Annals of emergency medicine
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To determine the incidence, type, and outcome of protocol deviations in an emergency medical services (EMS) system. ⋯ Protocol deviations committed in prehospital care do not usually cause direct harm to patients. On review of these deviations, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control. This type of quality assurance study has the ability to identify areas of strength and weakness in an EMS system, allowing planning of ongoing educational efforts in the system.
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The December 1989 assault in Panama provided an opportunity to examine the role of emergency physicians in low-intensity military operations. Emergency medicine specialists accompanied the assault forces and established casualty collection points (CCPs) at each target. Emergency physicians played a role in triage, resuscitation, and aeromedical evacuation. ⋯ The first casualties arrived at hospitals in Texas within 12 hours of the assault. From the drop zones through hospitalization in the United States, emergency physicians cared for combat casualties at every level of the evacuation system. The success of the medical plan for the assault suggests that the role of emergency physicians in military operations extends from the front lines to fixed medical facilities in the United States.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective study of manikin-only versus manikin and human subject endotracheal intubation training of paramedics.
To determine the effect of manikin-only training on field success of endotracheal intubation by paramedics. ⋯ Paramedics trained in endotracheal intubation using a systematic manikin-only teaching program can attain acceptable individual success rates in the actual field setting.
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Review
The impact of injury severity and prehospital procedures on scene time in victims of major trauma.
To evaluate the relationship among injury severity, prehospital procedures, and time spent at the scene by paramedics for victims of major trauma. ⋯ Extremely short scene times can be attained without foregoing potentially life-saving advanced life support interventions in an urban EMS system with strong medical control. In such a system, the most severely injured victims may spend less time at the scene although more procedures are performed on them.
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To compare relative costs of treating mildly head-injured patients by routine admission or by using skull radiographs or cranial computed tomography (CT) scanning to screen patients for admission. ⋯ Every patient with loss of consciousness or post-traumatic amnesia should have routine CT scanning. If the scan is normal and there are no other reasons for admission, the patients can be discharged safely from the emergency department. This represents optimal care from a medical standpoint and is justified from a cost-effectiveness point of view.