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
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.
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Background: Many severely injured patients are initially brought to a non-trauma centers for initial assessment and stabilization. Air ambulance services are commonly used to expedite interfacility transport of injured patients to trauma centers. Little is known of the types of delays experienced during interfacility transports. ⋯ In-hospital delays with the longest average length of delay included chest tube insertion (53 minutes), intubation (49 minutes) and delays for diagnostic imaging (46 minutes). Conclusions: In conclusion, we identified numerous modifiable causes of delay during interfacility transport. Efforts to reduce these delays can be made at both the air ambulance and hospital levels.
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Introduction: Deciding where to transport a patient is a key decision made by emergency medical services (EMS), particularly for children because pediatric hospital resources are regionalized. Since evidence-based guidelines for pediatric transport destinations are being developed, the purpose of this study was to use a large statewide EMS database to describe current patterns of EMS providers' transport destination decisions for pediatric patients. Methods: This is a retrospective study of pediatric transports from 2011-2016 in EMS Tracking and Reporting System (EMSTARS), Florida's statewide EMS database. ⋯ We found that just under half of patients were documented as closest facility, and over one-third as patient/family choice. Significant differences in destination reasons were noted for rural versus urban counties. This study can help those currently developing pediatric EMS destination guidelines by revealing a high proportion of patient/family choice and identifying conditions with high proportions of destination reasons other than closest facility.
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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.
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Objective: Prehospital spinal motion restriction as a prevention technique for secondary neurological injury is a key principle in emergency medicine. Our aim was to evaluate the effectiveness of different cervical spinal cord motion restriction techniques of awake and cooperative healthy volunteers during extrication. Methods: Twenty-three healthy volunteers were asked to exit a car (unassisted) with a rigid cervical collar (CC condition) or without it (autonomous exit: AE; instructed exit: IE); they were also extricated by two rescuers after setting a rigid cervical collar and by using an extrication device (CC + XT condition). ⋯ The lowest EMG activity was observed during maneuver in CC and CC + XT; during exit a lower EMG activity was observed in CC + XT compared to CC (p < 0.001). Thus, when an extrication device is utilized (CC + XT), a lower active control of the cervical spine region is associated with faster and more brisk movements of the cervical spine compared to CC alone. Conclusions: Our findings support the idea that spinal motion restriction via rigid cervical collar of awake and cooperative trauma patients is effective in reducing cervical spine motion in the sagittal plane during vehicle extrication.