Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The approach to managing out-of-hospital cardiac arrest (OOHCA) has generally involved either minimal on-scene resuscitation to reduce time to arrival at hospital or extended care at the scene to increase the chance of return of spontaneous circulation (ROSC) before transport. This study compared patient outcomes across EMS agencies with respect to the duration of on-scene time. We hypothesized that EMS agencies with greater average time on-scene would have more favorable outcomes. ⋯ This study suggests that HOSTAs have more favorable patient outcomes compared to LOSTAs. RESULTS indicate that spending more time on-scene performing resuscitation is associated with higher rates of ROSC, survival and survival with good neurologic function.
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To assess the accuracy of multiple Intravenous Infusion Flow Regulators (IIFRs) at infusion rates and hanging heights common to the prehospital setting. ⋯ Significant deviations from expected IIFR volume were observed across all devices, flow rates, and heights in a static, laboratory environment. These findings would lend caution to the use of IIFRs as they could lead to inaccurate medication dosing (both over- or under-dosing) in the prehospital environment.
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Multicenter Study Observational Study
New Immobilization Guidelines Change EMS Critical Thinking in Older Adults With Spine Trauma.
The impact of immobilization techniques on older adult trauma patients with spinal injury has rarely been studied. Our advisory group implemented a change in the immobilization protocol used by emergency medical services (EMS) professionals across a region encompassing 9 trauma centers and 24 EMS agencies in a Rocky Mountain state using a decentralized process on July 1, 2014. We sought to determine whether implementing the protocol would alter immobilization methods and affect patient outcomes among adults ≥60 years with a cervical spine injury. ⋯ There were no differences in neurologic deficit or patient disposition in the older adult patient with cervical spine trauma despite changes in spinal restriction protocols and resulting differences in immobilization devices.
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This study aims to evaluate the efficacy of two different spinal immobilization techniques on cervical spine movement in a simulated prehospital ground transport setting. ⋯ Spinal motion restriction controlled cervical motion at least as well as traditional spinal immobilization in a simulated prehospital ground transport setting. Given these results, along with well-documented potential complications of TSI in the literature, SMR is supported as an alternative to TSI. Future research should involve a true patient population.
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Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia. ⋯ A very high RSI procedural success rate was observed across the study period. This supports the growing recognition that appropriately trained paramedics can perform RSI safely in the prehospital environment.