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king county paramedic

Michael T Hilton, Max Wayne, Christian Martin-Gill
OBJECTIVES: Orotracheal intubation is a key component of prehospital airway management and success rates are dependent on procedural experience. Supraglottic airway devices are increasingly being used in the prehospital setting. As a result, paramedics may have fewer opportunities for performing intubation, limiting their proficiency in the procedure. We aimed to determine the trends in intubation versus supraglottic airway use over an 8 year period. We also aimed to determine the association between system-wide introduction of King LT guidelines and ETI success rates...
September 2016: Prehospital Emergency Care
Matthew E Prekker, Fernanda Delgado, Jenny Shin, Heemun Kwok, Nicholas J Johnson, David Carlbom, Andreas Grabinsky, Thomas V Brogan, Mary A King, Thomas D Rea
STUDY OBJECTIVE: Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. METHODS: We performed a retrospective analysis of EMS responses between 2006 and 2012 that involved attempted intubation of children younger than 13 years by paramedics in a large, metropolitan EMS system...
January 2016: Annals of Emergency Medicine
Matthew E Prekker, Heemun Kwok, Jenny Shin, David Carlbom, Andreas Grabinsky, Thomas D Rea
OBJECTIVES: Endotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics. DESIGN: Analysis of prehospital airway management using a prospective registry that was linked to an emergency medical services administrative database. SETTING: Emergency medical services system serving King County, Washington, 2006-2011...
June 2014: Critical Care Medicine
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
Christopher W Seymour, Thomas D Rea, Jeremy M Kahn, Allan J Walkey, Donald M Yealy, Derek C Angus
RATIONALE: Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care system-pre-hospital emergency care-is unknown. OBJECTIVES: We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke. METHODS: Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital...
December 15, 2012: American Journal of Respiratory and Critical Care Medicine
Catherine O Johnson, Rozenn N Lemaitre, Carol E Fahrenbruch, Stephanie Hesselson, Nona Sotoodehnia, Barbara McKnight, Kenneth M Rice, Pui-Yan Kwok, David S Siscovick, Thomas D Rea
BACKGROUND: Fatty acids provide energy and structural substrates for the heart and brain and may influence resuscitation from sudden cardiac arrest (SCA). We investigated whether genetic variation in fatty acid metabolism pathways was associated with SCA survival. METHODS AND RESULTS: Subjects (mean age, 67 years; 80% male, white) were out-of-hospital SCA patients found in ventricular fibrillation in King County, WA. We compared subjects who survived to hospital admission (n=664) with those who did not (n=689), and subjects who survived to hospital discharge (n=334) with those who did not (n=1019)...
August 1, 2012: Circulation. Cardiovascular Genetics
Jared Strote, Donald Cloyd, Thomas Rea, Mickey Eisenberg
BACKGROUND: Rapid glucose testing is a valuable tool for emergency medical services (EMS) patient evaluation and treatment. In most EMS systems, paramedics, but not emergency medical technicians (EMTs), are authorized to use glucometry. OBJECTIVES: To evaluate the influence of EMT glucometry on paramedic involvement in a two-tiered EMS response system. METHODS: King County, Washington, EMTs underwent training in glucometry to determine blood sugar levels for specific patient presentations...
July 2005: Prehospital Emergency Care
Bradley D Shy, Thomas D Rea, Linda J Becker, Mickey S Eisenberg
OBJECTIVE: To examine the correlation between time to paramedic intubation and survival after prehospital cardiac arrest. METHODS: This was a retrospective cohort study of 693 patients who had paramedic endotracheal intubation for prehospital cardiac arrest in King County, Washington (excluding Seattle), between January 1991 and May 2003. Based on the time from patient collapse until intubation, cases were divided into quartiles. Survival in the slower three quartiles (defined as "slow intubation") was compared with survival in the fastest quartile (defined as "quick intubation")...
October 2004: Prehospital Emergency Care
H Checkoway, D Levy, L Sheppard, J Kaufman, J Koenig, D Siscovick
Numerous recent epidemiologic studies report increases in the daily incidence of cardiovascular disease mortality and morbidity related to increases in daily levels of fine particulate matter (PM)* air pollution. This study sought to evaluate the possible association between the occurrence of out-of-hospital sudden cardiac arrest (SCA) and daily PM levels in the Seattle metropolitan area. The underlying hypothesis was that PM exposure may act as a cardiovascular trigger for SCA. A case-crossover study was conducted among 362 SCA cases identified by paramedics from October 1988 through June 1994...
December 2000: Research Report (Res Rep Health Eff Inst)
D S Siscovick, T E Raghunathan, D Lin, S Weinmann, P Arbogast, R N Lemaitre, B M Psaty, R Alexander, L A Cobb
Influenza epidemics are associated with an excess of mortality not only from respiratory diseases but also from other causes, and cardiovascular mortality increases abruptly during influenza epidemics, with little evidence of a lag period. In a population-based case-control study, the authors examined whether influenza vaccination was associated with a reduced risk of out-of-hospital primary cardiac arrest (PCA), a major contributor to cardiovascular mortality in the community. Cases of PCA (n = 342) without prior heart disease or life-threatening comorbidity that occurred in King County, Washington, were identified from paramedic incident reports from October 1988 to July 1994...
