Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Randomized Controlled Trial
Physiological recovery from firefighting activities in rehabilitation and beyond.
The primary objective of this study was to document the timeline of physiologic recovery from firefighting activities in order to inform emergency medical services (EMS) of vital sign values that might be expected during incident rehabilitation and in developing rehabilitation protocols to make decisions about when to return personnel to the fireground. Secondarily, we compared two different incident rehabilitation strategies to determine effectiveness in reducing physiologic strain following firefighting. ⋯ The timeline for recovery from firefighting activities is significantly longer than the typical 10-20-minute rehabilitation period that often is provided on the fireground. Modifications from the current rehabilitation protocol do not appear to improve the recovery timeline when rehabilitation is conducted in a cool room. While firefighters often are concerned about elevated blood pressures, this study suggests that firefighters and EMS personnel should also be cognizant of the potential dangers of hypotension.
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Drowning is a common cause of accidental death, particularly in younger people, and acute respiratory failure is common in these patients. This case report describes a healthy 18-year-old man who suffered a cardiorespiratory arrest due to submersion while swimming in a freshwater lake. First-responder cardiopulmonary resuscitation and defibrillation using an automated external defibrillator resulted in a return of spontaneous circulation. ⋯ This case report describes the pathophysiology and prehospital management of a patient with suspected early-onset ARDS secondary to drowning. This case report is unique because it describes the oxygenation and ventilation difficulties encountered in managing this patient in the transport setting, and possible strategies to deal with these difficulties. Finally, this case report highlights the prehospital bypass decision-making process for patients requiring specialized medical care.
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Randomized Controlled Trial Comparative Study
A comparison of cooling techniques in firefighters after a live burn evolution.
We compared the use of two active cooling devices with passive cooling in a moderate-temperature (≈ 22 °C) environment on heart rate (HR) and core temperature (T(c)) recovery when applied to firefighters following 20 minutes of fire suppression. ⋯ During 30 minutes of recovery following a 20-minute bout of fire suppression in a training academy setting, there is a slightly higher cooling rate for FI and no apparent benefit to CV when compared with P cooling in a moderate temperature environment.
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Multicenter Study
The increased mortality from witnessed out-of-hospital cardiac arrest in the home.
Research in 2008 demonstrated that the majority of out-of-hospital cardiac arrests (OHCAs) occur in the home, and many important characteristics differ between private and public locations. However, the influence of the location of collapse on survival from OHCA is not well understood. Furthermore, most of the reports have been from Western countries; there is little research from Asia that differentiates the conditions of OHCA. ⋯ The present analysis demonstrated that there were significant differences in survival between groups of patients who suffered from cardiac arrest inside and outside the home in Japan. The outside-the-home group had a higher rate of survival from OHCA; however, the location of collapse was not an independent predictor of survival from OHCA. Education of the families of high-risk patients in placing a rapid emergency call and performing effective CPR might be needed to improve survival from cardiac arrest in the home.
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Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury. ⋯ Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤ 8. Coma Scale score.