Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Objective: Retrospective analysis evaluating and comparing the feasibility, effectiveness and safety of intranasal fentanyl (INF) and subcutaneous fentanyl (SCF) for pain management of patients with acute severe pain in a rural/suburban Emergency Medical Services (EMS) system. Methods: Pre- and post-pain management data of all patients (aged ≥14 years) who were transported to the emergency department (January 2015-August 2017) were extracted from EMS and online medical control center records, and compared for groups receiving INF or SCF. Kaplan-Meier analysis and the log-rank test were used to describe and compare the percentage of patients in both groups who experienced relief according to their clinically significant pain relief score. ⋯ Conclusion: This retrospective analysis of prehospital patients in the Chaudière-Appalaches EMS system demonstrates that both IN and SC are feasible, effective and safe routes for administering fentanyl. The observed effects of INF were found to be greater among patients ≥70 years. Further research is required to compare these routes with more conventional methods of pain management.
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Double sequential external defibrillation (DSED) is a novel treatment option for cardiac arrest patients in refractory ventricular fibrillation (VF). There is limited research, however, examining the efficacy of this treatment in clinical practice. Previous research is further confounded by the use of other treatments such as advanced cardiac life support medications. We present the case of the successful use of DSED for refractory out-of-hospital cardiac arrest without the use of advanced life support care.
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Introduction: Hurricane Florence made landfall in North Carolina as a Category 1 hurricane on September 14, 2018 causing catastrophic flooding throughout much of eastern North Carolina. Large numbers of evacuees were housed in evacuation shelters established by state emergency management and county governments. The purpose of this study was to evaluate the implementation of a telemedicine service in evacuation shelters to determine whether the presence of telemedicine could alter EMS and ED utilization. ⋯ Only 9 (9.7%) patients were referred by the telemedicine service to an ED for an evaluation, with 3 (3.2%) being admitted. Conclusion: Our descriptive findings suggest telemedicine can be effectively utilized in a general population evacuation shelter to reduce EMS and ED utilization and address the medical needs of the population. Further studies should be performed to assess applicability to other disaster settings.
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Background: Air ambulance services are commonly used to expedite interfacility transport of injured patients to trauma centers. There is a lack of evidence surrounding risk factors for delays in interfacility transport of these patients. The purpose of this study was to examine patient, paramedic, and institutional-related characteristics for delay and identify specific causes of delays in interfacility transfers by air ambulance. ⋯ Third, interfacility transport times are heavily skewed and delays disproportionately affect longer patient transports. Conclusions: Ventilator dependence, paramedic level of care, classification of sending facility and helipad availability are associated with delays to interfacility transport of injured patients. Efforts can be made at both the air ambulance and institutional levels to ensure timely and efficient transports.