Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Now, more than ever before, the spirit of the emergency services professional is recognized by people everywhere. Individuals from every walk of life comprehend the reality of the job these professionals do each day. Placing the safety of others above their own is their acknowledged responsibility. ⋯ Strategies to protect the safety of both the patient and the public safety worker must be devised and tested. There are many questions that remain to be asked, many practices to be evaluated, and many procedures to be improved. Research is the key to obtaining the answers.
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Why does LEA-D intervention seem to work in some systems but not others? Panelists agreed that some factors that delay rapid access to treatment, such as long travel distances in rural areas, may represent insurmountable barriers. Other factors, however, may be addressed more readily. These include: absence of a medical response culture, discomfort with the role of medical intervention, insecurity with the use of medical devices, a lack of proactive medical direction, infrequent refresher training, and dependence on EMS intervention. ⋯ In most communities, however, LEA-D programs have tremendous lifesaving potential and are well worth the investment of time and resources. Law enforcement agencies considering adoption of AED programs should review the frequency with which police arrive first at medical emergencies and LEA response intervals to determine whether AED programs might help improve survival in their communities. It is time for law enforcement agency defibrillation to become the rule, not the exception.
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Based on its roots in military air evacuation, helicopter emergency medical services (HEMS) has always been emphasized as a tool for trauma transportation. Despite much discussion regarding resource allocation for HEMS, a literature search found little recent systematic review of pertinent studies. As HEMS utilization is subject to increased scrutiny in a health care dollar-conscious environment, it was felt that a compendium of available outcomes-related literature could assist those assessing utility of HEMS trauma transport. ⋯ The goal of this review is to provide a useful resource for those interested in pursuing systematic review of the HEMS trauma outcomes literature. The primary purpose of the review is bibliographic, but there is editorial comment after each paper's summary. The initial article in this two-part series focused on HEMS outcomes literature covering noninjured patients as well as papers assessing outcome in mixed trauma-nontrauma HEMS study groups.
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Comparative Study
Characteristics of twice-transferred, rural trauma patients.
Undertriage has seldom been evaluated in the trauma population. In rural states patients often go to the nearest hospital first, where they are evaluated and, if necessary, transferred to another hospital. If they are undertriaged when transferred to the second hospital, they will require a second transfer to a higher-level trauma center. ⋯ The authors infer from the data analysis that more serious or complex injuries took longer to evaluate. Since these patients were physiologically stable, reducing the number of twice-transferred trauma patients will involve refining transfer protocols concerning the need for specialty care.
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Santo Domingo is the largest city in the Dominican Republic. In recent years this city has experienced a significant increase in ambulance services. ⋯ Volunteers appeared to be less educated but with a higher long-term interest in EMS. Salary and better work hours seem to be important factors affecting satisfaction of paid providers, whereas occupational health and life insurance appear to affect the satisfaction of volunteers.