Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. ⋯ Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making.
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Case Reports
Case Report: Life Saving Application of Commercial Tourniquet in Pediatric Extremity Hemorrhage.
Hemorrhage is the leading preventable cause of death in civilian and military trauma. Recent data from the ongoing conflicts in Iraq and Afghanistan suggest that early and aggressive tourniquet utilization is a safe and effective way to dramatically reduce mortality from extremity hemorrhage. As a result, prehospital tourniquet use is now endorsed by a majority of professional emergency medicine, emergency medical service and trauma professional societies. However, there currently exists scant evidence supporting the efficacy of commercially available tourniquets in controlling extremity hemorrhage in pediatric trauma patients.
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Intimate partner violence (IPV) refers to abuse transpiring between people in an intimate relationship. Intimate partner violence is a leading cause of morbidity and mortality for women that paramedics frequently report encountering and yet paramedics rarely receive formal education or training to manage. The response of paramedics to IPV is likely to be directed by their individual knowledge, attitudes, and preparedness; all of which are currently unknown. This study aimed to measure paramedic students' knowledge, attitudes, and preparedness to manage IPV patients, and provides baseline data to inform the development of contemporary curricula. ⋯ Results indicate students require increased IPV education. Education should improve knowledge and preparedness to recognize and refer IPV patients, as well as change neutral and inappropriate attitudes. Incorporating such education and training into the paramedic curricula may improve the preparedness of practitioners, resulting in an improved response to IPV patients.
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Multicenter Study
Patient Characteristics and Temporal Trends in Police Transport of Blunt Trauma Patients: A Multicenter Retrospective Cohort Study.
Police transport (PT) of penetrating trauma patients has the potential to decrease prehospital times for patients with life-threatening hemorrhage and is part of official policy in Philadelphia, Pennsylvania. We hypothesized that rates of PT of bluntly injured patients have increased over the past decade. ⋯ PT affects a small minority of blunt trauma patients, and did not appear associated with higher mortality. However, PT patients included many who might have benefited from proven, prehospital intervention. Clinicians, EMS providers, and law enforcement should collaborate to optimize use of PT within the trauma system.
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To estimate the rate, characteristics, and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). ⋯ Without an understanding of EMS encounters and non-transport rates, surveillance based solely on emergency department and hospital data will significantly underestimate rates of severe hypoglycemia. Additionally, given that hypoglycemia is often safely and effectively treated by non-physicians, EMS protocols should provide guidance for non-transport of hypoglycemic patients whose blood glucose levels have normalized.