Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Patient refusal of paramedic transport against medical advice (AMA) has significant medical-legal implications. Previous studies have investigated patient outcomes after refusal of transport, but none has focused on these events in minors. This study was performed to evaluate the outcomes of this patient population after refusal of transport as well as the significance of base hospital physician discussion with parents in the decision to refuse transport. ⋯ Children whose parents refused EMS transport received medical follow-up in the majority of cases, with a small group requiring admission.
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Emergency medical services for children, or EMSC, is still a relatively underdeveloped component of most state and local EMS systems. Advocacy and funding for EMSC from the federal EMSC Program, availability of many useful EMSC products, and the rapidly enlarging literature in EMSC have created heightened awareness and interest in improving systems for pediatric emergency, trauma, and critical care. The new National Highway Traffic Safety Administration (NHTSA) EMS Technical Assistance (TA) re-assessment program, the second version of the successful original TA Program from 1988 to 1996, provides an ideal opportunity for state EMS professionals to evaluate EMSC capabilities and to integrate new EMSC products and services. ⋯ In order to facilitate state-of-theart reviews of EMSC within state EMS systems, a pediatric survey for the NHTSA re-assessments is presented. The survey, developed with the input of EMS administrators and physicians and approved by the National Association of State EMS Directors, follows the original ten-component model for EMS system review. It is intended for optional use within the overall EMS review process.
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Approximately 1,000 people in the United States suffer cardiac arrest each day, most often as a complication of acute myocardial infarction (AMI) with accompanying ventricular fibrillation or unstable ventricular tachycardia. Increasing the number of patients who survive cardiac arrest and minimizing the clinical sequelae associated with cardiac arrest in those who do survive are the objectives of emergency medical personnel. In 1990, the American Heart Association (AHA) suggested the chain of survival concept, with four links--early access, cardiopulmonary resuscitation (CPR), defibrillation, and advanced care--as the way to approach cardiac arrest. ⋯ This paper addresses a number of the issues associated with each of the links of the chain of survival, the evidence that exists, and what should be done to achieve the clinical evidence needed for true clinical significance. Also included in this paper are the consensus statements developed from small discussion groups held after the main presentation. These comments provide another perspective to the problems and to possible approaches to deal with them.