Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Rearrest after successful resuscitation from out-of-hospital cardiac arrest (OHCA) is common and is associated with worse patient outcomes. However, little is known about the effect of interventions designed to prevent rearrest. We assessed the association between a prehospital care protocol for immediate management after return of spontaneous circulation (ROSC) and rates of field rearrest and survival to discharge in patients with prehospital ROSC. ⋯ Introduction of a post-ROSC care protocol for patients with prehospital ROSC after OHCA was not associated with reduced odds of field rearrest. When elements of the care bundle were considered individually, push-dose epinephrine was associated with decreased odds of rearrest.
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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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Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. ⋯ Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.
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This study aims to demonstrate the feasibility of quantifying the off-balancing vectors experienced during ambulance transport and comparing them to high-quality cardiopulmonary resuscitation (HQ-CPR) metrics. ⋯ Off-balancing vector data can be successfully quantified during ambulance transport and compared with HQ-CPR performance parameters. Increasing off-balancing vectors experienced during ambulance transport are associated with worse HQ-CPR metrics and increased perceived physical exertion. These data may help guide future drive styles, ambulance design, or use of mechanical CPR devices to improve HQ-CPR delivery during selected patient transport scenarios.
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Emergency medical services (EMS) facilitated telemedicine encounters have been proposed as a strategy to reduce transports to hospitals for patients who access the 9-1-1 system. It is unclear which patient impressions are most likely able to be treated in place. It is also unknown if the increased time spent facilitating the telemedicine encounter is offset by the time saved from reducing the need for transport. The objective of this study was to determine the association between the impressions of EMS clinicians of the patients' primary problems and transport avoidance, and to describe the effects of telemedicine encounters on prehospital intervals. ⋯ In this study, most telemedicine evaluations resulted in ED transport avoidance, particularly for respiratory issues. Telemedicine interventions were associated with a median four-minute decrease in prehospital interval per call. Future research should investigate the long-term effects of telemedicine on patient outcomes.