Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Clinical Trial
A Practical Solution for Preoxygenation in the Prehospital Setting: A Nonrebreather Mask with Flush Rate Oxygen.
Prehospital clinicians need a practical means of providing adequate preoxygenation prior to intubation. A bag-valve-mask (BVM) can be used for preoxygenation in perfect conditions but is likely to fail in emergency settings. For this reason, many airway experts have moved away from using BVM for preoxygenation and instead suggest using a nonrebreather (NRB) mask with flush rate oxygen.Literature on preoxygenation has suggested that a NRB mask delivering flush rate oxygen (on a 15 L/min O2 regulator, maximum flow, ∼50 L/min) is noninferior to BVM at 15 L/min held with a tight seal. However, in the prehospital setting, where emergency airway management success varies, preoxygenation techniques have not been deeply explored. Our study seeks to determine whether preoxygenation can be optimally performed with NRB at flush rate oxygen. ⋯ Among healthy volunteers, flush rate preoxygenation using NRB masks is noninferior to BVM using either a portable oxygen tank or ambulance oxygen. This is significant because preoxygenation using NRB masks with flush rate oxygen presents a simpler alternative to the use of BVMs. Preoxygenation using NRB masks at 25 L/min from a portable tank is inferior to BVM at flush rate.
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In many parts of the world, emergency medical services (EMS) clinical care is traditionally delivered by different levels or types of EMS clinicians, such as emergency medical technicians and paramedics. In some areas, physicians are also included among the cadre of professionals administering EMS-based care. ⋯ NAEMSP first published recommendations regarding what some of these competencies should be in 1983 and subsequently updated those recommendations in 2002. This document is an updated work, given the evolution of the field.
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Background: The opioid epidemic is an ongoing public health emergency, exacerbated in recent years by the introduction and rising prevalence of synthetic opioids. The National EMS Scope of Practice Model was changed in 2017 to recommend allowing basic life support (BLS) clinicians to administer intranasal (IN) naloxone. This study examines local IN naloxone administration rates for 4 years after the new recommendation, and Glasgow Coma Scale (GCS) scores and respiratory rates before and after naloxone administration. ⋯ Mean respiratory rates before (mean = 12.6 - 12.6, r = -0.04, 95% CI: -0.09 - 0.01; p = 0.1) and after (mean = 15.2 - 14.9, r = -0.03, 95% CI: -0.08 - 0.01; p = 0.172) naloxone administration have not changed. While initial GCS scores have become significantly lower, GCS scores after administration of naloxone have not changed (initial median GCS 10 - 6, p < 0.001; final median GCS 15 - 15, p = 0.23). Conclusions: Current dosing protocols of naloxone appear effective in the era of synthetic opioids in our region, although patients may be marginally more likely to require repeat naloxone doses.
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Objectives: Diet quality often changes as shift workers adjust to atypical work schedules, however, limited research exists examining the early effects of starting rotating shift work on diet and body composition. This study explored dietary behavior changes occurring in graduate paramedics during the first year of exposure to rotating shift work, and investigated dietary intake, diet quality and anthropometric changes over two years. Methods: Participants from a graduate paramedic cohort in Melbourne, Australia were approached after two years of shift work for study inclusion. ⋯ While daily energy intake and diet quality scores did not differ in the first two years of shift work, daily energy from takeaway foods significantly increased (mean difference (MD): 2.96% EI; 95% CI: 0.44 - 5.48; p = 0.017) and increases in weight (MD: 2.96 kg; 95% CI: 0.89-5.04; p = 0.003), BMI (MD: 1.07 kg/m2; 95% CI: 0.26 - 1.87; p = 0.006) and waist circumference (MD: 5.07 cm; 95% CI: 1.25-8.89; p = 0.006) were also evident at two years. Conclusions: This study contributes new information on dietary changes and the current early trajectory of unintentional weight gain and takeaway reliance occurring within a graduate paramedic cohort over two years of shift work. To reduce the unintended metabolic consequences commonly observed with rotating shift schedules, workplaces could improve access to healthier food options and enable behavioral support/education to address nutrition-related health risks.
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Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs. ⋯ Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals. Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.