Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Randomized Controlled Trial Comparative Study
Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain.
In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. ⋯ There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in providing analgesia for ischemic-type chest pain. Fentanyl appears to be a safe and effective alternative to morphine for the management of chest pain in the prehospital setting.
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Case Reports
Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report.
Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. ⋯ He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.
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The primary objective of this observational study was to document the heart rate (HR) responses of firefighters during incident rehabilitation following firefighting activity in a high-rise building with a simulated fire on the 10th floor. Additionally, the study investigated potential factors, including firefighting workload, ambient temperature, firefighter movement, and individual characteristics, that may have affected HR during recovery. Firefighters (n = 198) were assigned to perform a simulation of fire suppression, search and rescue, or material support during one of six firefighting trials that involved different crew sizes and ascent modes, and were performed in different environmental conditions. After completing the simulated firefighting activity, firefighters reported to a rehabilitation area on the 8th floor. The rehabilitation area was staffed by firefighter/paramedics. HR was monitored continuously during simulated firefighting activity and a 15-minute rehabilitation period. Average HR during rehabilitation (HRmean) was calculated and compared across trials. Simulated firefighting activity was performed in the summer in Virginia, USA, and ambient conditions varied among trials (mean ± SD: 31 ± 4°C; 46 ± 15% relative humidity; 32 ± 4°C heat index). Duration of simulated firefighting activity ranged from 12.0 to 20.3 minutes among trials (mean: 15.4 ± 5.2 minutes). Over all trials, mean peak HR during simulations was 173 ± 18 beats·min(-1). Mean HR over all trials at entry into rehabilitation was 149 ± 24 beats·min(-1). Following 15 minutes of recovery, mean HR over all trials was 126 ± 23 beats·min(-1). Exploratory analyses revealed that higher workload during firefighting (stair trials), higher ambient temperature (≥30°C), greater movement during rehabilitation (≥0.1 g-force), higher age (≥45 years), and higher BMI (≥30.0 kg·m(-2)) were associated with higher HR responses during rehabilitation. During complex emergency operations, emergency medical service personnel will likely encounter considerable variability in HR responses upon initial evaluation and throughout rehabilitation. Following one bout of firefighting activity during a simulated fire scenario, HR decreased but remained elevated well above resting values following 15 minutes of rehabilitation. Based on current fire service recommendations, the majority of firefighters (88%) would not have been released from rehabilitation and eligible for reassignment after a 15-minute rehabilitation period following a brief bout of simulated firefighting activity. ⋯ medical monitoring, cardiac strain, firefighting.
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Multicenter Study Observational Study
Lights and Siren Transport and the Need for Hospital Intervention in Trauma Patients.
Emergent ambulance transportation is associated with increased risk of collision, injury, and death for EMS professionals, patients, and the general public. Time saved using lights and siren (L&S) is typically small, and often provides minimal clinical benefit. Our objective was to investigate the frequency of L&S transports, describe the precision of the decision to employ L&S to predict the need for a time critical hospital intervention (TCHI) within 15 minutes of hospital arrival, identify clinical predictors of a TCHI, and compare clinical outcomes in patients transported by Emergency Medical Services (EMS) with and without L&S in a trauma-specific population. ⋯ Among patients that received a TCHI, over a third that were transported with L&S (36.8%) expired, compared with two of 14 patients (14.3%) not transported L&S. EMS professionals in this study demonstrated a high ability to discern which trauma patients did not require L&S. Nevertheless, L&S transport resulted in a TCHI less than one quarter of the time, suggesting an opportunity for further reduction of L&S transports in trauma patients.
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Randomized Controlled Trial
Pilot Study Examining the Effects of Atropine on Performance during Uncompensable Heat Stress.
In many operational scenarios, hypohydration can be corrected with oral rehydration following the work interval. Although rare, there are potential situations that require extended intervals of uncompensable heat stress exposure while working in personal protective equipment (PPE). Under these conditions, retention of body water may be valuable to preserve work capacity and reduce cardiovascular strain. We conducted a pilot study comparing intramuscular atropine sulfate versus saline placebo to establish the safety profile of the protocol and to provide pilot data for future investigations. Five, healthy, heat-acclimated subjects completed this crossover design laboratory study. Each subject performed up to one hour of exertion in a hot environment while wearing a chemical resistant coverall. Atropine sulfate (0.02 mg/kg) or an equivalent volume of sterile saline was administered by intramuscular injection. Core temperature, heart rate, perceptual measures, and changes in body mass were measured. All five subjects completed the acclimation period and both protocols. No adverse events occurred, and no pharmacologically induced delirium was identified. Change in body mass was less following exercise influenced by atropine sulfate (p = 0.002). Exertion time tended to be longer in the atropine sulfate arm (p = 0.08). Other measures appeared similar between groups. Intramuscular atropine sulfate reduced sweating and tended to increase the work interval under uncompensable heat stress when compared to saline placebo. Heart rate and temperature changes during exertion were similar in both conditions suggesting that the influence of an anticholinergic agent on thermoregulation may be minimal during uncompensable heat stress. ⋯ thermoregulation; cholinolytic; anticholinergic; reaction time.