Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Multicenter Study Comparative Study
Factors associated with emergency medical services scope of practice for acute cardiovascular events.
To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. ⋯ We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department-based/non-fire department-based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS providers and offer important information for the transition towards the implementation of a national scope of practice model.
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Comparative Study
Variables associated with successful intubation attempts using video laryngoscopy: a preliminary report in a helicopter emergency medical service.
Multiple studies have demonstrated varying rates of successful endotracheal intubation (ETI). Until the application of video laryngoscopy, little information regarding prehospital intubation could be analyzed objectively by individuals other than the provider performing the ETI. ⋯ Video laryngoscopy can measure multiple components of ETI performance. Successful ETI attempts have significantly shorter entry-to-POGO times and entry-to-tube times, obtain better views of the glottic opening (POGO and C-L view), and have a lower incidence of recognized esophageal intubation.
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Comparative Study
Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers.
Ambulance transport of injured patients to the most appropriate medical care facility is an important decision. Trauma centers are designed and staffed to treat severely injured patients and are increasingly burdened by cases involving less-serious injury. Yet, a cost evaluation of the Field Triage national guideline has never been performed. ⋯ Application of the 2006 Field Triage guideline helps emergency medical services personnel manage overtriage in trauma centers, which could result in a significant national cost savings.
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Comparative Study
Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting.
The objective of this study was to determine the effects of low-fractional concentration of inspired oxygen (FiO(2)) continuous positive airway pressure (CPAP) in prehospital noninvasive ventilation (NIV). With increasing concerns about the detrimental effects of hyperoxia, we sought to determine whether CPAP using a low FiO(2) (28%-30%) was effective in the prehospital setting. ⋯ CPAP using a low FiO(2) (28%-30%) was highly effective in the treatment of commonly encountered prehospital respiratory emergencies.
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To describe the experience of a U.S. emergency medical services (EMS) agency utilizing a dispatch algorithm to identify low-acuity patients and determine whether secondary telephone triage by a nurse was associated with subsequent hospital admission among those patients. ⋯ This study identified a method for classifying patients during the dispatch period as low-acuity while attempting to ensure that those individuals received the medical care that they needed.