Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
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.
-
The choice of the optimal benzodiazepine to treat prehospital status epilepticus is unclear. Lorazepam is preferred in the emergency department, but concerns about nonrefrigerated storage limits emergency medical services (EMS) use. Midazolam is increasingly popular, but its heat stability is undocumented. ⋯ Lorazepam experiences small but statistically significant temperature-dependent degradation after 60 days in the EMS environment. Additional study is needed to evaluate whether clinically significant deterioration occurs after 60 days. Midazolam shows no degradation over this duration, even in high-heat conditions.
-
Despite its long history and current prominence in U.S. communities, only limited data describe the national characteristics of emergency medical services (EMS) care in the United States. We sought to characterize out-of-hospital EMS care in the United States. ⋯ These data highlight the breadth and diversity of EMS demand and care in the United States.
-
Emergency medical dispatch systems are used to help categorize and prioritize emergency medical services (EMS) resources for requests for assistance. ⋯ A small subset (8% of codes; 7% by call volume) of MPDS codes were associated with greater than 90% predictive ability for ED discharge. Older adults are at increased risk for admission/death in a separate subset of MPDS codes, suggesting that age criteria may be useful to identify higher-acuity patients within the MPDS code. These findings could assist in prehospital/hospital resource management; however, future studies are needed to validate these findings for other EMS systems and to investigate possible strategies for improvements of emergency response systems.
-
This case outlines a rarely seen disease in prehospital emergency care-namely, a traumatic loculated tension pneumothorax. Prehospital thoracic ultrasound as part of a standard extended focused assessment with sonography in trauma (EFAST) algorithm failed to diagnose this life-threatening injury. We have subsequently added scanning the lateral chest wall in the fifth intercostal space to the algorithm.