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 information exists about the in-flight use and outcomes associated with automated external defibrillators (AEDs) on commercial airlines. ⋯ Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest. Survival is poor among patients presenting with nonshockable rhythms. AEDs are used extensively for in-flight monitoring, with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests.
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Recently, emphasis has been placed on the simultaneous implementation of resuscitation interventions currently recommended within the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). The rate of successful outcomes from out-of-hospital cardiac arrest remains relatively low in most U. S. communities. ⋯ Little information exists regarding the system-of-care components most likely to result in successful outcomes. Inconsistent application of these components may be responsible in part for the variability of survival rates among communities. We present a case of acute myocardial infarction followed by sudden cardiac arrest benefiting from the application of coordinated, community-based systems of care.
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Patients belonging to a managed care organization (MCO) who call 9-1-1 are typically transported to their MCO facility only if it is also the closest emergency department (ED). As past medical records and close follow-up are unavailable at the non-MCO facility, unnecessary workups and/or admissions may result. ⋯ Our study suggests that paramedic transport of MCO patients to the nearest MCO hospital in lieu of the nearest ED is safe and feasible. Given the potential benefits to patient care, this program should be evaluated in other EMS systems.
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Performing fire suppression activities results in cardiovascular stress, hyperthermia, and hypohydration. Fireground rehabilitation (rehab) is recommended to blunt the deleterious effects of these conditions. ⋯ Performances during a second bout of exercise in TPC did not differ when firefighters were rehydrated with water, sport drink, or IV normal saline when full rehydration was provided. Of concern was the inability of all subjects to complete two consecutive periods of heavy exercise in TPC, suggesting that the NFPA's "two cylinders before rehab" guideline may not be appropriate in continuous heavy work scenarios.
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Few studies have examined employee turnover and associated costs in emergency medical services (EMS). ⋯ Annual rates of turnover and costs associated with turnover vary widely across types of EMS agencies. The study's mean annual rate of turnover was lower than expected based on information appearing in the news media and EMS trade magazines. Findings provide estimates of two key workforce measures--turnover rates and costs--where previously none have existed. Local EMS directors and policymakers at all levels of government may find the results and study methodology useful toward designing and evaluating programs targeting the EMS workforce.