Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Prehospital hypoxia and hypotension increase morbidity and mortality in head-injured patients. Etomidate is a sedative agent with increasing use for emergent rapid-sequence intubation (RSI) because of its favorable hemodynamic profile. This prospective, observational study documents the authors' preliminary experience with etomidate as part of an aeromedical RSI protocol. ⋯ An improvement in SBP after RSI with etomidate was observed (123 mm Hg to 136 mm Hg, p = 0.011) with a 9% incidence of hypotension, defined as a decrease in SBP to 90 mm Hg or less. Graphic analysis of individual SBP-time plots reveals hemodynamic stability, especially in patients with lower initial SBP values. These data suggest that the use of etomidate as part of a prehospital RSI protocol is associated with hemodynamic stability and a low incidence of hypotension.
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There has been concern regarding potential shock hazards for rescuers or bystanders when a defibrillator is used in a wet environment and the recommended safety procedure, moving the patient to a dry area, is not followed. ⋯ Thirty volts may result in some minor sensation by the operator or bystander, but is considered unlikely to be hazardous under these circumstances. The maximum currents were lower than allowed by safety standards. Although defibrillation in a wet environment is not recommended practice, our simulation of a patient and a rescuer/bystander in a wet environment did not show significant risk should circumstances demand it.
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To develop guidelines allowing emergency medical services (EMS) dispatchers to safely match callers to an EMS response or, alternatively, to a nontraditional resource. ⋯ The authors were able to use a demographic variable (age) to predict a population of callers to a 911 dispatch center triaged to the lowest acuity category, who have a very low risk of having an EMS or ED important finding. The decision rule developed here is preliminary, requiring further validation.
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To determine the compensation, benefit package, and level of satisfaction with the benefits of nationally registered emergency medical technicians (NREMTs) in 2001. ⋯ The adequacy of EMT compensation and benefit packages is an area of concern. It is not unreasonable to believe that these factors are associated with EMT retention and attrition. Additional longitudinal EMT information on compensation and benefits are anticipated to determine the extent to which compensation and benefits are factors in EMT retention.
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A considerable number of emergency medical services (EMS) responses for cardiac arrest occur in long-term care facilities. In some instances, these responses are for residents who have expressed wishes not to be resuscitated by signing a do not resuscitate (DNR) order. ⋯ Efforts to clarify existing regulations, streamline the DNR transfer process, and improve communication between EMS and long-term care facilities may result in better fulfillment of residents' end-of-life wishes and a saving of EMS resources.