Annals of emergency medicine
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To determine the time between ambulance arrival at the scene to paramedic arrival at the patient (arrival to patient contact) and the effect of barriers to paramedic movement on this time interval. ⋯ The arrival-to-patient contact interval adds a variable and potentially lengthy amount of time to the total prehospital response time interval, and barriers impeding paramedic movement to the patient prolong this time interval. In 25% of all observed paramedic calls, the arrival-to-patient contact interval was more than four minutes. Measurement of the time from ambulance arrival on the scene to paramedic arrival at the patient is necessary to appropriately determine the relationship among total prehospital response time, paramedic interventions, and patient outcome.
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To evaluate the ability of paramedics in a nonurban emergency medical services system to use the Combitube, a combined endotracheal and esophageal obturator airway adjunct, in prehospital cardiac arrest patients. ⋯ Although visualized endotracheal intubation remains the preferred method of airway control, the Combitube may be an effective prehospital airway device as both a backup to the endotracheal tube and a primary airway. Although the Combitube does not require visualization with a laryngoscope, comprehensive training and continuing education are key factors affecting skill retention.
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To estimate the frequency of violence directed toward prehospital providers; to identify the methods used to manage violent patients in the prehospital setting; and to identify the educational, medical, and legal issues in the prehospital management of violent patients. ⋯ The potential for injury to prehospital providers from violent patients is probably widespread, and no mechanism for identifying injuries or exposure to violent patients currently exists. All systems should have protocols for managing violent patients and for restraint application. Educational sessions for self-defense and assessment of the scene for violence may be indicated.
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To assess the current state of clinical and academic emergency medicine at Veterans Affairs medical centers in the nation's largest health care system. ⋯ In many EDs at Veterans Affairs medical centers, nonemergency medicine staff physicians and house staff unsupervised by emergency physicians care for patients seeking emergency medical care. In addition, there is a growing need for more emergency medicine staff physicians and emergency medicine house staff in the Veterans Affairs system. Organized emergency medicine should initiate efforts to inform administrators and legislators responsible for Veterans Affairs policy making and funding.