Resuscitation
-
Despite potential harm to patients, families, and emergency personnel, a low survival rate, and high costs and intensity of care, attempting resuscitation after prehospital cardiac arrest is the norm, unless there are signs of irreversible death or the presence of a valid, state-issued DNR. ⋯ Paramedics are more likely to forgo, and less likely to attempt, resuscitation in victims of cardiac arrest after implementation of a new policy. There was also an associated decrease in the percentage of patients who had signs of irreversible death, which might reflect a change in paramedic behavior.
-
Treating cardiac arrest is linked to the mutual performance of several health-care individuals' task coordination. Non-technical skills, including communication, leadership and team interaction, could improve sequencing the tasks in the cardiac arrest algorithm. Non-technical skills have been a part of crew resource management training, created to improve safety in aviation. This study aimed, first, to establish crew resource management and non-technical skill-based learning objectives and behavioural markers for the performance of multi-professional resuscitation teams; second, to develop a checklist and to evaluate the validity and reliability of the checklist; and, finally, to develop a simulation-based course including the checklist on behavioural markers, as a tool for learning and assessment. ⋯ A full-scale simulation course and a checklist with 22 behavioural markers were developed. Good inter-rater reliability and concurrent validity of the checklist were demonstrated. Single items on the checklist need refinement to improve accuracy.
-
Anaphylaxis is of increasing prevalence and concern in Western communities. Ambulance services are often called to deal with these emergencies. There are few published studies that examine the demand and management of allergic reactions by emergency services. The aim of this study was to investigate the frequency, severity and outcome of calls, as well as whether intramuscular adrenaline was required for successful management of allergic reactions by paramedics and first aiders. ⋯ Emergency call-outs for allergic reactions made up <1% of total ambulance workload. Most cases were successfully managed without intramuscular adrenaline. Adrenaline appeared to be used appropriately by paramedics. The lack of correlation between clinical severity and adrenaline use by first aiders suggests that they may often not understand the correct clinical indications for this drug.
-
To describe the reasons for medical emergency team (MET) activation, and to verify the association of the MET score with 30-day mortality. ⋯ MET score presents a strong association with 30-day mortality in patients seen on the ward.