Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Swift assessment of patients presenting with chest pain results in faster treatment and improved outcomes. Allowing ambulance crews to use point-of-care (POC) devices to measure cardiac troponin I levels during transport of patients to the emergency department (ED) may result in earlier diagnosis of acute myocardial infarction, particularly in those patients without ST-segment elevation. The ability of POC devices to measure cardiac troponin I levels reliably in a moving ambulance has not previously been tested. Objective. This study was conducted to determine whether POC devices operated in a moving ambulance reliably duplicate the measurement of cardiac troponin I levels obtained by POC devices in the ED. ⋯ When used in a moving ambulance, the POC device provided results of cardiac troponin I assays that were highly correlated to the results when the device was used in the ED. The feasibility, practicality, and clinical utility of prehospital use of POC devices must still be assessed. Key words: point-of-care systems; prehospital emergency care; troponin; reliability of results; ambulances; myocardial infarction; chest pain.
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To employ a battery of previously validated surveys and neuropsychological tests to compare changes in fatigue and cognitive abilities of air medical providers after 12- and 24-hour shifts. ⋯ This study identified no changes in cognitive performance following 12- and 24-hour shifts in air medical providers. This suggests that 24-hour shifts in an air medical service with low to moderate utilization do not have a detrimental effect on cognition as measured by this test battery, and are comparable to 12-hour shifts in terms of impact on cognitive function.
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The purpose of this analysis was to determine whether there is an association between type of emergency medical services (EMS) medical direction and local EMS agency practices and characteristics specifically related to emergency response for acute cardiovascular events. ⋯ Our study demonstrated that EMS agencies with a paid medical director and agencies with medical director interaction with EMTs in the previous four weeks were more likely to have prehospital cardiovascular procedures in place. Given the strong relationship that both employment status and direct interaction have with the presence of these practices, agencies with limited resources to provide a paid medical director or a medical director that can be actively involved with EMTs should be supported through partnerships and other interventions to ensure that they receive the necessary levels of medical director oversight.
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Review Case Reports
Successful administration of intranasal glucagon in the out-of-hospital environment.
We present a case of successful prehospital treatment of hypoglycemia with intranasal (IN) glucagon. Episodes of hypoglycemia can be of varying severity and often requires quick reversal to prevent alteration in mental status or hypoglycemic coma. Glucagon has been shown to be as effective as glucose for the treatment of hypoglycemia. ⋯ Intranasal administration of glucagon has been shown to be as effective as the IV route and may be used for rapid correction of hypoglycemic episodes where IV access is difficult or unavailable and IM administration is undesirable. We describe the first documentation in the peer-reviewed literature of the successful treatment and reversal of an insulin-induced hypoglycemic episode with IN glucagon in the prehospital setting. We also present a review of the literature regarding this novel medication administration route.
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Intravenous (IV) line placement is an important prehospital advanced life support skill, but IV success rates are variable among providers. Little is known about what factors are associated with successful IV placement, limiting the ability to develop benchmarks for skill maintenance, such as requiring a specific number of IV placements per year. ⋯ In this retrospective study, larger IV catheter size, but not the prehospital providers' previous year's experience, was associated with successful IV placement in adult patients. These data fail to support requirements for a minimum number of yearly IV placements by full-time paramedics to improve success rates.