Prehospital and disaster medicine
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Prehosp Disaster Med · Oct 1996
Multicenter Study Comparative Study Clinical Trial Controlled Clinical TrialComparison of inhaled metaproterenol via metered-dose and hand-held nebulization in prehospital treatment of bronchospasm.
Although the efficacy of the administration of beta-adrenergic bronchodilators has been demonstrated, the best method available for the delivery of these drugs in the prehospital setting has not been defined. This paper compares the effects of administration of metaproterenol when administered by paramedics using either a metered-dose inhaler (MDI) or a hand-held nebulizer (HHN). ⋯ In the prehospital setting, the administration of metaproterenol using a hand-held nebulizer is more effective than delivering the drug using a metered-dose inhaler. The hand-held nebulizer is easier to use and delivers a higher dose of the drug than is convenient using the metered-dose inhaler.
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Prehosp Disaster Med · Oct 1996
Comparative StudyRequiring on-line medical command for helicopter request prolongs computer-modeled transport time to the nearest trauma center.
Rapid transport from scene to closest trauma center requires optimal use of public safety first responder (FR), basic life support (BLS), advanced life support (ALS), and transport resources (ground or air). In some parts of this regional emergency medical services (EMS) system, on-scene ALS requires contact with on-line medical command (OLMC) to obtain authorization for air medical helicopter (AMH) dispatch, because some EMS medical directors believe that this may decrease overutilization of AMH services. ⋯ Optimal use of AMH requires balancing the need for early helicopter dispatch to fully exploit its speed advantage with the disadvantage of expensive overutilization. This computer model indicates that the best person to request AMH varies by venue: in urban settings, the OLMC physician should request AMH dispatch; in suburban venues, BLS should request AMH dispatch; and in rural venues, FRs should request AMH dispatch.
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Prehosp Disaster Med · Oct 1996
Comparative StudyA comparison of EMS continuing education for paramedics in the United States.
To determine characteristics of continuing education programs for paramedics in large metropolitan areas, and to make recommendations for changes in the Chicago Emergency Medical Services (EMS) system. ⋯ EMS systems primarily use didactic sessions to meet their continuing education requirements. Nearly half of the systems requiring clinical continuing education use in-field credit to fulfill these requirements. In-field credit systems are poorly developed to date. This mechanism may be an effective alternative to usual clinical experiences for paramedics and deserves further investigation.
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Prehosp Disaster Med · Oct 1996
EMS knowledge and skills in rural North Carolina: a comparison with the National EMS Education and Practice Blueprint.
Many state and local emergency medical services (EMS) systems may wish to modify provider levels and their scope of practice to align their systems with the recommendations of the National Emergency Medical Services Education and Practice Blueprint. To determine any changes that may be needed in a typical EMS system, the knowledge and skills of EMS providers in one rural area of North Carolina were compared with the knowledge and skills recommended in the National Emergency Medical Services Education and Practice Blueprint. ⋯ In North Carolina, combining the EMT and EMT-Defibrillator levels and eliminating the EMT-Intermediate level would create three levels of certification, which would be more consistent with levels recommended by the Blueprint. The results of this study should be considered in any effort to revise the levels of EMS certification in North Carolina and in planning the training curricula for bridging those levels. Other states may require similar action to align with the National Emergency Medical Services Education and Practice Blueprint.
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The capnometric demonstration of end-tidal carbon dioxide (CO2) is a reliable method of differentiating between a correct endotracheal tube position and an accidental misplacement of the tube into the esophagus. Recently, several CO2 detectors have been introduced for monitoring end-tidal CO2 in the "out-of-hospital" setting, where quantitative capnometry with capnography is not yet available. ⋯ The presence of 5% CO does not interfere with infrared spectrometry detection (MiniCAP and StatCAP) or chemical detection (EasyCAP, PediCAP, and Colibri) of CO2. The devices can be used safely in patients with CO poisoning for monitoring of endotracheal tube position.