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) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. ⋯ Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.
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Multicenter Study Comparative Study
Epidemiology of out-of hospital pediatric cardiac arrest due to trauma.
To determine the epidemiology and survival of pediatric out-of-hospital cardiac arrest (OHCA) secondary to trauma. ⋯ The overall survival rate for OHCA in children after trauma was low, but some trauma mechanisms are associated with better survival rates than others. Most OHCA in children is preventable, and education and prevention strategies should focus on those overrepresented populations and high-risk mechanisms to improve mortality.
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Comparative Study
Surrogate markers of transport distance for out-of-hospital cardiac arrest patients.
Transport of out-of-hospital cardiac arrest (OHCA) patients expeditiously to appropriately equipped hospitals is of paramount importance. ⋯ The use of centroids of census blocks via network distance is a valid surrogate for actual location of an OHCA event when calculating transport distance.
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Comparative Study
Abnormal end-tidal carbon dioxide levels on emergency department arrival in adult and pediatric intubated patients.
The utility of prehospital intubation is controversial, as uncontrolled studies in trauma patients suggest adverse outcomes with prehospital intubation, perhaps secondary to inappropriate ventilation once intubation is accomplished. ⋯ Nearly half of all patients transported by prehospital providers had abnormal ETCO(2) measurements on initial ED presentation, suggesting an area for potential improvement. Trauma patients with abnormal initial ETCO(2) levels were more likely to die.
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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.