Annals of emergency medicine
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Review Meta Analysis
Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis.
Noninvasive positive-pressure ventilation (NIPPV) is increasingly being used by emergency medical services (EMS) for treatment of patients in respiratory distress. The primary objective of this systematic review is to determine whether out-of-hospital NIPPV for treatment of adults with severe respiratory distress reduces inhospital mortality compared with "standard" therapy. Secondary objectives are to examine the need for invasive ventilation, hospital and ICU length of stay, and complications. ⋯ Out-of-hospital administration of NIPPV appears to be an effective therapy for adult patients with severe respiratory distress.
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Collective knowledge and coordination of vital interventions for time-sensitive conditions (ST-segment elevation myocardial infarction [STEMI], stroke, cardiac arrest, and septic shock) could contribute to a comprehensive statewide emergency care system, but little is known about population access to the resources required. We seek to describe existing clinical management strategies for time-sensitive conditions in Pennsylvania hospitals. ⋯ Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions.
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Review
Toward Patient-Centered Care: A Systematic Review of Older Adults' Views of Quality Emergency Care.
Observers have cited a quality gap between the current emergency care and the needs of elderly adults in the emergency setting. The Institute of Medicine identified patient-centeredness as a vital aim of quality health care. To develop a patient-centered approach in the emergency setting, we must first understand the elderly patients' views of their emergency care. Thus, we performed a systematic review to synthesize the current knowledge about the elderly patient's preferences and views of their emergency care. ⋯ Current qualitative research on the views of the elderly patient to hospital-based emergency care reveals common themes that should be considered in efforts to improve delivery of care to the elderly patient.
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Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. ⋯ We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care.