Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Comparative Study Observational Study
Paramedic-Delivered Fibrinolysis in the Treatment of ST-Elevation Myocardial Infarction: Comparison of a Physician-Authorized versus Autonomous Paramedic Approach.
Background: For those patients who receive fibrinolysis in the treatment of ST-elevation myocardial infarction (STEMI), early treatment, i.e., within 2 hours of symptom onset, confers the greatest clinical benefit. This rationale underpins paramedic-delivered fibrinolysis in the prehospital setting. However, the current New Zealand approach requiring paramedics to first gain physician authorization, has proved inefficient and time consuming, particularly due to technological failings. ⋯ No significant difference was observed between groups in terms of 6-month mortality. Conclusions: Prehospital fibrinolysis provided autonomously by paramedics without direct physician oversight is safe and feasible. Moreover, this independent approach can significantly improve time-to-treatment, resulting in short term mortality benefit and reduced hospital LOS.
-
Objective: To determine the impact of a new dispatch system on the efficiency of first resource assignment for critical EMS patients. Methods: In December 2014, the Los Angeles Fire Department (LAFD) implemented a new, internally-developed dispatch system. An interrupted time series study compared 9-1-1 incidents processed by LAFD-telecommunicators using either the Medical Priority Dispatch System® (MPDS, January 1 - September 30, 2014), or Los Angeles Tiered Dispatch System (LA-TDS, January 1 - September 30, 2015). ⋯ The over-triage rate using MPDS was 44%, which decreased to 33% using LA-TDS. LA-TDS was associated with significant improvements in specificity, positive predictive value and accuracy of initial resource assignment, and is projected to have saved over 23,000 EMS resource dispatches over the 9-month study period. Conclusion: The new Los Angeles Tiered Dispatch System significantly improved the efficiency of initial 9-1-1 resource assignments by decreasing both over-triage and critical under-triage, thus sending more appropriate resources to each 9-1-1 call.
-
Objective: The proximal tibia is a recommended and commonly used site for pediatric emergency intraosseous vascular access (IO). During forensic whole body postmortem computed tomography (PMCT), we evaluated accuracy of emergency placement of tibial IO access. Methods: We conducted a retrospective review of 92 state medical examiner cases to assess presence and placement of tibial IO needles. ⋯ Failures occur during both prehospital and emergency department care. In infants age 6 months or younger, use of a 25-mm needle should be avoided. Procedures for IO insertion in infants age 6 months or younger should be reviewed and modification considered.
-
Randomized Controlled Trial
A Randomized Crossover Trial of Conventional versus Modified "Koch" Chest Compressions in a Height-Restricted Aeromedical Helicopter.
Aim: Low overhead height can negatively affect chest compression performance. An adapted compression technique has been proposed by paramedic H. Koch (pron. "Cook"). ⋯ Conclusions: In a height-restricted aeromedical helicopter, the average overall quality score improved using Koch compressions, although the mean rate, mean depth, correct release and land marking were found to be similar between techniques. Qualitative feedback described Koch compressions as easier and more sustainable. In settings where the compressor is affected by reduced overhead working height, Koch compressions may be an advisable alternative.
-
Background: Many severely injured patients are initially brought to a non-trauma centers for initial assessment and stabilization. Air ambulance services are commonly used to expedite interfacility transport of injured patients to trauma centers. Little is known of the types of delays experienced during interfacility transports. ⋯ In-hospital delays with the longest average length of delay included chest tube insertion (53 minutes), intubation (49 minutes) and delays for diagnostic imaging (46 minutes). Conclusions: In conclusion, we identified numerous modifiable causes of delay during interfacility transport. Efforts to reduce these delays can be made at both the air ambulance and hospital levels.