Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The therapeutic window for intervention in acute cerebral ischemia is brief. Prehospital identification of acute stroke patients and paramedic administration of neuroprotective agents may soon become critical components of successful acute stroke treatment. This preliminary study sought to demonstrate that a new prehospital screening instrument, the Los Angeles Prehospital Stroke Screen (LAPSS), sensitively identifies acute stroke patients. Further, the study evaluated the potential time savings that could be achieved by paramedic administration of neuroprotective agents in the field. ⋯ The LAPSS sensitively identifies ambulance-arriving acute stroke patients, and a substantial time savings will potentially occur if neuroprotective agents are administered by paramedics in the field. The LAPSS is a promising tool that may enable paramedic recognition of stroke with a high degree of sensitivity and simplicity in a short period of time.
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To determine whether paramedics influence the outcome of cardiac arrest patients in a rural area. ⋯ In this rural setting, a paramedic on the scene significantly improved the ROSC (paramedics = 46% vs 18% for EMT-III, p = 0.01) and survival to ICU admission (38% vs 15%, p = 0.03). The presence of a paramedic on the scene increased survival to hospital discharge neurologically intact (20% vs 9%), although this was not statistically significant.
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To determine the effect of the blizzard of 1996 on the utilization of a pediatric emergency department (ED). ⋯ Among other effects, a significant increase in severity of presentations to a pediatric ED following a severe storm can be observed.
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Comparative Study
Air vs ground transport and outcome in trauma patients requiring urgent operative interventions.
To study trauma patients requiring urgent operative interventions to determine whether transport mode was associated with outcome difference. ⋯ This study failed to identify, but had insufficient power to rule out, outcome benefit to air medical transport in a subset of trauma patients requiring urgent operative interventions.
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To determine whether mode of arrival is associated with seriousness of etiology and use of diagnostic testing in patients treated in the emergency department for headache. ⋯ In this EMS system, patients with headache who arrive by EMS are more likely to have serious causes. Mode of arrival may be of use to the clinician in assessing risk of serious illness among patients with headache. Whether this observation represents an element of self-triage or a combination of other factors remains to be determined.