Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Epinephrine and vasopressin are the only vasopressors associated with return of spontaneous circulation (ROSC). While current guidelines recommend rapid and frequent vasopressor administration during cardiac arrest, delays in their administration in the out-of- hospital setting remain a concern. ⋯ The interval between scene arrival and first administration of vasopressors is significantly shorter among patients who experience ROSC compared with those who do not. Airway control procedures delay vasopressor administration and reduce the likelihood of ROSC. Although the interdosing intervals of most patients were not consistent with current recommendations, there was no difference in the mean interdosing times between those who achieved ROSC and those who did not.
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Responses for "lift assists" (LAs) are common in many emergency medical services (EMS) systems, and result when a person dials 9-1-1 because of an inability to get up, is subsequently determined to be uninjured, and is not transported for further medical attention. Although LAs often involve recurrent calls and are generally not reimbursable, little is known of their operational effects on EMS systems. We hypothesized that LAs present an opportunity for earlier treatment of subtle-onset medical conditions and injury prevention interventions in a population at high risk for falls. Objectives. To quantify LA calls in one community, describe EMS returns to the same address within 30 days following an index LA call, and characterize utilization of EMS by LA patients. ⋯ Lift-assist calls are associated with substantial subsequent utilization of EMS, and should trigger fall prevention and other safety interventions. Based on our data, these calls may be early indicators of medical problems that require more aggressive evaluation.
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Although pain is a major reason why patients summon emergency medical services (EMS), prehospital medical providers administer analgesic agents at inappropriately low rates. One possible reason is the role of EMS provider attitudes. ⋯ A number of potentially modifiable attitudinal barriers to appropriate pain management were revealed.
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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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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.