Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2002
Review Historical ArticleTactical emergency medical support.
As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of death or grievous harm to law officers, bystanders, hostages, or perpetrators. ⋯ National professional organizations within law enforcement and emergency medicine have identified and support the fundamental need for mission safety and the development of a standard model to train and incorporate TEMS into law enforcement special operations. The overall objective of TEMS is to minimize the potential for injury and illness and to promote optimal medical care from the scene of operations to a definitive care facility. The design, staffing, and implementation of a TEMS program that maximally uses the community resources integrates previously disparate law enforcement, EMS, and emergency medical/trauma center functions to form a new continuum of care [55].
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Recent research efforts have demonstrated that many longstanding practices for the prehospital resuscitation of trauma patients may be inappropriate under certain circumstances. For example, traditional practices, such as application of anti-shock garments and i.v. fluid administration to raise blood pressure, may even be detrimental in certain patients with uncontrolled bleeding, particularly those with penetrating injuries. ETI, although potentially capable of transiently prolonging a patient's ability to tolerate circulatory arrest, may also be harmful if overzealous PPV further compromises cardiac output, particularly in those patients with severe hemodynamic instability. ⋯ Furthermore, the efficacy of a single intervention may be masked by a confounding variable [5]. For example, a trial of an effective new HBOC in moribund patients that indicates no advantage in the study results may have been confounded by overzealous PPV, which may have led to suboptimal outcomes. It is hoped that, in the future, EMS physicians will be able to not only better discriminate in their management of patients with major trauma but also improve outcomes as a result.
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Emergency ventilation is an essential component of basic life support. Respiratory emergencies occur far more frequently than cardiac arrest and, if not treated promptly and effectively, may lead to cardiac arrest. ⋯ The American Heart Association sponsored conferences in 1999 and 2000 to review and revise guidelines for cardiopulmonary resuscitation. This article reviews the science behind guideline changes related to pulmonary resuscitation and discusses recent advances in emergency airway management, focusing on noninvasive techniques for ventilation (mouth-to-mouth ventilation, bag-mask ventilation) and alternative airway devices (laryngeal mask airway, the Combitube).
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Very early defibrillation, within the first few minutes of VF cardiac arrest, results in significantly improved survival rates [1,10-12,34]. Most EMS systems cannot consistently provide defibrillation within the first few minutes following cardiac arrest. Defibrillation within the first few minutes following collapse is potentially achievable through the use of AEDs and PAD [9-14,62]. ⋯ Effective PAD requires significant investment in time, energy, informed planning, and rigorous quality improvement; however, the benefits are enormous. Reported VF survival rates can approach 50% or higher [11,12,62]. PAD provides the potential opportunity to transform cardiac arrest into a survivable event for most victims by making the community the ultimate coronary care unit.
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In 1996, the National Highway Traffic Safety Administration and the Health Resources and Services Administration, Maternal and Child Health Bureau published the EMS Agenda for the Future. To date, thousands of copies have been distributed to EMS-knowledgeable people, and those who aspire to be, throughout the United States. This article reviews the findings discussed within the EMS Agenda for the Future. This discussion also assesses the effects of these findings on EMS development.