Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. ⋯ Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
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Homelessness is a rapidly growing issue throughout the United States and has important public health implications. Los Angeles, like other large urban cities, has seen a recent increase in homelessness. However, little is known about emergency medical service (EMS) utilization by those experiencing homelessness. ⋯ Homeless patients were younger (mean 46.1 v 52.6 years) and more likely to be male (71% v 49.1%). Acuity was lower in the homeless group, 31.4% v 42.5% received advanced life support. Conclusion: In the City of Los Angeles, people experiencing homelessness demonstrated disproportionately high use of EMS services and ambulance transports, were more frequently younger, male, and had lower acuity conditions when compared with housed patients.
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Randomized Controlled Trial
Verbal Motivation vs. Digital Real-Time Feedback During Cardiopulmonary Resuscitation: Comparing Bystander CPR Quality in a Randomized and Controlled Manikin Study of Simulated Cardiac Arrest.
The use of smartphone applications increases bystander CPR quality as well as the use of telephone CPR protocols. The present prospective, randomized, controlled manikin trial analyses the effects of a smartphone application (PocketCPR©) on CPR quality in a bystander CPR scenario compared to a dispatcher-assisted telephone CPR with the additional use of a metronome and verbal motivation. Methods: 150 laypersons were included to perform 8-minute CPR on a manikin. ⋯ Median compression rate in the telephone + app-group was significantly elevated (108 min-1 [IQR 96-119 min-1]) compared to the telephone-group (78 min-1 [IQR 56-106 min-1]; p < 0.001) and the telephone + motivation-group (99 min-1 [IQR 91-101 min-1]; p < 0.001). Conclusions: The use of a smartphone application as well as verbal motivation by a dispatcher during telephone CPR leads to higher CPR quality levels compared to standard telephone CPR. Thereby, the use of the smartphone application mainly shows an increase in compression rate, while increased compression rate with simultaneously increased compression depth was only apparent in the telephone + motivation-group.
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Randomized Controlled Trial
Comparison of Chest Compression Quality Between Transfer Sheet and Stretcher Use for Transporting Out-Of-Hospital Cardiac Arrest Patients in a High-Rise Building - A Randomized and Open-label Cross-over Design.
Stretchers are commonly used for transporting cardiac arrest patients, but their use may be limited in confined spaces, like elevators. Use of transfer sheet as an alternative has not been explored. We aimed to compare manual chest compression quality between these two methods. ⋯ The TS group showed shorter time intervals of simulation start-to-first-compression (TS: 13.9 [12.4-15.1] sec vs S90: 15.9 [13.3-16.4] sec, p = 0.04) and total run time (TS: 145.7 [135.1-151.4] sec vs S90: 160.0 [151.9-175.4] sec, p < 0.01) than the S90 group. Conclusion: In this simulation, using transfer sheet outperform using stretcher for transporting cardiac arrest patients from high-rise buildings. Rescuers need to be aware of full chest recoil.