Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Background: Recent studies demonstrate an association between spinal immobilization and neck pain, increased use of radiographs, and increased admission rates for pediatric trauma patients. There is an increasing trend toward spinal protection protocols that limit the use of backboards in trauma patients. However, many of these protocols do not address the youngest patients. ⋯ We did not find a significant difference in the percentage of trauma patients who received spinal imaging pre- and post-protocol change (20% vs. 18%, OR 0.84 [95% CI 0.66, 1.07]), but did observe a significant reduction in the proportion of trauma patients who were admitted to the hospital (25% vs. 18%, OR 0.66 [95% CI 0.52, 0.83]). This reduced admission rate was not observed in the neighboring jurisdiction. Conclusions: Implementation of a selective spinal immobilization protocol was associated with reduced admission rates, but did not significantly reduce rates of plain radiographs.
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Objective: Prehospital electrocardiography (ECG) is recommended for patients with suspected acute coronary syndrome (ACS), yet only 20-80% of chest pain patients receive a prehospital ECG. Less is known about prehospital ECG use in patients with less common complaints (e.g., fatigue) suspicious for ACS who are transported by emergency medical services (EMS). The aims of this study were to determine: (1) the proportion of patients with chest pain and less typical complaints, and (2) patient characteristics associated with prehospital ECG use in patients transported by EMS to emergency departments across North Carolina. ⋯ Patients' presenting complaints were the strongest predictor of prehospital ECG use, adjusting for age, sex, race, ethnicity, urbanicity, and date and time of EMS dispatch. Conclusions: Patients with chest pain were significantly more likely to receive a prehospital ECG compared to those with less typical but suspicious complaints for ACS. Patients with less common presentations remain disadvantaged for early triage, risk stratification, and intervention prior to the hospital.
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Randomized Controlled Trial
Layperson Ability and Willingness to Use Hemostatic Dressings: A Randomized, Controlled Trial.
Background: The Hartford Consensus and Stop the Bleed Campaign empower the public to stop bleeding. While evidence for civilian tourniquet use is mounting, there is limited evidence regarding the public's ability to use hemostatic dressings. This study seeks to determine if laypeople can apply hemostatic dressings, and which hemostatic dressing they can use most successfully. ⋯ Educators and planners should consider including injectable sponges in their Stop the Bleed programs and products. Level of Evidence: II (RCT with significant difference. One negative criterion for observer blinding).
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The opioid crisis is a growing concern for Americans, and it has become the leading cause of injury-related death in the United States. An adjunct to respiratory support that can reduce this high mortality rate is the administration of naloxone by Emergency Medical Services (EMS) practitioners for patients with suspected opioid overdose. However, clear evidence-based guidelines to direct EMS use of naloxone for opioid overdose have not been developed. ⋯ Where we are unable to make recommendations due to evidence limitations (dosing, titration, timing, and transport) we offer technical remarks. Limitations of our work include the introduction of novel synthetic opioids after many of the reviewed papers were produced, which may affect the dose of naloxone required for effect, high risk of bias and imprecision in the reviewed papers, and the introduction of new naloxone administration devices since many of the reviewed papers were published. Future research should be conducted to evaluate new devices and address the introduction of synthetic opioids.
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Background: Symptomatic hypoglycemia frequently results in utilization of emergency medical services (EMS). Understanding the characteristics of hypoglycemic patients with high EMS utilization may help providers optimize resource allocation. Objective: To describe characteristics of patients utilizing EMS for hypoglycemia and to determine if any factors identifiable in the prehospital setting are associated with recurrent EMS utilization. ⋯ Those who did had lower initial blood glucose at the index visit and were more likely to have received prehospital treatment with medications other than oral glucose. Demographic characteristics did not yield any patterns predictive of repeat utilization. Refusing transport to the hospital after EMS treatment for hypoglycemia did not increase the risk of recurrent utilization.