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: EMS professionals frequently work more than a standard 40-hour work week. For some EMS professionals, working overtime or multiple jobs may be necessary to make ends meet. Our objective was to evaluate the association between job satisfaction, intention to leave EMS, and financial dependence on overtime or working multiple jobs. ⋯ Conclusion: Many EMS professionals depend on additional work to make a living. Financial dependence was associated with increased odds of workforce-reducing factors, including job satisfaction and intention of leaving. This can lead to poor individual outcomes such as stress and burnout, as well as to turnover within the workforce, thus reducing the number of individuals available to provide high quality emergency care.
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Following an analysis of national EMS agendas, National Association of EMS Educators developed a position supporting educator degree requirements in EMS. This position provided a framework for degree requirements at varying levels of EMS education. Identified support and appreciation for interprofessional approaches as well as EMS specific education was included in the position. The need for an educational workforce capable of providing robust degree options and innovative education emerged in response to the growing academic needs and professional complexities within EMS.
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Observational Study
Complications during inter-hospital transfer of patients with acute ischemic stroke for endovascular therapy.
Purpose: Few data are available on complications occurring during inter-hospital transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (EVT) after large vessel occlusion (LVO). Therefore, we prospectively studied data from consecutive patients transferred from our PSC to the next CSC during 4 years to determine the incidence and risk factors of complications during transfer. Methods: This observational, single-center study included consecutive patients transferred from January 1, 2015 to December 31, 2018. ⋯ Conclusion: Complications occurred in 26.9% of patients during transfer. Only BA occlusion could predict complication during transfer. Future studies should identify variables to help stratifying patients at high and low risk of complications during transportation.
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Background: To address the growing number of low-acuity patients in the 911-EMS system, the Los Angeles Fire Department (LAFD) launched a pilot program placing an Advanced Provider Response Unit (APRU) in the field so that a prehospital nurse practitioner (NP) could offer patients treatment/release on scene, alternative destination transport, and linkage with social services. Objective: To describe the initial 18-month experience implementing this new APRU. Methods: This is a retrospective, descriptive review of all APRU-attended patients from January 2016 to June 2017. ⋯ Of the 400 911-patients that did not go to the emergency department (ED), 26 (6.5%) re-contacted 911 within 3 days: all were transported to the ED with normal vital signs and without prehospital intervention, and all were ultimately discharged home from the ED. As a result of APRU intervention, 458 other LAFD field resources were quickly placed back in service and made available for the next time-critical call. Conclusions: Advanced practice providers such as nurse practitioners can be incorporated into the prehospital setting to address a growing subset of 911-patients whose needs can be met outside of the ED.
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Objective: The two objectives of this report are: first, to describe a comparison of chest compressions unsynchronized or synchronized to native cardiac activity in a porcine model of hypotension, and second, to develop an algorithm to provide synchronized chest compressions throughout a range of native heart rates likely to be encountered when treating PEA cardiac arrest. Methods: We adapted our previously developed signal-guided CPR system to provide compressions synchronized to native electrical activity in a porcine model of hypotension as a surrogate of PEA arrest. We describe the first comparison of unsynchronized to synchronized compressions in a single animal as a proof-of-concept. ⋯ Conclusions: Synchronized chest compression therapy for pulseless electrical rhythms is feasible. A high degree of synchronization can be maintained over a broad range of intrinsic heart rates while maintaining the compression rate within a satisfactory range. Further investigation to assess benefit for treatment of PEA is warranted.