Annals of emergency medicine
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To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. ⋯ Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.
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To determine the speed and characteristics of patient response to urban first-responder defibrillation and to determine whether amplitude of ventricular fibrillation (VF) can predict outcome in these patients. ⋯ Patients in VF who were treated by early countershock refibrillated much more frequently than previously reported. Refibrillations occur both early and late. Initial VF maximum amplitude is strongly predictive of outcome. Future reports of VF cardiac arrest should control for this previously neglected variable. Increased amplitude of VF during repeated refibrillation episodes is associated with increased hospital discharge, so future studies of advanced cardiac life support interventions should explore changes in VF amplitude as an outcome variable.
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The selection of emergency medicine residents requires review of medical school performance and, usually, an interview in which applicants and program directors exchange important information. Computer technology is available to assist programs in the analysis of information about applicants. Ethnic diversity and minority recruitment should also be considered as 40% of all emergency medicine residencies have no minority residents. Suggestions for developing a valid, humane, and fair selection process are made.
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The emergency medical services (EMS) system of the future has the opportunity to serve as a regional community health monitoring and referral system. Such a system would shift attention from care of the individual to cost-effective community health efforts using community resource integration, while emphasizing individual responsibility for health. ⋯ Coordination through the EMS system and a regional center would permit these resources to be used in an efficient and accountable fashion. We propose a model in which the EMS system could contribute to coordinated regional health monitoring and maintenance, timely and appropriate health care legislation and regulation, and high-impact health care education and intervention in the setting of self-destructive individual behavior.
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To test the ability of a locally designed priority dispatch system to safely exclude the need for advanced life support (ALS). ⋯ A computer-aided dispatch triage algorithm can facilitate improvements in both EMS system operations and prehospital patient care by safely and reliably identifying EMS incidents requiring only BLS.