Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Limited data exist that examine the relationship between prehospital response times (RTs) and improved patient outcomes. Objective. We tested the hypothesis that patient outcomes do not differ substantially based on an explicitly chosen advanced life support (ALS) RT upper limit of 10 minutes 59 seconds (10:59 minutes). ⋯ Compared with patients who wait 10:59 minutes or less for ALS response, Priority 1 patients who wait longer than 10:59 minutes could experience between a 6% increase and a 4% decrease in mortality, and do not have an increase in critical procedures performed in the field. Our data are most consistent with the inference that neither the mortality nor the frequency of critical procedural interventions varies substantially based on this prespecified ALS RT.
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Review Meta Analysis
Paramedic determinations of medical necessity: a meta-analysis.
Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. ⋯ The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.
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During normal operations, public safety personnel may become injured, leading them to seek medical care and possible time off. Examining the nature and patterns of injury may help to identify preventive health measures for all public safety personnel and address specific needs of each discipline based on actual risk. Objective. To determine the types and severity of injuries encountered by public safety personnel during routine work conditions within a single urban population. ⋯ Public safety personnel are affected by both profession-specific and non-profession-specific injuries. Overall, EMS has higher rates of missed time and medical evaluations than both fire and police. These data highlight the need to make direct comparisons of various public safety personnel bureaus using a common time interval and locale in order to rationally plan interventions and apply resources.
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To identify the specific educational strategies used by paramedic educational programs that have attained consistently high success rates on the National Registry of Emergency Medical Technicians (NREMT) examination. ⋯ Twelve specific strategies were identified by representatives from high-performing paramedic education programs. Further study should be conducted to determine whether implementation of these recommendations would improve program pass rates on the NREMT credentialing examination and improve entry-level paramedic field performance.
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We sought to determine the effect of the preshock pause (PSP) on coronary perfusion pressure (CPP) decay and subsequent rescue shock (RS) outcome in porcine ventricular fibrillation (VF). ⋯ During the resuscitation PSP in these porcine studies of prolonged VF, CPP dropped precipitously, but RS outcome was not adversely affected.