Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). ⋯ Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents.
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Multicenter Study
Predictors and outcomes of frequent emergency department users.
To identify predictors and outcomes associated with frequent emergency department (ED) users. ⋯ Frequent ED visits are associated with socioeconomic distress, chronic illness, and high use of other health resources. Efforts to reduce ED visits require addressing the unique needs of these patients in the emergency and primary care settings.
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Comparative Study
Comparison of perceived and actual times spent by residents performing ultrasound examinations on patients.
Emergency medicine (EM) ultrasonography (US) has become a part of residency education. More residents will be taking time during their shifts to perform bedside US examinations for educational purposes, thus further challenging time resources. ⋯ In this study, residents underestimated the amount of time spent performing an ultrasound examination. The small difference between the actual and perceived scan times was statistically significant; the clinical significance of this time difference is not known.
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Comparative Study
Underdosing of midazolam in emergency endotracheal intubation.
To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid-sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents. ⋯ Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used.
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Patients with altered level of consciousness may be suffering from elevated intracranial pressure (EICP) from a variety of causes. A rapid, portable, and noninvasive means of detecting EICP is desirable when conventional imaging methods are unavailable. ⋯ Despite small numbers and selection bias, this study suggests that bedside ED US may be useful in the diagnosis of EICP.