Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The purpose of this observational study was to determine the baseline rate of adherence to current American Heart Association guidelines with regard to use of epinephrine in out-of-hospital cardiac arrests. ⋯ Epinephrine administration in accordance with current advanced cardiac life support guidelines occurred in 14% of out-of-hospital cardiac arrest patients.
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Historical Article
History of trauma field triage development and the American College of Surgeons criteria.
The use of trauma field triage criteria is designed to match a patient's injury type and severity to prioritized transport and an institution with the resources to provide timely, definitive care. Triage schemes used in austere environments created by war or mass casualty events are less applicable to day-to-day civilian trauma. ⋯ As organized trauma systems continue to mature, the need for more accurate direction of high- versus low-acuity patients to regional centers, stratified by their capabilities, becomes more apparent and is essential in avoiding a completely 'exclusive' trauma system. New technology utilizing vehicular telemetry and Web-based information systems may simplify the seemingly simple but often formidable task of creating destination decision rules for victims of major injury.
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Conventional field triage schemes, including those discussed in this series of reports, assume a high degree of consistency in the availability of resources at designated receiving hospitals. In an organized trauma system, designated trauma receiving facilities of all levels are typically required to maintain a high level of consistency in terms of available facility and human resources for the care of the injured patient. ⋯ When gaps in resource availability do occur, their often unpredictable nature nullifies the effectiveness of any established triage protocol, may result in trauma center closures or downgrades, and undermines the entire system of care. It may be necessary in some regions to develop more flexible triage processes, creating a time-sensitive responsiveness to fluctuations in resource availability in a way that dynamically minimizes overtriage and undertriage.