Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study
Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial.
Continuous positive airway pressure ventilation (CPAP) in appropriately selected patients with acute respiratory failure has been shown to reduce the need for tracheal intubation in hospital. Despite several case series, the effectiveness of out-of-hospital CPAP has not been rigorously studied. We performed a prospective, randomized, nonblinded, controlled trial to determine whether patients in severe respiratory distress treated with CPAP in the out-of-hospital setting have lower overall tracheal intubation rates than those treated with usual care. ⋯ Paramedics can be trained to use CPAP for patients in severe respiratory failure. There was an absolute reduction in tracheal intubation rate of 30% and an absolute reduction in mortality of 21% in appropriately selected out-of-hospital patients who received CPAP instead of usual care. Larger, multicenter studies are recommended to confirm this observed benefit seen in this relatively small trial.
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Evidence-based medical literature is lacking about the best methods to train health care providers in disaster response. We systematically review the recent literature to report whether training interventions in disaster preparedness improve knowledge and skills in disaster response. ⋯ The available evidence is insufficient to determine whether training interventions for health care providers are effective in improving knowledge and skills in disaster response.
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Multicenter Study
Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest.
In an effort to improve neurologically normal survival of victims of cardiac arrest, a new out-of-hospital protocol was implemented by the emergency medical system medical directors in 2 south-central rural Wisconsin counties. The project was undertaken because the existing guidelines for care of such patients, despite their international scope and periodic updates, had not substantially improved survival rates for such patients during nearly 4 decades. ⋯ In adult patients with a witnessed cardiac arrest and an initially shockable rhythm, implementation of an out-of-hospital treatment protocol based on the principles of cardiocerebral resuscitation was associated with a dramatic improvement in neurologically intact survival.
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Multicenter Study
Assessment of the reliability of the Johns Hopkins/Agency for Healthcare Research and Quality hospital disaster drill evaluation tool.
The Joint Commission requires hospitals to implement 2 disaster drills per year to test the response phase of their emergency management plans. Despite this requirement, there is no direct evidence that such drills improve disaster response. Furthermore, there is no generally accepted, validated tool to evaluate hospital performance during disaster drills. We characterize the internal and interrater reliability of a hospital disaster drill performance evaluation tool developed by the Johns Hopkins University Evidence-based Practice Center, under contract from the Agency for Healthcare Research and Quality (AHRQ). ⋯ We found a high degree of internal reliability in the AHRQ instrument's items, suggesting the underlying construct of hospital preparedness is valid. Conversely, we found substantial variability in interrater reliability, suggesting that the instrument needs revision or substantial user training, as well as verification of interrater reliability in a particular setting before use.