Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Objective: For patients at risk for out-of-hospital cardiac arrest (OHCA) after Emergency Medical Services (EMS) arrival, outcomes may be mitigated by identifying impending arrests and intervening before they occur. Tools such as the Modified Early Warning Score (MEWS) have been developed to determine the risk of arrest, but involve relatively complicated algorithms that can be impractical to compute in the prehospital environment. A simple count of abnormal vital signs, the "EMS Modified Early Warning Score" (EMEWS), may represent a more practical alternative. ⋯ EMEWS demonstrated an AUC of 0.74 (95% CI: 0.73 - 0.75), with 81.3% sensitivity and 53.9% specificity for EMEWS ≥ 2. Conclusions: EMEWS showed a similar ability to predict EMS-witnessed cardiac arrest compared to MEWS-T, despite being significantly simpler to compute. Further study is needed to evaluate whether the implementation of EMEWS can aid EMS clinicians in anticipating and preventing OHCA.
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Background: Most potentially preventable deaths occur in the prehospital setting before reaching a military treatment facility with surgical capabilities. Thus, optimizing the care we deliver in the prehospital combat setting represents a ripe target for reducing mortality. We sought to analyze prehospital data within the Department of Defense Trauma Registry (DODTR). ⋯ S. military medical system provided prehospital medical care to at least 28,950 combat casualties consisting mostly of U. S. military personnel and host nation civilian care. There was a rapid decline in combat casualty volumes since 2014, however, on a per-encounter basis there was no apparent drop in procedural volume.
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Objective: Shift work is an established risk factor for weight gain, cardiovascular disease, Type II diabetes mellitus, and impaired health-related quality of life (HRQoL). Prolonged exposure to shift work is common in paramedics and other emergency medical service (EMS) providers. Sub-populations of EMS workers may have varying health outcomes when exposed to shift work, but the reasons for this have not been investigated. ⋯ Although shift work influences the amount of physical activity, ICFPs exceeded minimum recommendations even when rostered to duty. Despite lengthy careers in EMS, ICFPs demonstrate an excellent health profile that is likely due to high physical activity levels and healthy BMI. This information may be useful in guiding health interventions in the wider EMS workforce.
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Objective: To evaluate the effect of a Mobile Integrated Hospice Healthcare (MIHH) program including hospice education and expansion of paramedic scope of practice to use hospice medication kits. Primary outcome was the effect on hospice patient transport to the Emergency Department. Secondary outcomes included reasons for patient transport and review of MIHH kit utilization. ⋯ Conclusion: MIHH decreased the transportation of hospice patients to the ED. MIHH provided hospice education, provided family grief support and developed treatment plans with hospice nurses. An expanded scope of practice, including a paramedic hospice kit, was not contributory to this decrease.
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Case Reports
Life-threatening cyanide intoxication after ingestion of amygdalin in prehospital care.
Amygdalin is originally a natural cyanogenic glycoside available as a dietary supplement used in the alternative treatment of cancer patients. Amygdalin hydroxylates to toxic cyanide in the body, which can cause life-threatening intoxication. The case report presents a 72-year-old patient with life-threatening cyanide poisoning after ingesting a dietary supplement containing amygdalin identified in prehospital care, which was successfully treated with hydroxocobalamin.