Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Endotracheal intubation may be required for the transport of critically ill neonates and children. Data suggest that first pass success (FPS) is associated with lower rates of complications. Thus, understanding factors associated with FPS can have important implications for clinical outcomes. ⋯ Use of VL increased significantly over the study period. Conclusion: We found use of a C-MAC videolaryngoscope by a critical care transport team was associated with improved FPS during endotracheal intubation of pediatric patients but not neonates, after controlling for other patient and provider characteristics. In addition to the impact on FPS, use of VL may offer additional educational and quality benefits.
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Implementation of traumatic brain injury (TBI) guideline recommendations for prehospital care is associated with improved outcomes, but prehospital guideline uptake is frequently delayed. Our objective was to estimate how well TBI guidelines are reflected in a national sample of prehospital TBI protocols in 2012 and 2018, 5 and 11 years after guideline publication. Methods: A purposeful sample of publicly accessible prehospital protocols were obtained in 2012, and updates of those protocols were obtained in 2018. ⋯ Results: None of the protocols contained all twenty-three elements of the guidelines, and more than one-third (19/53, 35%) did not have a TBI-specific protocol. While some individual items appeared more frequently in 2018 than 2012, more than half of the reviewed protocols do not contain guidance on ventilation or definitions of hypoxemia, hypotension, or pupil asymmetry. Conclusions: Evaluation of a diverse sample of EMS protocols demonstrates a significant deficit in the adoption of TBI guidelines more than a decade after publication.
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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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The objective of this study was to evaluate the emergency care provided by the Israeli Military Airborne Combat Evacuation Unit (MACEU) during helicopter winching operations. Methods: A retrospective cohort study was performed of all patients rescued by winching by the MACEU between December 2011 and October 2018. Data were extracted from the electronic medical records of the unit registry. ⋯ All the six patients who had oxygen saturation ≥89% after entrance into the cabin, survived. Conclusions: The reported MACEU experience provides useful information on the clinical characteristics, medical interventions, and outcomes of patients rescued using a winching operation. Study findings emphasize the importance of airway management and ventilation during winching.