Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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This study aimed to determine whether short cardiopulmonary resuscitation (CPR) by emergency medical services before defibrillation (CPR first) has a better outcome than immediate defibrillation followed by CPR (shock first) in patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT) out-of-hospital cardiac arrest. ⋯ In our study, CPR prior to attempted defibrillation did not present a better outcome compared with shock first as measured by either one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. Further studies are required to determine whether CPR first has an advantage over shock first.
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Regionalization of emergency care for patients with serious infections has the potential to improve outcomes, but is not feasible without accurate identification of patients in the prehospital environment. ⋯ Including prehospital provider impression to objective physiologic factors identified three more patients with infection at the cost of overtriaging five. Future research should determine the effect of training or diagnostic aids for improving the sensitivity of prehospital identification of patients with serious infection.
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The clinical provision of medical care by emergency medical services (EMS) providers in the out-of-hospital environment and the operation of EMS systems to provide that care are unique in the medical arena. There is a substantive difference in the experience of individuals who provide medical care in the out-of-hospital setting and the experience of those who provide similar care in the hospital or other clinical settings. ⋯ Physicians without specific EMS oversight experience are not uniformly qualified to provide expert opinion regarding the provision of EMS. This resource document reviews the current issues in expert witness testimony in cases involving EMS as these issues relate to the unique qualifications of the expert witness, the standard of care, and the ethical expectations.
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The National Association of EMS Physicians (NAEMSP) believes that emergency medical services (EMS) medical directors may prescribe any legally marketed product for off-label use. This document is the official position of the NAEMSP.
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Statewide emergency medical services (EMS) data linked to outcomes are critical for promoting high-quality emergency care; however, many states do not have such a resource. ⋯ Developing a statewide EMS database linked to hospital outcomes is feasible. The processes used in this study and match rate estimates may provide a template for other states to follow, enhancing opportunities for outcomes-based EMS research and EMS quality assurance efforts.