Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Case Reports
Prehospital Laryngeal Tube Airway Device Placement Resulting in Hypopharyngeal Perforation: A Case Report.
A 26-year-old female patient presented in cardiac arrest from presumed opioid overdose. An Ambu King LTS-D laryngeal device was placed by EMS providers for airway management during the resuscitation. There was no documented difficulty with placement and breath sounds and waveform capnography were consistent with appropriate placement. ⋯ The case report describes a rare, yet potentially life-threatening, complication of laryngeal tube airway device placement- hypopharyngeal injury. If unrecognized, this injury could lead to serious complications. Providers should be aware of the common and uncommon injuries that are associated with prehospital laryngeal tube airway device placement.
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Observational Study
Assessment of Paramedic Performance on Difficult Airway Simulation.
Objective: Airway management is a common, important intervention for critically ill patients in the United States. A key element of prehospital airway management is endotracheal intubation (ETI). Prehospital ETI success rates have been shown to be as low as 77% compared to in-hospital rates of 95%. ⋯ Conclusion: In a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices. Future work needs to be directed at identifying the key determinants for airway management success and the development of interventions to improve success with the use of a comprehensive airway management plan.
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Observational Study
Laryngeal Tube Practice in a Metropolitan Ambulance Service: A Five-year Retrospective Observational Study (2009-2013).
Background: The endotracheal tube (ETT) is considered the gold standard in emergency airway management, although supraglottic airway devices, especially the laryngeal tube (LT), have recently gained in importance. Although regarded as an emergency device in case of failure of endotracheal intubation in most systems, we investigated the dynamics of the use of the LT in a metropolitan ambulance service without any regulations on the choice of airway device. Methods: A retrospective, observational study on all patients from the Municipal Ambulance Service, Vienna in need of advanced airway management over a 5-year period. ⋯ There was no difference regarding airway device due to underlying causes requiring airway management and no relationship to the NACA-score. Conclusion: In a European EMS system of physician and paramedic response, the proportion of airway managed by LT over ETT rose considerably over five years. Although the ET is still the gold standard, the LT is gaining in importance for EMS physicians and paramedics.
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Background: The nationally-certified advanced emergency medical technician (AEMT) level was created as an intermediate level of care integrating both basic life support and limited advanced life support. Despite adoption of the AEMT certification level nationally, the characteristics of AEMTs have not previously been described. Our objectives were to describe the demographics of nationally-certified AEMTs in the U. ⋯ Conclusion: AEMTs fill an important gap in prehospital care between the EMT and paramedic levels in the United States. Many AEMT programs required a current EMT certification and completion of a portfolio and course-ending examination. Implementation of the AEMT certification level could be strengthened through further research into high-quality educational practices for AEMT training programs.
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Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. ⋯ Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given review findings that interdisciplinary communication and relationships can be challenging.