Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services (EMS), particularly in regard to children. Roughly 27.7 million (or 27%) of the annual emergency department visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. ⋯ The findings of our study suggest that, just as in hospital medicine, factors at the systems, team, child/family, and individual provider level system contribute to errors in prehospital emergency care. These factors may be modifiable through interventions and systems improvements. Future studies are needed to ascertain the generalizability of these findings and further refine the underlying mechanisms.
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Although pediatric-specific objectives for the initial education of prehospital providers have been established, uniform implementation of these objectives and guidelines for hours of required pediatric continuing education (CE) for prehospital providers have not been established. ⋯ Modifying statewide policies on prehospital education and increasing hands-on training may overcome identified barriers.
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Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard. ⋯ The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions.
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The purpose of this study was to evaluate community member feedback from community consultation and public disclosure activities performed for a clinical investigation involving a device designed to treat traumatic brain injury in prehospital contexts. The clinical investigation of that device was to be performed under the federal regulations providing an exception from prospective informed consent requirements in emergency settings. Secondarily, we sought to assess the community consultation process by measuring the levels of outreach provided by the different communication methods used in these activities, with special attention to the effectiveness of social media for community outreach. ⋯ The internal and external websites provided the most effective means for sharing research-related information to community members. While cost-effective, social media outreach was very limited and did not foster communication with community members.
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Comparative Study
Degradation of Benzodiazepines after 120 Days of EMS Deployment.
EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. ⋯ Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.