Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The use of ambulances for low-acuity medical complaints depletes emergency medical services (EMS) resources that could be used for higher-acuity conditions and contributes to emergency department (ED) overcrowding and ambulance diversion. Objective. We sought to understand the characteristics of patients who use ambulances for low-acuity conditions. We hypothesized that patients who arrive to the ED by ambulance for low-acuity conditions are more likely to be members of vulnerable populations. ⋯ Our study builds on a body of work highlighting the factors associated with ambulance transport to EDs, confirms that certain vulnerable populations disproportionately use ambulances, and may inform interventions aimed at increasing access to nonambulance transportation and urgent care for these patients.
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Injury and other medical emergencies are becoming increasingly common in low- and middle-income countries (LMICs). Many to most of the deaths from these conditions occur outside of hospitals, necessitating the development of prehospital care. Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most LMICs. ⋯ Expansion of prehospital care to currently underserved or unserved areas, especially in low-income countries and in rural areas, could make use of the already-existing networks of first responders, such as commercial drivers and laypersons. Efforts to increase their effectiveness, such as more widespread first-aid training, and better encompassing their efforts within formal EMS, are warranted. In terms of existing formal EMS, there is a need for increased and more regular funding, integration and coordination among existing services, and improved organization and leadership, as could be accomplished by making EMS administration and leadership a more desirable career path.
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Monitoring core body temperature to identify heat stress in first responders and in individuals participating in mass gatherings (e.g., marathons) is difficult. ⋯ High-resolution thermal imaging in the middle-wave infrared spectrum (3-5 μm) can be used to accurately estimate core body temperature during exertion in a hot room while participants are wearing wildland firefighting garments. Although this technology is promising, it must be refined. Using alternative measurement sites such as the skin over the carotid artery, using multiple measurement sites, or adding pulse detection may improve the estimation of body temperature by thermal imagery.
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Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. ⋯ Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.
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This study reports measurements of hydration status among firefighters prior to training, documents changes in hydration status after prolonged firefighting training, and reports the utility of salivary measurements to assess changes in hydration in field environments. ⋯ Firefighters arriving in a dehydrated state are at risk for heat injuries and may be in a physically and/or psychologically compromised state at the outset of firefighter training. Even during cool autumn days with ample fluids available, firefighters experience dehydration during typical firefighting activities, so the ability to measure hydration status throughout such activities may be important. Our data suggest that quantification of changes in hydration status through salivary osmolality measurements may provide a viable field measurement tool for such activities.