Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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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.
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Comparative Study
Interevaluator reliability of a mock paramedic practical examination.
Prior to graduation, paramedic students must be assessed for terminal competency and preparedness for national credentialing examinations. Although the procedures for determining competency vary, many academic programs use a practical and/or oral examination, often scored using skill sheets, for evaluating psychomotor skills. However, even with validated testing instruments, the interevaluator reliability of this process is unknown. Objective. We sought to estimate the interevaluator reliability of a subset of paramedic skills as commonly applied in terminal competency testing. ⋯ There was high variability and low reliability among qualified evaluators using skill sheets as a scoring tool in the evaluation of a mock terminal competency assessment. Further research is needed to determine the true overall interevaluator reliability of this commonly used approach, as well as the ideal number, training, and characteristics of prospective evaluators.
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To evaluate the frequency of use, placement site, success and misplacement rates, and need for intervention for tube thoracostomies (TTs), and the complications with endotracheal intubation associated with TT in the prehospital setting. ⋯ Tube thoracostomy positioning mostly depends on the discretion of the physician on scene. The Monaldi and Bülau positions do not differ in misplacement or complication rates.
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Comparative Study
Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients.
The prognostic value of emergency echocardiography (EE) in the management of cardiac arrest patients has previously been studied in an in-hospital setting. These studies mainly included patients who underwent cardiopulmonary resuscitation (CPR) by emergency medicine technicians at the scene and who arrived at the emergency department (ED) still in a state of cardiac arrest. In most European countries, cardiac arrest patients are normally treated by physician-staffed emergency medical services (EMS) teams on scene. Transportation to the ED while undergoing CPR is uncommon. ⋯ Our results support the idea of focused echocardiography as an additional criterion in the evaluation of outcome in CPR patients and demonstrate its feasibility in the prehospital setting.