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: End-of-life treatment decisions present special challenges for prehospital emergency providers. Paramedics regularly make value-laden choices that transcend technical judgment and professional skill, affecting the type of care, how and to whom it is provided. Changes in prehospital emergency care over the last decade have created new moral challenges for prehospital emergency providers; these changes have also accentuated the need for paramedics to make rapid and reasoned ethical judgments. ⋯ Participants described ethical dilemmas when families asked them to initiate CPR in the presence of DNR orders and cognitive dissonance when CPR has been initiated but a valid DNR/MOLST is subsequently located. Conclusions: The study findings demonstrate the invaluable contribution of OLMD for complex end-of-life care decisions by prehospital providers, especially when there are difficult legal, ethical, and logistical questions. OLMD provides far more than technical support.
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Background: Large and unacceptable variation exists in cardiac resuscitation care and outcomes across communities. Texas is the second most populous state in the US with wide variation in community and emergency response infrastructure. We utilized the Texas-CARES registry to perform the first Texas state analysis of out-of-hospital cardiac arrest (OHCA) in Texas, evaluating for variations in incidence, care, and outcomes. ⋯ Survival to hospital discharge ranged from 6.7% to 14.0%, and there were three communities above and two below the adjusted 95% confidence interval. Conclusion: While overall OHCA care and outcomes were similar in Texas compared to national averages, bystander CPR, bystander AED use, and survival varied widely across communities in Texas. These variations signal opportunities to improve OHCA care and outcomes in Texas.
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Objective: High quality cardiopulmonary resuscitation (CPR) is crucial for patients experiencing cardiac arrest. CPR quality declines within the first few minutes of CPR performance. Being more fit is associated with higher CPR quality, yet the fitness parameters needed remain uncertain. ⋯ Sex (female) was predictive of better chest compression recoil percentages (R2=0.15). Conclusion: Most rescuers can maintain high quality CPR if given two minute breaks between cycles. Rescuers with high anaerobic fitness and muscular strength may be able to provide higher quality CPR.
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Objective: Out-of-hospital cardiac arrests (OHCA) in schools and universities are uncommon. However, these institutions must plan and prepare for such events to ensure the best outcomes. To evaluate their preparedness we assessed baseline characteristics, survival outcomes and 12-year trends for OHCA in schools/universities compared to other public locations. ⋯ However, after adjustment for favorable cardiac arrest factors, such as younger age, bystander CPR and PAD, survival was similar between schools/universities and public locations. Conclusion: The majority of OHCA in schools and universities were witnessed and received bystander CPR, however less than half received PAD. Developing site-specific cardiac emergency response plans and providing age appropriate CPR training to primary, secondary and university students would help improve PAD rates.