Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
How much force is required to dislodge an alternate airway?
Endotracheal tube (ETT) dislodgment is a potentially catastrophic adverse event. Newer alternate airway devices-esophageal-tracheal Combitube (ETC), King laryngeal tube disposable airway (King LT), and laryngeal mask airway (LMA)-are easier to insert, but their relative extubating forces remain unknown. ⋯ In a cadaver model of unintended airway dislodgment, the ETC required the most force for dislodgment. The King LT and LMA performed similarly to a standard ETT.
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Comparative Study
Comparison of low-energy versus high-energy biphasic defibrillation shocks following prolonged ventricular fibrillation.
Since the initial development of the defibrillator, there has been concern that, while delivery of a large electric shock would stop fibrillation, it would also cause damage to the heart. This concern has been raised again with the development of the biphasic defibrillator. ⋯ Biphasic 360-J shocks do not cause more cardiac damage than biphasic 150-J shocks in this animal model of prolonged VF and resuscitation.
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To determine the accuracy of SALT (sort-assess-lifesaving interventions-treatment/transport) triage during a simulated mass-casualty incident, the average time it takes to make triage designations, and providers' opinions of SALT triage. ⋯ We found that assessments using SALT triage were accurate and made quickly during a simulated incident. The accuracy rate was higher than those published for other triage systems and of similar speed. Providers also felt confident using SALT triage and found it was similar or easier to use than their current triage protocol. Using SALT triage during a drill improved confidence.
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To determine whether the number of advanced life support-trained personnel at the scene of an out-of-hospital cardiac arrest (OHCA) was associated with return of spontaneous circulation (ROSC) or survival to hospital discharge. ⋯ The presence of three or more paramedics at the scene of OHCA was not associated with improved survival to hospital discharge when compared to crews with two paramedics. Additional research is needed to determine the potential cause of this finding.
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The EMS Agenda for the Future describes emergency medical services (EMS) as the intersection between public health, public safety, and health care. The most comprehensive method to describe, evaluate, and optimize these systems of care is using a state EMS data system. A centralized EMS data system can be a valuable tool to identify, evaluate, target, and improve EMS service delivery and patient care. Significant barriers, however, still exist to the standardization of EMS data systems and infrastructure nationally. Indeed, there is no comprehensive measurement of EMS service delivery or patient volume at the national level. ⋯ The North Carolina EMS Data System represents the successful development of a large, fully integrated, comprehensive statewide EMS database and quality improvement effort. The North Carolina EMS Data System applications include the Prehospital Medical Information System (PreMIS), the Credentialing Information System (CIS), the State Medical Asset Resource Tracking Tool (SMARTT), and the EMS Performance Improvement Toolkits. The system provides a quality and performance improvement program consistent with the idealized EMS design described in the EMS Agenda for the Future. The program has already achieved significant improvements in the quality of EMS service delivery, patient care, and integrated systems of care. Consistent with the goals of the 2007 Institute of Medicine's recommendations for EMS, the linkage of the North Carolina EMS Data System with other health care registries has created an environment that can evaluate larger systems of care and ultimate patient outcomes.