Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. ⋯ Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
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Implementation of traumatic brain injury (TBI) guideline recommendations for prehospital care is associated with improved outcomes, but prehospital guideline uptake is frequently delayed. Our objective was to estimate how well TBI guidelines are reflected in a national sample of prehospital TBI protocols in 2012 and 2018, 5 and 11 years after guideline publication. Methods: A purposeful sample of publicly accessible prehospital protocols were obtained in 2012, and updates of those protocols were obtained in 2018. ⋯ Results: None of the protocols contained all twenty-three elements of the guidelines, and more than one-third (19/53, 35%) did not have a TBI-specific protocol. While some individual items appeared more frequently in 2018 than 2012, more than half of the reviewed protocols do not contain guidance on ventilation or definitions of hypoxemia, hypotension, or pupil asymmetry. Conclusions: Evaluation of a diverse sample of EMS protocols demonstrates a significant deficit in the adoption of TBI guidelines more than a decade after publication.
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Randomized Controlled Trial
Comparison of Chest Compression Quality Between Transfer Sheet and Stretcher Use for Transporting Out-Of-Hospital Cardiac Arrest Patients in a High-Rise Building - A Randomized and Open-label Cross-over Design.
Stretchers are commonly used for transporting cardiac arrest patients, but their use may be limited in confined spaces, like elevators. Use of transfer sheet as an alternative has not been explored. We aimed to compare manual chest compression quality between these two methods. ⋯ The TS group showed shorter time intervals of simulation start-to-first-compression (TS: 13.9 [12.4-15.1] sec vs S90: 15.9 [13.3-16.4] sec, p = 0.04) and total run time (TS: 145.7 [135.1-151.4] sec vs S90: 160.0 [151.9-175.4] sec, p < 0.01) than the S90 group. Conclusion: In this simulation, using transfer sheet outperform using stretcher for transporting cardiac arrest patients from high-rise buildings. Rescuers need to be aware of full chest recoil.
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In continued support of establishing and maintaining a foundation for standards of care, our organizations remain committed to periodic review and revision of this position statement. This latest revision was created based on a structured review of the National Model EMS Clinical Guidelines Version 2.2 in order to identify the equipment items necessary to deliver the care defined by those guidelines. ⋯ Some items may be considered optional at the local level as determined by agency-defined scope of practice and applicable clinical guidelines. In addition to the items included in this position statement our organizations agree that all EMS service programs should carry equipment and supplies in quantities as determined by the medical director and appropriate to the agency's level of care and available certified EMS personnel and as established in the agency's approved protocols.
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The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. ⋯ In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.