted...
January 2015: American Journal of Emergency Medicine
Marcia Garnica, Marcos Oliveira da Cunha, Rodrigo Portugal, Angelo Maiolino, Arnaldo L Colombo, Marcio Nucci
BACKGROUND: Risk factors for invasive fusariosis (IF) have not been characterized. We attempted to identify risk factors for IF in a prospective cohort of hematologic patients treated in 8 centers in Brazil. METHODS: Patients with (cases) and without (controls) proven or probable IF diagnosed in a cohort of patients with acute myeloid leukemia (AML) or myelodysplasia (MDS), and in allogeneic hematopoietic cell transplant (HCT) recipients (early, until day 40; late, after day 40 posttransplant) were compared by univariate Cox regression analysis...
March 15, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Fernando Sabia Tallo, Simone de Campos Vieira Abib, André Luciano Baitello, Renato Delascio Lopes
OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59...
September 2014: Clinics
B H Bester, Simpiwe Sobuwa
OBJECTIVE: To describe the use of intravenous (IV) therapy in the South African (SA) prehopsital setting, and to determine the proportion of prehopsital cannulations considered unnecessary when graded against the South African Triage Score (SATS) chart. METHODS: The study was conducted in the prehospital emergency medical care setting in the Western Cape Province, SA. Using a descriptive research design, we looked at the report forms of patients treated and transported by personnel currently employed in the public sector, serving the urban and rural areas stipulated by the municipal boundaries...
September 2014: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Jan Klimas, Martin O'Reilly, Mairead Egan, Helen Tobin, Gerard Bury
BACKGROUND: Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose. OBJECTIVES: The objective of the study is to examine the baseline incidence of all new ODs in an ambulance service and their relationship with urban deprivation and presence of addiction services...
October 2014: American Journal of Emergency Medicine
James S Davis, Shevonne S Satahoo, Frank K Butler, Harrison Dermer, Daniel Naranjo, Katherina Julien, Robert M Van Haren, Nicholas Namias, Lorne H Blackbourne, Carl I Schulman
BACKGROUND: Since their inception in the late 1970s, trauma networks have saved thousands of lives in the prehospital setting. However, few recent works have been done to evaluate the patients who die in the field. Understanding the epidemiology of these deaths is crucial for trauma system performance evaluation and improvement. We hypothesized that specific patterns of injury could be identified and targeted for intervention. METHODS: Medical examiner reports in a large, urban county were reviewed including all trauma deaths during 2011 that were not transported to a hospital (i...
August 2014: Journal of Trauma and Acute Care Surgery
Craig Vincent-Lambert, Andrew Peter Carpenter
PURPOSE: In an emergency, the administration of fluids and medications remains a vital component of patient care. Although this is usually achieved via an intravenous line, intraosseous (IO) cannulation is accepted as a useful alternative for the administration of fluids and medications in situations where intravenous cannulation is difficult or impossible. Despite this, IO cannulation appeared to be infrequently performed by paramedics in Johannesburg (JHB). This study investigated factors that may be affecting the frequency with which IO cannulation is performed by paramedics in JHB...
November 2014: Journal of Vascular Access
Adam Frisch, Joshua C Reynolds, Joseph Condle, Danielle Gruen, Clifton W Callaway
OBJECTIVES: The timing of and interval between events in prehospital care is important for system design, patient outcome, and prehospital research. Since these data can guide treatment recommendations, it is imperative that time-based prehospital documentation is accurate and precise, especially for time-sensitive conditions such as out-of-hospital cardiac arrest (OHCA). We compared the times of select events documented in the medical record (PCR) with times from time-stamped audio recordings in the monitor-defibrillator (AUD)...
August 2014: Resuscitation
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