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
Use of Ultrasound for Joint Dislocation Reduction in an Austere Wilderness Setting: A Case Report.
Point-of-care ultrasound has been shown to have a demonstrable impact in the austere/out-of-hospital environment. As ultrasounds become more affordable and portable, a myriad of uses in austere environments are becoming recognized. ⋯ This procedure allowed the patient to hike out under his own power, avoiding the potential dangers of extrication to both patient and rescuers. We believe this case demonstrates the feasibility and utility of ultrasound in the out-of-hospital environment both procedurally and diagnostically.
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Objective: Strong earthquakes often cause massive structural and nonstructural damage, timely assessment of the catastrophe related massive casualty incidents (MCIs) for deploying rescue resource are critical in order to minimize ongoing fatalities. A magnitude 6.6 earthquake struck southern Taiwan on February 6, 2016 (the so-called 02/06 Meinong earthquake). It led to 117 deaths and 522 injuries. ⋯ Results: We, for the first time, attempted to use cyber devices including an internet-protocol camera and a multi-rotor unmanned aerial vehicle (UAV) equipped with a high-resolution digital camera used to acquire imagery during the rescue operation. Moreover, a photo-realistic 3-D model reconstructed by the acquired UAV imagery could provide real-time information from UAV to rescue team leaders in remote location for effectively deploying medical posts and emergency resources at scene. Conclusion: We proposed the concept of real-time UAV imagery for reconstructing photo-realistic 3-D model, which might greatly improve prehospital emergency management after disaster.
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Background: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. ⋯ Conclusions: EMS interactions with LVAD patients are infrequent but have high rates of admission and incidence of life-threatening diagnoses. The most common prehospital presenting symptoms were weakness and chest pain, and most prehospital interactions did not require LVAD-specific interventions. In addition to acquiring technical knowledge regarding LVADs, EMS providers should be aware of non-device-related complications including intracranial and GI bleeding and take this into account during their assessment.
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Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ethnic/sex-related differences among any of those measurements. ⋯ There were neither significant sex-related differences nor any racial/ethnic/sex differences in the relatively short EMS-related intervals. Conclusions: Following acute stroke onset, time elapsed for EMS response and transport is relatively short compared to the lengthy intervals elapsing between symptom onset and 9-1-1 system activation, regardless of demographics. Exploration of innovative strategies to improve public education regarding stroke symptoms and immediate 9-1-1 system activation are strongly recommended.
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Comparative Study
Evaluation and Comparison of Different Prehospital Triage Scores of Trauma Patients on In-Hospital Mortality.
Introduction: Several prehospital major trauma patient triage scores have been developed, the triage revised trauma score (T-RTS), Vittel criteria, Mechanism/Glasgow Coma Scale/Age/Systolic blood pressure score (MGAP), and the new trauma score (NTS). These scoring schemes allow a rapid and accurate prognostic assessment of the severity of potential lesions. The aim of our study was to compare these scores with in-hospital mortality predictions in a cohort of consecutive trauma patients admitted in a Level 1 trauma center. ⋯ Only Vittel's criteria allowed undertriage below 5% as recommended by the American College of Surgeons Committee on Trauma (ACSCOT). Conclusion: The comparison of these different triage scores concluded with a superiority of the MGAP and NTS scores compared with the T-RTS. Including the calculation of MGAP or NTS scores with the Vittel criteria would reduce the risk of overtriage in the Level 1 trauma centers by further directing patients at low risk of death to a lower-level trauma facility.