Annals of emergency medicine
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To evaluate the effectiveness of the emergency medical services (EMS) system in a rural island community in resuscitating victims of out-of-hospital cardiac arrest over the past 16 years. ⋯ The combined paramedic/emergency medical technician system used on San Juan Island has yielded survival rates comparable to those of urban areas. This system may serve as a model for other rural communities, especially those with well-defined geographic areas and established 911 central dispatching.
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To compare diagnostic strategies for the emergency assessment of patients with suspected acute thoracic aortic dissection and to measure the effect of delays related to the availability of these tests on the selection of the most appropriate one. ⋯ All patients in whom aortic dissection is suspected, even if the index of suspicion is very low, should undergo one of the available diagnostic procedures (except TTE). A patient with a moderate to high probability of disease should undergo a second investigation if the findings of the first are negative. When the probability of dissection is high, the physician must consider delays in obtaining specific diagnostic tests and order those that will be the most quickly available.
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To determine how accurately paramedics interpret common lung sounds on an audiotape in comparison with emergency physicians. ⋯ In our study, paramedics did not assess lung sounds as accurately as emergency physicians, and experienced paramedics did not interpret sounds more accurately than new paramedics. Correct identification of lung sounds improved significantly for paramedics when medical history was known.