Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Introduction: Deciding where to transport a patient is a key decision made by emergency medical services (EMS), particularly for children because pediatric hospital resources are regionalized. Since evidence-based guidelines for pediatric transport destinations are being developed, the purpose of this study was to use a large statewide EMS database to describe current patterns of EMS providers' transport destination decisions for pediatric patients. Methods: This is a retrospective study of pediatric transports from 2011-2016 in EMS Tracking and Reporting System (EMSTARS), Florida's statewide EMS database. ⋯ We found that just under half of patients were documented as closest facility, and over one-third as patient/family choice. Significant differences in destination reasons were noted for rural versus urban counties. This study can help those currently developing pediatric EMS destination guidelines by revealing a high proportion of patient/family choice and identifying conditions with high proportions of destination reasons other than closest facility.
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Observational Study
Success of pediatric intubations performed by a critical care transport service.
Background: Prehospital pediatric endotracheal intubation (ETI) is rarely performed. Previous research has suggested that pediatric prehospital ETI, when performed by ground advanced life support crews, is associated with poor outcomes. In this study, we aim to evaluate the first-attempt success rate, overall success rate and complications of pediatric prehospital ETI performed by critical care transport (CCT) personnel. ⋯ Conclusion: Critical care flight nurses and paramedics performed successful intubations in pediatric patients at a high rate of success. Younger age was associated with lower success rates. Improved ETI training for younger patients and use of an induction agent and NMB may improve airway management in critically ill children.
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Objective: Prehospital spinal motion restriction as a prevention technique for secondary neurological injury is a key principle in emergency medicine. Our aim was to evaluate the effectiveness of different cervical spinal cord motion restriction techniques of awake and cooperative healthy volunteers during extrication. Methods: Twenty-three healthy volunteers were asked to exit a car (unassisted) with a rigid cervical collar (CC condition) or without it (autonomous exit: AE; instructed exit: IE); they were also extricated by two rescuers after setting a rigid cervical collar and by using an extrication device (CC + XT condition). ⋯ The lowest EMG activity was observed during maneuver in CC and CC + XT; during exit a lower EMG activity was observed in CC + XT compared to CC (p < 0.001). Thus, when an extrication device is utilized (CC + XT), a lower active control of the cervical spine region is associated with faster and more brisk movements of the cervical spine compared to CC alone. Conclusions: Our findings support the idea that spinal motion restriction via rigid cervical collar of awake and cooperative trauma patients is effective in reducing cervical spine motion in the sagittal plane during vehicle extrication.
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Background: EMS professionals frequently work more than a standard 40-hour work week. For some EMS professionals, working overtime or multiple jobs may be necessary to make ends meet. Our objective was to evaluate the association between job satisfaction, intention to leave EMS, and financial dependence on overtime or working multiple jobs. ⋯ Conclusion: Many EMS professionals depend on additional work to make a living. Financial dependence was associated with increased odds of workforce-reducing factors, including job satisfaction and intention of leaving. This can lead to poor individual outcomes such as stress and burnout, as well as to turnover within the workforce, thus reducing the number of individuals available to provide high quality emergency care.
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Following an analysis of national EMS agendas, National Association of EMS Educators developed a position supporting educator degree requirements in EMS. This position provided a framework for degree requirements at varying levels of EMS education. Identified support and appreciation for interprofessional approaches as well as EMS specific education was included in the position. The need for an educational workforce capable of providing robust degree options and innovative education emerged in response to the growing academic needs and professional complexities within EMS.