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Advanced paramedic

Joseph K Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
November 2016: Journal of Trauma and Acute Care Surgery
Ben Beck, Janet E Bray, Karen Smith, Tony Walker, Hugh Grantham, Cindy Hein, Melanie Thorrowgood, Anthony Smith, Madoka Inoue, Tony Smith, Bridget Dicker, Andy Swain, Emma Bosley, Katherine Pemberton, Michael Mckay, Malcolm Johnston-Leek, Peter Cameron, Gavin D Perkins, Judith Finn
OBJECTIVE: The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest (OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus-ROC Epistry. METHODS: A structured questionnaire was completed by each of the ambulance services participating in the Aus-ROC Epistry...
October 11, 2016: Emergency Medicine Australasia: EMA
Jodi Taylor, Sarah Black, Stephen J Brett, Kim Kirby, Jerry P Nolan, Barnaby C Reeves, Maria Robinson, Chris A Rogers, Lauren J Scott, Adrian South, Elizabeth A Stokes, Matthew Thomas, Sarah Voss, Sarah Wordsworth, Jonathan R Benger
Health outcomes after out of hospital cardiac arrest (OHCA) are extremely poor, with only 7-9% of patients in the United Kingdom (UK) surviving to hospital discharge. Currently emergency medical services (EMS) use either tracheal intubation or newer supraglottic airway devices (SGAs) to provide advanced airway management during OHCA. Equipoise between the two techniques has led to calls for a well-designed randomised controlled trial. The primary objective of the AIRWAYS-2 trial is to assess whether the clinical effectiveness of the i-gel, a second-generation SGA, is superior to tracheal intubation in the initial airway management of OHCA patients in the UK...
September 30, 2016: Resuscitation
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
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
K A Martin Ginis, J R Tomasone, M Welsford, K Ethans, A R Sinden, M Longeway, A Krassioukov
STUDY DESIGN: Single-group pre-/post-test with 3- and 6-month follow-ups. OBJECTIVES: To test the effects of the 'ABCs of AD' educational module on immediate and longer-term changes in paramedics' knowledge and beliefs about using the autonomic dysreflexia clinical practice guidelines (AD-CPGs). SETTING: Canada. METHODS: A total of 119 paramedics completed an AD knowledge test and measures of attitudes, perceived control, self-efficacy, social pressure from patients and health-care professionals, and intentions to use the AD-CPGs before and 1 week, 3 months and 6 months after viewing 'ABCs of AD'...
September 13, 2016: Spinal Cord
Bálint Bánfai, Ádám Éliás, Tamás Nagy, Emese Pék, József Betlehem
INTRODUCTION: Resuscitation knowledge is necessery for emergency care workers. AIM: The aim of the authors was to investigate the advanced life support knowledge of paramedic students in Hungary. METHOD: The research has been executed at University of Pécs - Faculty of Health Sciences, Semmelweis University - Faculty of Health Sciences, and University of Debrecen - Faculty of Health Care. 97 students (n = 97) were involved in the study from third and fourth grades...
September 2016: Orvosi Hetilap
Karen A Abrashkin, Jonathan Washko, Jenny Zhang, Asantewaa Poku, Hyun Kim, Kristofer L Smith
Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals' homes...
August 30, 2016: Journal of the American Geriatrics Society
Naama Constantini, Gideon Mann
Sports Medicine is a relatively new subject in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age...
June 2016: Harefuah
Daniel L Wolfson, Margaret A Tandoh, Mohit Jindal, Patrick M Forgione, Valerie S Harder
OBJECTIVE: Intraosseous (IO) access is increasingly being used as an alternative to peripheral intravenous access, which is often difficult or impossible to establish in critically ill patients in the prehospital setting. Until recently, only Paramedics performed adult IO access. In 2014, Vermont Emergency Medical Services (EMS) expanded the Advanced Emergency Medical Technicians (AEMTs) scope of practice to include IO access in adult patients. This study compares successful IO access in adults performed by AEMTs compared to Paramedics in the prehospital setting...
