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: The use of air ambulance to facilitate interfacility transfer has been associated with improved mortality; however, air ambulance is a limited resource and sometimes the optimal resource to transport a patient is unavailable. When a non-optimal resource is used there is an inherent delay and critically unwell patients may deteriorate as a result. This study aimed to identify risk factors associated with non-optimal resource utilization for adult patients undergoing emergent interfacility transport by air ambulance in Ontario, Canada. ⋯ Optimal resource utilization did not significantly affect delta REMS (beta coefficient 0.002, p = 0.64). Conclusions: Patients who required mechanical ventilation and were transferred out from a nursing station had higher odds of non-optimal resource utilization while patients that required advanced or critical care level of care and spring season had lower odds of non-optimal resource use. Additionally, non-optimal resource use for air ambulance interfacility transfers did not result in patient deterioration as measured by a delta REMS score.
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On March 13, 2019 the EMS Examination Committee of the American Board of Emergency Medicine (ABEM) approved modifications to the Core Content of EMS Medicine. The Core Content is used to define the subspecialty of EMS Medicine, provides the basis for questions to be used during written examinations, and leads to development of a certification examination blueprint. The Core Content defines the universe of knowledge for the treatment of prehospital patients that is necessary to practice EMS Medicine. It informs fellowship directors and candidates for certification of the full range of content that might appear on certification examinations.
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Case Reports
Out Of Hospital Transesophageal Echocardiogram For Cardiac Arrest Resuscitation: The Initial Case.
Objective: The use of transesophageal echocardiogram (TEE) during cardiac arrest in the emergency department (ED) is a newer concept. TEE provides dynamic evaluation of chest compressions and rhythm analysis. ⋯ Results: This case is a proof of concept that TEE can be successfully performed and contribute to clinical care of cardiac arrest in the out of hospital setting. Conclusion: Further research needs to be performed to determine the clinical benefit, indications, and curriculum for emergency providers to successfully deliver this potentially valuable resource prior to widespread adoption.
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Objective: The purpose of this study was to examine the attitudes and behaviors of emergency medical technicians (EMTs) and Paramedics when faced with the decision to care for patients with suspected Ebola Virus Disease (EVD) and to illicit suggestions for improvement of infectious disease (ID) preparedness. Methods: A convenience sample of 22 EMT/Paramedics were recruited from an emergency department at one of the designated Ebola centers. Each provider participated in one of three on-site focus groups. ⋯ Suggestions for improvement of ID preparedness included continuing education, tiered training models, peer training models, collaboration between emergency medical services (EMS) systems, better communication between departments, and the development of an infectious disease response team. Conclusions: Although first responders were excited to be a part of the response to EVD, this did not come without hesitation and emotional distress. Some of these concerns may be mitigated by first providing a clear definition of "duty to care," followed by interventions such as the development of clear and consistent ID preparedness training and interventions that address the emotional distress experienced by these providers.
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Background: Syncope is a common condition that may be prevented. There are non-pharmacological interventions that may be of benefit during the acute episode preceding syncope (presyncope), including physical counter-pressure maneuvers (PCM) or change of body position. We performed a systematic review of interventions that may be applied during presyncope as an immediate, first aid tactic. ⋯ No adverse events were reported. Conclusion: While there is a minimal amount of evidence available and the findings were mixed, PCM may provide benefit for prevention of syncope during acute episodes of presyncope and may be tried in the first aid setting. No evidence was found for other non-pharmacologic interventions or for the use of PCM in children.