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 amount of myocardial perfusion required for successful defibrillation after prolonged cardiac arrest is not known. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study reported that a threshold of 15 mmHg was necessary for return of spontaneous circulation (ROSC), and that CPP was predictive of ROSC. A distinction between threshold and dose of CPP has not been reported. ⋯ Higher CPP threshold and dose are associated with and predictive of ROSC.
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Comparative Study
The effect of physical exertion in chemical and biological personal protective equipment on physiological function and reaction time.
The primary objective of this study was to describe and compare changes in heart rate, venous pH, venous partial pressure of carbon dioxide (pCO(2)), venous bicarbonate level, lactate level, oxygen saturation (SpO(2)), and tympanic membrane (TM) temperature occurring in a group of healthy volunteers during 20 minutes of physical exertion, both with and without chemical and biological personal protective equipment (PPE). A further aim was to establish whether any significant prolongation of reaction time occurred after physical exertion in chemical and biological PPE, compared to baseline values without the protective equipment. ⋯ This study did not identify any effect of 20 minutes of heavy exercise in highly fit volunteers wearing level C chemical and biological PPE on reaction time. Heart rate response and TM temperature were higher during exertion in PPE. These differences, along with other physiological alterations observed, were not of clinical relevance. Further studies using arterial blood gas analysis and a more accurate measure of core body temperature are needed to better assess the physiological effect of this level and duration of exercise on subjects wearing similar PPE. Other aspects of cognition also require investigation under these conditions, in order to assess their effect on patient and rescuer safety.
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Many emergency medical services (EMS) systems dispatch nonparamedic firefighter first responders (FFRs) to selected EMS 9-1-1 calls, intending to deliver time-sensitive interventions such as defibrillation, cardiopulmonary resuscitation (CPR), and bag-mask ventilation prior to arrival of paramedics. Deciding when to send FFRs is complicated because critical cases are rare, paramedics often arrive before FFRs, and lights-and-siren responses by emergency vehicles are associated with the risk of en-route traffic collisions. ⋯ This model provides a robust generalized methodology allowing EMS systems to optimize FFR lights-and-siren responses to emergency medical calls. Further validation is warranted to assess the model's generality.
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Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence. ⋯ This study was the first known baseline assessment of EMS professionals regarding the key health indicators identified by Healthy People 2010. Investigations regarding the impact of health and wellness in relation to workforce stability should be undertaken. Further research should also be conducted to identify strategies to improve the health of the EMS workforce.
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1) To compare the outcomes of adult trauma patients transported to a level I trauma center by helicopter vs. ground ambulance. 2) To determine whether using a unique "natural experiment" design to obtain the ground comparison group will reduce potential confounders. ⋯ This unique natural experiment led to better matched air vs. ground cohorts for comparison. As per TRISS analysis, air transport of the adult major trauma patient is associated with significantly improved survival as compared with ground transport.