Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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In this discussion, two principal types of ambulance deployment systems were compared and contrasted: 1) the multipurpose, sole-provider all-advanced life support (all-ALS) ambulance system in which all ambulance-related services (emergent and nonemergent) for a city or region are provided by one fleet of ambulances, each of which is staffed by ALS providers (paramedics); and 2) the tiered ambulance system (tiered) in which some 911 ambulances are staffed by paramedics and others are staffed by basic emergency medical technicians (EMT-Bs) who provide basic life support (BLS) care. When managed with advanced system status management (SSM) techniques, the multipurpose, sole-provider all-ALS ambulance system can significantly reduce response intervals while simultaneously providing both fiscal and operational efficiencies. It can also be used to readily integrate and expand the scope of services for the ambulance provider service, such as interfacility transfers, thus increasing revenues. ⋯ This approach requires fewer paramedics in the system and appears, in some systems, to also provide medical care advantages in terms of skills utilization for individual ALS providers as well as a more concentrated focus for medical supervision. Therefore, both of these deployment systems can offer certain advantages depending on local emergency medical services (EMS) system needs as well as the local philosophy of health care delivery. Applicability must therefore be considered in terms of local service demands and other factors that affect the EMS system, including catchment population, statutory and jurisdictional issues, available funding, accessibility of receiving facilities, and medical quality concerns.
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To describe and evaluate a training program to teach civilian prehospital care to military medics in the Sudan People's Liberation Army (SPLA). ⋯ A field medic training program in Southern Sudan was conducted utilizing an interactive training curriculum. This program may serve as an educational model to teach prehospital care principles in other areas of international conflict.
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Comparative Study
Combination pharmacotherapy with delayed countershock vs standard advanced cardiac life support after prolonged ventricular fibrillation.
To test the hypothesis that combination pharmacotherapy with delayed countershock would produce higher rates of return of spontaneous circulation (ROSC) and one-hour survival when compared with standard Advanced Cardiac Life Support (ACLS) therapy. ⋯ Combination pharmacotherapy with delayed countershock (group 1) produced significantly higher rates of ROSC (p = 0.03) and one-hour survival (p = 0.001) when compared with standard ACLS in this porcine model of prolonged VF.
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To determine the time saving associated with lights and siren (L&S) use during emergency response in an urban EMS system. ⋯ In this urban EMS system, L&S reduce ambulance response times by an average of 1 minute, 46 seconds. Although statistically significant, this time saving is likely to be clinically relevant in only a very few cases. A large-scale multicenter L&S trial may help address this issue on a national level.
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Pharmacologic agents have been used in the prehospital setting for facilitating endotracheal intubation (ETI). The purpose of this study was to determine the utility of intravenous midazolam for prehospital patients who require pharmacologic relaxation to facilitate ETI. ⋯ Although it is of limited efficacy, MFI is underutilized and should be considered by medical direction as a pharmacologic adjunct to ETI in selected field patients.