Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. ⋯ In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness.
-
Defibrillation is essential for resuscitating patients with ventricular fibrillation (VF), but shocks often fail to defibrillate. We hypothesized that small variations in pad placement affect shock success, and that defibrillation waveform and shock dose could compensate for suboptimal pad placement. In 10 swine experiments, electrode pads were attached at 3 adjacent anterolateral positions, less than 3 centimeters apart. ⋯ Small variations in pad placement can significantly affect defibrillation shock efficacy. However, anatomical variation between individuals and the challenging conditions of real-world resuscitations make optimal pad placement impractical. Suboptimal pad placement can be overcome with defibrillation waveform and shock dose.
-
Position Statement: Emergency Incident Rehabilitation The National Association of EMS Physicians® believes that: Emergency operations and training conducted while wearing protective clothing and respirators is physiologically and cognitively demanding. The heat stress and fatigue created by working in protective clothing and respirators creates additional risk of illness/injury for the public safety provider. Emergency incident rehabilitation provides a structured rest period for rehydration and correction of abnormal body core temperature following work in protective clothing and respirators. ⋯ An appropriately qualified physician should have oversight over the creation and implementation of emergency incident rehabilitation protocols and may be separate from the roles and responsibilities of the occupational medicine physician. There are no peer-reviewed data related to cold weather rehabilitation. Future studies should address this limitation to the literature.
-
Observational Study
Use of Radio Frequency Identification to Establish Emergency Medical Service Offload Times.
Emergency medical services (EMS) crews often wait for emergency department (ED) beds to become available to offload their patients. Presently there is no national benchmark for EMS turnaround or offload times, or method for objectively and reliably measuring this. This study introduces a novel method for monitoring offload times and identifying variance. ⋯ RFID monitoring is a simple and effective means of monitoring EMS traffic and wait times. At our institution, most squads are able to offload their patients within 15 minutes, with many in less than 10 minutes. Variations in wait times are seen and are a topic for future study.
-
Observational Study
Achieving a Safe Endotracheal Tube Cuff Pressure in the Prehospital Setting: Is It Time to Revise the Standard Cuff Inflation Practice?
Numerous studies have reported unsafe endotracheal tube (ETT) cuff pressures (CP) in the prehospital environment. The purpose of this study was to identify an optimal cuff inflation volume (CIV) to achieve a safe CP (20-30 cmH2O). This observational study utilized 30 recently harvested ovine tracheae, which were warmed from refrigeration in a water bath at 85°F prior to testing. ⋯ Our study showed a high frequency of CP measurements outside of the desired norms. The CIV range of 6-7 cc resulted in the highest likelihood of achieving the desired cuff pressure range, while cuffs inflated with 8-10 cc resulted in dangerously high CPs in all instances. In the absence of a more ideal solution, the results of this study suggest that narrowing the recommended CIV from 5-10 cc to 6-7 cc might be a reasonable target for any tube size.