Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Since the 1980s, the specialized field of tactical medicine has evolved with growing support from numerous law-enforcement and medical organizations. On-scene backup from tactical emergency medical support (TEMS) providers has not only permitted more immediate advanced medical aid to injured officers, victims, bystanders, and suspects, but also allows for rapid after-incident medical screening or minor treatments that can obviate an unnecessary transport to an emergency department. The purpose of this report is to document one very explicit benefit of TEMS deployment, namely, a situation in which a police officer's life was saved by the routine on-scene presence of specialized TEMS physicians. ⋯ Two TEMS physicians, who had been integrated into the tactical law-enforcement team, were on scene, controlled the hemorrhage, and provided a surgical airway. By the time of arrival at the hospital, the patient had begun purposeful movements and, within 12 hours, was alert and oriented. Considering the rapid decline in the patient's condition, it was later deemed by quality assurance reviewers that the on-scene presence of these TEMS providers was lifesaving.
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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.
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Multicenter Study
The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort.
The validity of using adult physiologic criteria to triage injured children in the out-of-hospital setting remains unproven. Among children meeting adult field physiologic criteria, we assessed the availability of physiologic information, the incidence of death or prolonged hospitalization, and whether age-specific criteria would improve the specificity of the physiologic triage step. ⋯ The incidence of high-risk injured children meeting adult physiologic criteria is relatively low and the findings from this sample do not support using age-specific values to better identify such children. However, the amount and pattern of missing data may compromise the value and practical use of field physiologic information in pediatric triage.
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To describe changes in out-of-hospital cardiac arrest (OOHCA) survival before and after the release of the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). ⋯ In this large city, substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA guidelines for CPR and ECC. These changes were associated with improvements in the quality of CPR.
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This case series evaluated provider use of the King LTS-D as a primary airway in patients requiring rapid-sequence intubation (RSI). ⋯ In this case series, paramedics were able to successfully place and use the King LTS-D in patients meeting our emergency medical services (EMS) system indications for RSI.