Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Emergency medical services (EMS) responses to some scenes are potentially more dangerous than others, requiring EMS systems to develop policies that stage medical responders away from the scene until law enforcement has the area secured. ⋯ The practice of staging ambulances while police secure potentially dangerous scenes added approximately 4.5 minutes to the response time. We were unable to demonstrate a difference in RLS return to the hospital (our proxy for patient acuity) between SC and NSC.
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Review Meta Analysis
A meta-analysis of prehospital airway control techniques part I: orotracheal and nasotracheal intubation success rates.
Airway management is a key component of prehospital care for seriously ill and injured patients. Although endotracheal intubation has been a commonly performed prehospital procedure for nearly three decades, the safety and efficacy profile of prehospital intubation has been challenged in the last decade. Reported intubation success rates vary widely, and established benchmarks are lacking. ⋯ We provide pooled estimates of placement success rates for prehospital airway interventions. For some patient and clinician characteristics, OETI has relatively low success rates. For nonarrest patients, DFI and RSI appear to increase success rates. Across all clinicians, NTI has a low rate of success, raising questions about the safety and efficacy of this procedure.
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Multicenter Study
Airway management success and hypoxemia rates in air and ground critical care transport: a prospective multicenter study.
To assess critical care transport (CCT) crews' endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation. ⋯ CCT crews' ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO(2) derangement. CCT crews' ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews.
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In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA). ⋯ ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.
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Thirst perception involves neurochemical signals attributed to acute elevation of arginine vasopressin (AVP) and angiotensin II (AT2) levels, and may accompany acute hemorrhage. ⋯ The results of this study imply that thirst severity and AVP and AT2 plasma levels are not reliable predictors of impending hemorrhagic shock, injury severity, or outcome. The presence or absence of severe thirst should not be employed as a primary marker for dismissing or suspecting incipient shock.