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: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We analyzed the Singapore cohort of Pan-Asia Resuscitation Outcome Study (PAROS), a multi-center, prospective OHCA registry between 2010 and 2015. The Singapore Socioeconomic Disadvantage Index (SEDI) score, obtained according to zip code, was used as surrogate for neighborhood SES. ⋯ Ethnicity did not reach statistical significance (p = 0.072) in forward selection model of Utstein survival, while SEDI score and category were not significant (p > 0.2 and p = 0.349). Conclusions: We found Malay and Indian communities to be at higher risks of OHCA compared to Chinese, and additionally, the Malay community is at higher risk of subsequent mortality than the Chinese and Indian communities. These disparities were not explained by neighborhood SES.
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Objective: Naloxone is an opioid receptor antagonist that reverses life-threatening effects of opioid overdose. Since the 1970s, naloxone products have been developed as injectable solutions, and more recently as nasal sprays. Naloxone products have saved many lives in emergency settings. ⋯ Conclusion: This quality assessment demonstrates that expired naloxone products may still meet USP standards, even after many years. Further pharmaceutical, clinical, and regulatory investigation should be conducted to confirm our findings, especially for new naloxone products with different formulations and routes of administration. Extending the shelf-life of naloxone products may have important financial and public health consequences in addressing future drug shortages and meeting the needs for this critical drug.
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Introduction: Traumatic injury is the fourth leading cause of death in western countries and the leading cause of death in younger age. However, it is still unclear which groups of patients benefit most from advanced prehospital trauma care. A minimal amount is known about the effect of prehospital physician-based care on patients with specifically traumatic brain injury (TBI). ⋯ Results of the remaining outcome measures differed widely. Conclusion: The included literature did not show a clear beneficial effect of P-EMS in the prehospital management of patients with severe TBI. The available evidence showed contradictory results, suggesting more research should be performed in this field with focus on decreasing heterogeneity in the compared groups.
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Background: Emergency medical services (EMS) personnel face a disproportionally high risk for fatality and injury due to the nature of their work; and current ambulance and EMS equipment design standards do not adequately safeguard EMS personnel from sacrificing personal safety for patient care, a known human factors and ergonomic (HFE) design challenge. Despite the desire to include HFE interventions or considerations into a standard, the effectiveness of existing HFE interventions for EMS is unclear. Objective: Therefore, this study aimed to synthesize the peer-reviewed literature on the design features of patient compartments and EMS equipment that affect EMS personnel's performance or well-being. ⋯ Newer generations of ambulances have not been shown to be safer during collisions and there is a knowledge gap in how occupants and contents of a patient compartment behave during a collision. Crash-tests have been performed with restrained occupants and supplies; however, that scenario is unrealistic in the field. While the existing literature provided initial ideas and innovations for improving the HFE of patient handling and patient transport, it is important for future research to convey findings in a manner that can be used to inform design standards.
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Objective: The objective of this study was to determine if neighborhood rates of pediatric Emergency Medical Services (EMS) encounters correlate with rates of child maltreatment reporting and if there are neighborhood-level risk factors for EMS encountering children with maltreatment reports. Methods: We conducted a retrospective cohort study using the electronic medical records of children ages <18 years who had Columbus Division of Fire EMS encounters between 2011 and 2015. We used Nationwide Children's Hospital electronic medical records to identify child maltreatment reports. ⋯ The multivariate analysis also identified protective factors, which included neighborhoods with higher proportions of residents who had bachelor's degrees, spoke a language other than English, and had the same residence the previous year. Conclusion: This study showed that in Franklin County, Ohio, neighborhoods with high EMS utilization had a strong positive correlation with areas that had high rates of child maltreatment reports. We also identified four neighborhood characteristics that were independently associated with EMS encountering children at risk for maltreatment (risk factor: poverty; protective factors: residents with college educations, non-English speaking households, and residents maintaining the same residence as the previous year).