Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.
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Forgoing resuscitation in prehospital cardiac arrest has previously required a written prehospital do-not-resuscitate (DNR) order. Some emergency medical services (EMS) agencies, including Los Angeles County (LAC), have implemented policies allowing surrogate decision makers to verbally request to forgo resuscitation. The impact of a verbal DNR policy is unclear, given the absence of information about how often cardiac arrest occurs at home, or in the presence of a family member. ⋯ A written DNR order is uncommonly used in the prehospital setting as a reason to forgo resuscitation in LAC. Even when family members state that the patient has a DNR order, patients are often resuscitated. A majority of cardiac arrests occurs at the patient's home, and in many cases in the presence of family members, some of whom may be able to express a patient's preferences regarding end-of-life care.
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To determine the impact of prehospital 12-lead electrocardiograms (ECGs) on door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients prior to the establishment of formally designated STEMI receiving centers. ⋯ Paramedic transport of STEMI patients with prehospital 12-lead ECG acquisition was associated with shorter door-to-balloon times than the times for patients who self-transported to PCI-capable EDs.
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We report our use of noninvasive ventilation (NIV) during pediatric interhospital ground transport. ⋯ Though the use of NIV during pediatric interhospital ground transports was not associated with serious out-of-hospital complications, advanced pediatric airway skills were frequently required.
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Comparative Study
Predictive value of the Ontario prehospital stroke screening tool for the identification of patients with acute stroke.
In 2005, a prehospital stroke screening tool was implemented in Toronto, Ontario, Canada. Patients identified by paramedics through the use of this tool in the field were transported to a regional stroke center under an acute stroke protocol. ⋯ In this preliminary study, the Ontario Prehospital Stroke Screening Tool had a high PPV for acute stroke and appeared to be effective for identifying patients who required triage to a single regional stroke center. Following implementation of a citywide acute stroke protocol using this screening tool, we observed an increase in the number of patients who were eligible for and received fibrinolysis at our stroke center.