Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Older injured persons are frequently undertriaged, increasing the risk for preventable mortality and morbidity in an already-vulnerable population. Changes made in 2006 to the American College of Surgeons Committee on Trauma (ACS-COT) Field Triage Decision Scheme might improve triage accuracy for this population. ⋯ There is a positive trend in triage accuracy for older injured persons since 2004. Ongoing funding, continued trauma system development with more training emphasis on scene evaluation of older adults, and the use of the ACS-COT triage decision scheme are essential for further improvement of triage accuracy. More research is needed to identify and validate additional triage criteria that are sensitive to severe injuries in older persons.
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Comparative Study
Advanced rescuer- versus citizen-witnessed cardiac arrest: Is there a difference in outcome?
Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes. ⋯ Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests.
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To determine how often out-of-hospital cardiac arrest (OHCA) patients who achieve return of spontaneous circulation (ROSC) experience rearrest during their emergency medical services (EMS) care and to analyze their arrest characteristics, including survival to hospital discharge. ⋯ A significant number of OHCA patients who achieved field ROSC experienced rearrest prior to hospital arrival. Patients who experienced rearrest were less likely to survive.
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OBJCTIVE: The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting. ⋯ Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM, or oral route. When available to paramedics, ondansetron is used frequently.
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This study was undertaken to characterize the carbon emissions from a broad sample of North American emergency medical services (EMS) agencies, and to begin the process of establishing voluntary EMS-related emission targets. ⋯ EMS operations produce substantial carbon emissions, primarily from vehicle-related fuel consumption. The 75th percentiles from our data suggest 106.5 pounds of CO(2)e per unit response and/or 11.2 pounds of CO(2)e per service-area resident as preliminary maximum emission targets. Air medical services can anticipate higher per-flight but lower population-based emissions.