Prehospital and disaster medicine
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Prehosp Disaster Med · Apr 2011
Evaluation of success rate and access time for an adult sternal intraosseous device deployed in the prehospital setting.
Access to the vascular system of the critically ill or injured adult patient is essential for resuscitation. Whether due to trauma or disease, vascular collapse may delay or preclude even experienced medical providers from obtaining standard intravenous (IV) access. Access to the highly vascular intramedullary space of long bones provides a direct link to central circulation. The sternum is a thin bone easily identified by external landmarks that contains well-vascularized marrow. The intraosseous (IO) route rapidly and reliably delivers fluids, blood products, and medications. Resuscitation fluids administered by IV or IO achieve similar transit times to central circulation. The FAST-1 Intraosseous Infusion System is the first FDA-approved mechanical sternal IO device. The objectives of this study were to: (1) determine the success rate of FAST-1 sternal IO device deployment in the prehospital setting; (2) compare the time of successful sternal IO device placement to published data regarding time to IV access; and (3) describe immediate complications of sternal IO use. ⋯ This is the first study to prospectively evaluate the prehospital use of the FAST-1 sternal IO as a first-line device to obtain vascular access in the critically ill or injured patient. The FAST-1 sternal IO device can be a valuable tool in the paramedic arsenal for the treatment of the critically ill or injured patient. The device may be of particular interest to specialty disaster teams that deploy in austere environments.
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Prehosp Disaster Med · Apr 2011
Trial to end ambulance diversion in Boston: report from the conference of the Boston teaching hospitals consortium.
Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours. ⋯ The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The "no diversion" policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.
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Prehosp Disaster Med · Apr 2011
Research issues for nursing and midwifery contributions in emergencies.
This special report was prepared as a white paper for the First World Health Organization (WHO) Consultation on Nursing and Midwifery Contributions in Emergencies held in Geneva on 22-24 November 2006. Pertinent issues related to research of nurses and midwives were identified based on prior international conferences. ⋯ Global perspective recommendations were made for consideration by the WHO and other nursing organizations. Finally, possible discussion questions were posed that were used during the consultation, but could also be used in other international nursing conferences.