October 1, 2000: American Journal of Epidemiology
R N Lemaitre, D S Siscovick, T E Raghunathan, S Weinmann, P Arbogast, D Y Lin
BACKGROUND: Because the risks of sudden cardiac death and myocardial infarction are transiently increased during acute bouts of high-intensity activity, it is an important question from the public health perspective whether regular participation in moderate-intensity activity confers overall protection from sudden cardiac death. PARTICIPANTS AND METHODS: We used data from a population-based case-control study to assess the associations of regular high-intensity and moderate-intensity leisure-time physical activity with primary cardiac arrest...
April 12, 1999: Archives of Internal Medicine
S Weinmann, D S Siscovick, T E Raghunathan, P Arbogast, H Smith, V E Bovbjerg, L A Cobb, B M Psaty
We conducted a population-based case-control study in King County, WA, to evaluate the association between usual caffeine intake and primary cardiac arrest. We identified primary cardiac arrest cases (N = 362) without a history of clinical heart disease or major comorbidity through paramedic incident reports during the period 1988-1994. We identified controls (N = 581), individually matched to cases on age (+/-7 years) and gender and meeting the same general health criteria, through random digit dialing. We interviewed the spouses of cases and controls to obtain information on usual caffeine intake from coffee, tea, and cola during the prior year...
September 1997: Epidemiology
L Becker, M P Larsen, M S Eisenberg
STUDY OBJECTIVE: To assess the incidence of cardiac arrest among patients who use self-transport to seek medical care for chest pain. METHODS: This was a retrospective cohort study of patients admitted to a CCU for suspected acute myocardial infarction (AMI) and patients experiencing out-of-hospital cardiac arrest preceded by symptoms in King County, Washington, between January 1, 1992, and July 31, 1994. Participants were identified through use of the databases compiled by the Myocardial infarction Triage and intervention Trial, which reviewed medical records in all area hospitals, and the Cardiac Arrest Surveillance System, which tracks all incidences in which CPR is performed by EMS personnel in King County...
December 1996: Annals of Emergency Medicine
D Brownstein, R Shugerman, P Cummings, F Rivara, M Copass
STUDY OBJECTIVE: To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation. METHODS: We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990...
July 1996: Annals of Emergency Medicine
E M Andresen, J A Lee, R E Pecoraro, T D Koepsell, A P Hallstrom, D S Siscovick
We estimated the reporting of diabetes on death certificates for persons known to have diabetes. Surveillance of 19 hospitals and two paramedic emergency medical services during 12 months in Seattle and King County, Washington, ascertained acute ischemic heart disease events for persons with diabetes and yielded 1235 persons with suspected ischemic heart disease. Mortality was 23.6%, and 41% of death certificates listed diabetes. The reporting of diabetes on the death certificate was not random, and it varied by patient and physician characteristics...
July 1993: American Journal of Public Health
G Lombardi, J Gallagher, P Gennis
OBJECTIVE: To determine survival from out-of-hospital cardiac arrest in New York City and to compare this with other urban, suburban, and rural areas. DESIGN: Observational cohort study. SETTING: New York City. PARTICIPANTS: Consecutive out-of-hospital cardiac arrests occurring between October 1, 1990, and April 1, 1991. INTERVENTION: Trained paramedics performed immediate postarrest interviews with care providers, using a standardized questionnaire...
March 2, 1994: JAMA: the Journal of the American Medical Association
M P Larsen, M S Eisenberg, R O Cummins, A P Hallstrom
STUDY OBJECTIVE: To develop a graphic model that describes survival from sudden out-of-hospital cardiac arrest as a function of time intervals to critical prehospital interventions. PARTICIPANTS: From a cardiac arrest surveillance system in place since 1976 in King County, Washington, we selected 1,667 cardiac arrest patients with a high likelihood of survival: they had underlying heart disease, were in ventricular fibrillation, and had arrested before arrival of emergency medical services (EMS) personnel...
November 1993: Annals of Emergency Medicine
H Meischke, M S Eisenberg, M P Larsen
STUDY OBJECTIVE: To investigate the effect of heart-related medical conditions and demographic variables on patients' tendency to delay contacting emergency medical services for symptoms of acute myocardial infarction. TYPE OF PARTICIPANTS: A sample of 2,947 patients with acute myocardial infarction but no cardiac arrest, transported by paramedics to the coronary care units of 19 hospitals in King County, Washington, between January 1988 and April 1991. MEASUREMENTS: Patient record abstracts contained information on medical history, age, gender, delay interval, and means of transportation...
October 1993: Annals of Emergency Medicine
S M Dull, J R Graves, M P Larsen, R O Cummins
STUDY OBJECTIVE: To determine the outcome, location, preexisting conditions, and resuscitation wishes of prehospital cardiac arrest patients. DESIGN: Retrospective review of paramedic and emergency medical technician run reports. SETTING: Urban area with a two-tiered emergency medical services response system covering an area of 2,128 square miles and serving a population of 1,413,900 (in 1988). PARTICIPANTS: All prehospital cardiac arrest patients to which the King County, Washington, Emergency Medical Services (KCEMS) system responded to during a 12-month period...
May 1994: Annals of Emergency Medicine
L L Culley, D K Henwood, J J Clark, M S Eisenberg, C Horton
STUDY OBJECTIVES: To determine whether criteria based dispatch (CBD) improved the efficiency of the emergency medical services system. DESIGN: A before and after design was used to measure effects of CBD. Data were reviewed from medical reports from January 1986 through June 1992. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Residents who called 911 to report a medical emergency. INTERVENTIONS: Emergency medical dispatching (EMD), basic life support (BLS), and advanced life support (ALS)...
November 1994: Annals of Emergency Medicine
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