Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Evaluating an emergency medical services-initiated nontransport system.
To evaluate both factors predicting nontransport and mortality rates in an emergency medical services system with a nontransport policy. ⋯ Age is a determinant when deciding on transporting patients. Patients with complaints with potentially higher acuity were transported most often. Only two nontransported patients died within 30 days, although it is unknown whether initial transport would have changed their mortality. Our data suggest that emergency medical services-initiated nontransport is influenced only by age and chief complaint and may not result in significant mortality.
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We conducted a time-motion study of emergency medical technician (EMT) flow in an urban, academic emergency department (ED). Our objective was to describe the activity of the EMTs during their time in the ED. Secondary objectives included the association of time of day, age, and triage code with the various time intervals. ⋯ More time was spent in the pretriage and posttriage intervals as compared with the triage interval. Further time-motion studies in the ED will be necessary to plan interventions aimed at decreasing the time spent in-hospital by EMTs.
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Endotracheal intubation (ETI) is commonly used by paramedics for definitive airway management. The predictors of success and therapeutic value with regard to oxygenation are not well studied. ⋯ A relationship between intubation success and perfusion status, GCS score, and initial EtCO2 value was observed. Capnometry was effective in eliminating unrecognized esophageal intubations. Both noninvasive and invasive airway management strategies were effective in increasing SpO2 values and decreasing the incidence of hypoxemia, with additional benefit observed with invasive airway maneuvers in some patients.
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This report examines the efficacy of current trauma triage rules to determine the exigency of field care and transport of severely injured patients from a variety of medical populations.
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Previous literature has documented that prehospital 12-lead electrocardiography (ECG) decreases the time to reperfusion in patients with an acute ST-segment elevation myocardial infarction (STEMI). ⋯ A minority of patients with EMS ECGs had prearrival AMI team activation. EMS ECGs combined with systems that activate hospital resources, but not EMS ECGs alone, decrease time to laboratory and reperfusion.