Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Randomized Controlled Trial
Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher.
Introduction: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit. ⋯ Median tourniquet pressure was 256 mmHg and median-end blood loss was 1,365 mL. A total of 198 participants (80.49%) were able to completely stop the bleeding while 16 participants (6.5%) had the tourniquet applied with some bleeding still occurring, and 32 participants (13.01%) exceeded the threshold of 2,500 mL of blood loss, resulting in the "patient" not surviving. Conclusions: The study findings demonstrated that untrained bystanders provided with instructions via phone from a trained Emergency Medical Dispatcher applied a tourniquet and successfully stopped the bleeding completely in most cases.
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Introduction: The necessity of rapid preload and afterload reduction in patients with decompensated congestive heart failure (CHF) and acute pulmonary edema (APE) is well established. In the hospital setting, intravenous (IV) nitroglycerin demonstrates improved patient morbidity and mortality. However, prehospital treatment is typically limited to sublingual nitroglycerin at doses that often do not affect afterload. ⋯ Conclusion: This case series found that patients who were treated by paramedics with IV NTG had improved systolic blood pressure and oxygen saturation upon ED arrival as compared to their initial presentation. Over 90% of these patients were correctly identified by paramedics as having CHF with APE based on ED evaluation. Only one patient had an adverse event, which was transient hypotension that did not require intervention.
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Background: The shock index (SI) is defined as the ratio of the heart rate to systolic blood pressure and a pediatric age-adjusted SI (SIPA) is more specific than the standard adult cutoff of 0.9 in identifying the sickest children presenting to a trauma center. Goal: To utilize prehospital vital signs to calculate the SIPA score and compare them to the SIPA calculated in the trauma bay to determine if they have the same validity in identifying critically ill children as determined by the consensus based standard criteria for trauma activation. Methods: Retrospective study using a cohort of patients transferred by EMS to a free standing, urban, level one, pediatric trauma center aged 1 to 16 years inclusive, and seen between January 1, 2016 and December 31, 2017. ⋯ Both SI and SIPA have a poor PPV but high NPV. Conclusions: This study utilized prehospital vital signs to calculate the SIPA score and compare them to the SIPA calculated in the trauma bay. Both scores had similar test metrics when based on the consensus based standard trauma criteria and could be utilized in the triage traumatic injuries.
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EMS personnel in the U. S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. ⋯ Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care.
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This commentary discusses the findings of the CONDI-2/ERIC-PPCI trial in the context of the existing literature on the topic, and the implications for prehospital and Emergency Medicine in terms of clinical practice and research relating to ischemic conditioning.