Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Non-exertional heat stroke is defined as exposure to high outdoor temperatures, core body temperature >40 °C, and alteration of mentation. Early identification and treatment are imperative to reduce morbidity and mortality in these patients. Cold water immersion therapy is the most efficient and efficacious modality in treating heat stroke, yet it is rarely initiated in the prehospital setting. ⋯ He was treated with cold water immersion using a body bag in the back of the ambulance and cooled to 104.1 °F during transport. During the 9-minute transport, the patient regained consciousness, followed basic commands, and answered basic questions. This case highlights the novel use of body bag cold water immersion as early initiation of treatment for heat stroke patients.
-
The requirements for emergency medical services (EMS) medical directors are commonly defined by state rules and regulations without national standardization. The extent of variability in the requirements to be an EMS medical director in the US is unclear. The objective of this study is to describe the state requirements to function as an EMS medical director in the US. ⋯ Requirements for EMS medical direction across the US are not standardized. Many states require a medical license, but emergency medicine board certification is not a common requirement. Future work will need to focus on required competencies for EMS medical direction to set clear standards and educational requirements in the US.
-
Patients with severe traumatic brain injury (TBI) are commonly intubated during prehospital treatment despite a lack of evidence that this is beneficial. Accumulating evidence even suggests that prehospital intubation may be hazardous, in particular when performed by inexperienced EMS clinicians. To expand the limited knowledge base, we studied the relationship between prehospital intubation and hospital mortality in patients with severe TBI in a large Dutch trauma database. We specifically hypothesized that the relationship differs depending on whether a physician-based emergency medical service (EMS) was involved in the treatment, as opposed to intubation by paramedics. ⋯ The data do not support the common practice of prehospital intubation. The effect of prehospital intubation on mortality might depend on EMS clinician experience, and it seems prudent to involve prehospital personnel well proficient in prehospital intubation whenever intubation is potentially required. The decision to perform prehospital intubation should not merely be based on the largely unsupported dogma that it is generally needed in severe TBI, but should rather individually weigh potential benefits and harms.
-
Observational Study
Sex disparities in prehospital advanced cardiac life support in out-of-hospital cardiac arrest in South Korea.
Sex disparities have been reported in the prehospital and in-hospital care among patients with out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services (EMS). ⋯ Compared to male patients, female patients were less likely to receive prehospital ACLS. This offers opportunities for EMS systems to reduce disparities and to improve compliance with OHCA resuscitation guidelines and outcomes through quality improvement and educational interventions.
-
The COVID-19 pandemic disrupted access to routine in-person prenatal care, potentially leading to higher risk of out-of-hospital deliveries. Unplanned out-of-hospital deliveries pose a substantial risk of morbidity and mortality for pregnant patients and newborns. Our objective was to determine the change in rate of emergency medical services (EMS)-attended out-of-hospital deliveries during the COVID-19 pandemic. We hypothesized that COVID-19-related stay-at-home orders were associated with a higher rate of out-of-hospital deliveries during the initial wave of COVID-19. ⋯ EMS-attended out-of-hospital deliveries remained rare during the COVID-19 pandemic, but there was an immediate increase during the initial wave of the pandemic with evidence of geographic variation. Large-scale disruptions in the health care system may result in increases in uncommon patient presentations to EMS.