Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To determine whether methicillin-resistant Staphylococcus aureus (MRSA) could be found in ambulances in a predominantly rural state. ⋯ A significant number of ambulances operating in southern Maine have MRSA contamination, and ambulances may represent an important reservoir for the transmission of potentially serious infections to patients and EMS personnel. There was no statistical difference between the service types (fire-based vs. non-fire-based) or annual call volume. There was, however, a statistically significant lower rate of contamination in services that provided paid, 24-hour coverage versus those that did not.
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An unusual motor vehicle collision case is presented involving a complex, prolonged extrication with crush injury. While crush injury and crush syndrome are often considered to be in the realm of disaster medicine and urban search and rescue, more typical single-patient or few-patient incidents such as industrial accidents and vehicular crashes can involve these clinical entities. All emergency medical services (EMS) personnel should have a basic working familiarity with the operational and clinical issues involved in crush injury and crush syndrome. Crush syndrome is reviewed here from the perspective of prehospital management.
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Airway compromise is the third leading cause of potentially preventable death on the battlefield. An understanding of the injuries associated with fatal airway compromise is necessary to develop improvements in equipment, training, and prehospital management strategies in order to maximize survival. ⋯ Airway compromise from battlefield trauma results in a small number of PS fatalities. Penetrating trauma to the face or neck may be accompanied by significant hemorrhage, severe and multiple facial fractures, and airway disruption, leading to death from airway compromise. Cricothyroidotomy may be required to salvage these patients, but the procedure failed in all instances in this series of cases. Further studies are warranted to determine the appropriate algorithm of airway management in combat casualties sustaining traumatic airway injuries.
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Standard of care for patients with acute coronary syndrome/ST-segment elevation myocardial infarction (ACS/STEMI) is rapid revascularization of ischemic myocardium. Current optimal treatment is primary percutaneous coronary intervention (PCI) within 90 minutes after the patient accesses the health care system, and strategies to lower this time may improve outcomes. ⋯ A policy of transferring patients from one hospital directly to a cardiac catheterization laboratory using only bolus medications significantly reduces total door-to-needle time without adverse effects on LOS or mortality. Other institutions may want to consider such policies for interfacility transport of ACS patients.