Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Objective: The proximal tibia is a recommended and commonly used site for pediatric emergency intraosseous vascular access (IO). During forensic whole body postmortem computed tomography (PMCT), we evaluated accuracy of emergency placement of tibial IO access. Methods: We conducted a retrospective review of 92 state medical examiner cases to assess presence and placement of tibial IO needles. ⋯ Failures occur during both prehospital and emergency department care. In infants age 6 months or younger, use of a 25-mm needle should be avoided. Procedures for IO insertion in infants age 6 months or younger should be reviewed and modification considered.
-
Objective: To determine the impact of a new dispatch system on the efficiency of first resource assignment for critical EMS patients. Methods: In December 2014, the Los Angeles Fire Department (LAFD) implemented a new, internally-developed dispatch system. An interrupted time series study compared 9-1-1 incidents processed by LAFD-telecommunicators using either the Medical Priority Dispatch System® (MPDS, January 1 - September 30, 2014), or Los Angeles Tiered Dispatch System (LA-TDS, January 1 - September 30, 2015). ⋯ The over-triage rate using MPDS was 44%, which decreased to 33% using LA-TDS. LA-TDS was associated with significant improvements in specificity, positive predictive value and accuracy of initial resource assignment, and is projected to have saved over 23,000 EMS resource dispatches over the 9-month study period. Conclusion: The new Los Angeles Tiered Dispatch System significantly improved the efficiency of initial 9-1-1 resource assignments by decreasing both over-triage and critical under-triage, thus sending more appropriate resources to each 9-1-1 call.
-
Observational Study
Success of pediatric intubations performed by a critical care transport service.
Background: Prehospital pediatric endotracheal intubation (ETI) is rarely performed. Previous research has suggested that pediatric prehospital ETI, when performed by ground advanced life support crews, is associated with poor outcomes. In this study, we aim to evaluate the first-attempt success rate, overall success rate and complications of pediatric prehospital ETI performed by critical care transport (CCT) personnel. ⋯ Conclusion: Critical care flight nurses and paramedics performed successful intubations in pediatric patients at a high rate of success. Younger age was associated with lower success rates. Improved ETI training for younger patients and use of an induction agent and NMB may improve airway management in critically ill children.
-
Randomized Controlled Trial
A Randomized Crossover Trial of Conventional versus Modified "Koch" Chest Compressions in a Height-Restricted Aeromedical Helicopter.
Aim: Low overhead height can negatively affect chest compression performance. An adapted compression technique has been proposed by paramedic H. Koch (pron. "Cook"). ⋯ Conclusions: In a height-restricted aeromedical helicopter, the average overall quality score improved using Koch compressions, although the mean rate, mean depth, correct release and land marking were found to be similar between techniques. Qualitative feedback described Koch compressions as easier and more sustainable. In settings where the compressor is affected by reduced overhead working height, Koch compressions may be an advisable alternative.
-
Comparative Study Observational Study
Paramedic-Delivered Fibrinolysis in the Treatment of ST-Elevation Myocardial Infarction: Comparison of a Physician-Authorized versus Autonomous Paramedic Approach.
Background: For those patients who receive fibrinolysis in the treatment of ST-elevation myocardial infarction (STEMI), early treatment, i.e., within 2 hours of symptom onset, confers the greatest clinical benefit. This rationale underpins paramedic-delivered fibrinolysis in the prehospital setting. However, the current New Zealand approach requiring paramedics to first gain physician authorization, has proved inefficient and time consuming, particularly due to technological failings. ⋯ No significant difference was observed between groups in terms of 6-month mortality. Conclusions: Prehospital fibrinolysis provided autonomously by paramedics without direct physician oversight is safe and feasible. Moreover, this independent approach can significantly improve time-to-treatment, resulting in short term mortality benefit and reduced hospital LOS.