Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Disparities have been observed in the treatment of pain in emergency department patients. However, few studies have evaluated such disparities in emergency medical services (EMS). We describe pain medication administration for trauma indications in an urban EMS system and how it varies with patient demographics. ⋯ Among patients with isolated traumatic injuries treated in a single, urban EMS system, African American and female patients were less likely to receive analgesia than White or male patients. Analgesics were given to a small percentage of patients who were eligible for treatment by protocol, and intravenous opioids were used in the vast majority patients who received treatment.
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During the COVID-19 pandemic, many emergency medical services (EMS) agencies modified treatment guidelines for clinical care and standard operating procedures. For the prehospital care of pediatric asthma exacerbations, modifications included changes to bronchodilator administration, systemic corticosteroid administration, and introduction of alternative medications. Since timely administration of bronchodilators and systemic corticosteroids has been shown to improve pediatric asthma clinical outcomes, we investigated the association of COVID-19 protocol modifications in the prehospital management of pediatric asthma on hospital admission rates and emergency department (ED) length-of-stay. ⋯ Despite a decrease in prehospital bronchodilator administration after COVID-19 changes to prehospital pediatric asthma management protocols, hospital admission rates and ED length-of-stay did not significantly increase. However, this finding is tempered by the marked decrease in study patients treated after COVID-19 prehospital protocol modifications. Given the potential for future waves of COVID-19 variants, further studies with larger patient populations are warranted.
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Several studies have demonstrated the high frequency of medication errors in pediatric patients by prehospital providers during both patient care and simulation. In 2015, our hospital-based urban EMS system introduced the HandtevyTM Field Guide that provides precalculated pediatric doses in milliliters (mL) by patient age. We hypothesized that implementation of the Field Guide would increase the percentage of correct pediatric medication doses to greater than 85%. ⋯ After implementation of a precalculated mL dose system by patient age for EMS providers, most pediatric medications were reportedly administered within the appropriate dose range. A field guide with precalculated doses (in mL) may be an effective tool for reducing pediatric medication dosing errors by EMS providers.
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The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organizations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this article was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context. ⋯ CRD42021232196.
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The survival rate of patients with out-of-hospital cardiac arrest has improved in recent years; however, it remains low. One approach to improving outcomes in these cases is to implement point-of-care ultrasound as an integral part of advanced cardiac life support management. Due to its growing popularity among emergency physicians, several protocols for this examination have been developed; however, there are little data on its use in the prehospital setting. We present a case report on the role of ultrasound examination in cardiac arrest for both diagnostic and therapeutic management.