August 5, 2016: Prehospital Emergency Care
Joseph Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide life-saving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
May 27, 2016: Journal of Trauma and Acute Care Surgery
John W Hafner, Blake W Perkins, Joshua D Korosac, Alayna K Bucher, Jean C Aldag, Kelly L Cox
OBJECTIVE: This study attempts to determine if newer indirect laryngoscopes or intubating devices are superior to a standard laryngoscope for intubation success among helicopter emergency medical service (HEMS) personnel. METHODS: Flight nurses and paramedics intubated standardized mannequins with a normal airway, a trauma airway, and a difficult airway using a standard laryngoscope, a gum elastic bougie, the Airtraq laryngoscope (King System Corp, Noblesville, IN), the Glidescope Ranger laryngoscope (Verathon Inc, Bothell, WA), and the S...
May 2016: Air Medical Journal
Filippo Sanfilippo, Federica Chiarenza, Dirk M Maybauer, Marc O Maybauer
STUDY OBJECTIVE: Endotracheal intubation is considered the criterion-standard technique for securing the airway. Supraglottic airway devices (SADs) represent a major advance in airway management and are recommended by the guidelines in difficult situations such as Advanced Life Support and "cannot ventilate-cannot intubate" scenarios. The Easytube (EzT) is an SAD introduced a decade ago but not included yet in the above guidelines. DESIGN: Systematic review of MEDLINE and EMBASE according to PRISMA guidelines available up to January 12, 2016...
June 2016: Journal of Clinical Anesthesia
Raphael van Tulder, Christoph Schriefl, Dominik Roth, Peter Stratil, Martin Thalhammer, Hermann Wieczorek, Friedrich Lausch, Andreas Zajicek, Jochen Haidvogel, Dieter Sebald, Wolfgang Schreiber, Fritz Sterz, Anton Laggner
BACKGROUND: The endotracheal tube (ETT) is considered the gold standard in emergency airway management, although supraglottic airway devices, especially the laryngeal tube (LT), have recently gained in importance. Although regarded as an emergency device in case of failure of endotracheal intubation in most systems, we investigated the dynamics of the use of the LT in a metropolitan ambulance service without any regulations on the choice of airway device. METHODS: A retrospective, observational study on all patients from the Municipal Ambulance Service, Vienna in need of advanced airway management over a 5-year period...
April 26, 2016: Prehospital Emergency Care
C Mac Donncha, N Cummins, D Hennelly, A Hannigan, D Ryan
BACKGROUND: Emergency medical services (EMS) practitioners in Ireland have been recently licensed to use continuous positive airway pressure (CPAP) ventilation for patients with pulmonary oedema. Both the British Thoracic Society and the Canadian Medical Association advocate the use of CPAP in hospital for patients with severe exacerbations of pulmonary oedema. AIMS: The aim of this study was to identify prehospital patients in the Midwest, over a 6-month period, which could potentially benefit from CPAP if it were available in the National Ambulance Service...
April 18, 2016: Irish Journal of Medical Science
Ranjit Unnikrishnan, Ranjit Mohan Anjana, Viswanathan Mohan
India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations...
June 2016: Nature Reviews. Endocrinology
Christopher C D Evans, Ashley Petersen, Eric N Meier, Jason E Buick, Martin Schreiber, Delores Kannas, Michael A Austin
BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries...
August 2016: Journal of Trauma and Acute Care Surgery
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
Adrian P Murphy, Macartan Hughes, Siobhan Mccoy, Gloria Crispino, Abel Wakai, Ronan O'Sullivan
INTRODUCTION: Acute pain is the most common symptom in the emergency setting and its optimal management continues to challenge prehospital emergency care practitioners, particularly in the paediatric population. Difficulty in establishing vascular access and fear of opiate administration to small children are recognized reasons for oligoanalgesia. Intranasal fentanyl (INF) has been shown to be as safe and effective as intravenous morphine in the treatment of severe pain in children in the Emergency Department setting...
March 15, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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
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