Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Current methods of evaluating the technical competence of Michigan emergency medical technician (EMT) licensure candidates are subjective and potentially unreliable. Evaluators are required to attend a workshop before evaluating practical examination candidates. Despite the workshop, there is too much score variation and not enough observational consistency on the standardized examination. ⋯ Notable variation in scores given by evaluators for a single observed student, combined with low levels of evaluator agreement about skill performance, suggests that evaluators do not reliably rate student performance using the Michigan practical examination instrument.
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During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. ⋯ They are integration of health services, EMS research, legislation and regulation, system finance, human resources, medical direction, education systems, public education, prevention, public access, communication systems, clinical care, information systems, and evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.
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To determine whether EMS providers can accurately apply the clinical criteria for clearing cervical spines in trauma patients. ⋯ EMS and EP assessments to rule out cervical spinal injury have moderate to substantial agreement. However, the authors recommend that systems allowing EMS providers to decide whether to immobilize patients should follow those patients closely to ensure appropriate care and to provide immediate feedback to the EMS providers.
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Comparative Study
Comparison of bag-valve-mask, manually triggered ventilator, and automated ventilator devices used while ventilating a nonintubated mannikin model.
To determine whether there were differences in tidal volume (Vt), minute volume (MV), average mask leak per breath (ML), gastric insufflation (GI), and peak airway pressure (PAP) when ventilating a nonintubated mannikin with a bag-valve-mask (BV), manually triggered ventilator (MTV), and automated ventilator (AV). The authors' hypothesis was that there would be no differences among the devices for any of these variables. ⋯ All three devices delivered similar volumes when used by EMTs, but the BV was associated with higher PAP, ML, and GI.