Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Introduction: Collaboration between emergency medical services (EMS) and hospitals receiving stroke patients is critical to ensure prompt, effective treatment, and is a key component of the stroke systems of care (SSoC). The goal of our study was to evaluate the association between presentation by EMS and EMS prenotification with odds of receiving Tissue-type Plasminogen Activator (IV-tPA) in a state implementing SSoC while rigorously accounting for missing data. Methods: We utilized data from the Massachusetts Paul Coverdell Stroke Registry for this study, and analyzed adult patients presenting with ischemic stroke to Massachusetts Coverdell hospitals between 2016 and 2018. ⋯ Conlcusion: Our analysis indicates that presentation by EMS and EMS prenotification are associated with increased odds of receiving IV-tPA in a state implementing the SSoC. Our results lend importance to the critical role of EMS in the SSoC. Future interventions should work to increase rates of prenotification by EMS and assess inequities in receipt of IV-tPA.
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Background: Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of the continuum of care for these patients. This study described real-world clinical practice in prehospital management of STEMI patients in Queensland, Australia. Methods: Retrospective analysis of data sourced from the STEMI database of the Queensland Ambulance Service, Australia. ⋯ For patients receiving prehospital fibrinolysis, median (IQR) time from STEMI identification to administration of a fibrinolytic agent was 21 (12-33) minutes. Conclusion: The implementation of a statewide prehospital reperfusion strategy has markedly improved the rate of prehospital reperfusion treatment and key time metrics. Ongoing quality improvement efforts are required to further reduce delays in reperfusion.
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Introduction: San Diego has one of the busiest international land border crossings in the world. The epidemiology of prehospital care at the San Diego (California, USA)-Tijuana (Baja California, Mexico) border crossings are previously unreported. Investigators sought to describe prehospital care provided at the San Diego border crossings. ⋯ Respiratory distress and blunt trauma were the most frequent complaints and oxygen was the most frequent medication. The busiest day of the week was Sunday, and the busiest month of the year was July. Our newly described findings may assist EMS agencies with optimizing staff, equipment, and training at international border crossings.
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Observational Study
Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury.
Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. ⋯ Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818-1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.
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Background: The nationally-certified advanced emergency medical technician (AEMT) level was created as an intermediate level of care integrating both basic life support and limited advanced life support. Despite adoption of the AEMT certification level nationally, the characteristics of AEMTs have not previously been described. Our objectives were to describe the demographics of nationally-certified AEMTs in the U. ⋯ Conclusion: AEMTs fill an important gap in prehospital care between the EMT and paramedic levels in the United States. Many AEMT programs required a current EMT certification and completion of a portfolio and course-ending examination. Implementation of the AEMT certification level could be strengthened through further research into high-quality educational practices for AEMT training programs.