Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Most duties performed by firefighters require the use of personal protective equipment, which inhibits normal thermoregulation during exertion, creating an uncompensable heat stress. Structured rest periods are required to correct the effects of uncompensable heat stress and ensure that firefighter safety is maintained and that operations can be continued until their conclusion. While considerable work has been done to optimize firefighter cooling during fireground operations, there is little consensus on when or how cooling should be deployed. ⋯ Cooling during work thus far has been limited primarily to cooling vests and liquid- or air-cooled suits. In general, liquid-perfused suits appear to be superior to air-cooled garments, but both add weight to the firefighter, making current iterations less desirable. There is still considerable work to be done to determine the optimal cooling strategies for firefighters and hazardous materials operators during work.
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Review Case Reports
Successful administration of intranasal glucagon in the out-of-hospital environment.
We present a case of successful prehospital treatment of hypoglycemia with intranasal (IN) glucagon. Episodes of hypoglycemia can be of varying severity and often requires quick reversal to prevent alteration in mental status or hypoglycemic coma. Glucagon has been shown to be as effective as glucose for the treatment of hypoglycemia. ⋯ Intranasal administration of glucagon has been shown to be as effective as the IV route and may be used for rapid correction of hypoglycemic episodes where IV access is difficult or unavailable and IM administration is undesirable. We describe the first documentation in the peer-reviewed literature of the successful treatment and reversal of an insulin-induced hypoglycemic episode with IN glucagon in the prehospital setting. We also present a review of the literature regarding this novel medication administration route.
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Preventable harm from medical care has been extensively documented in the inpatient setting. Emergency medical services (EMS) providers care for patients in dynamic and challenging environments; prehospital emergency care is a field that represents an area of high risk for errors and harm, but has received relatively little attention in the patient safety literature. ⋯ We found a paucity of scientific literature exploring patient safety in EMS. Research is needed to improve our understanding of problem magnitude and threats to patient safety and to guide interventions.
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Abstract The out-of-hospital setting is unique to health care and presents many challenges to providing safe, high-quality medical care in emergency situations. The challenges of the prehospital environment require thoughtful design of systems and processes of care. The unique challenges of ambulance safety may be met by analyzing systems and incorporating process improvements. ⋯ The agent of injury refers to the energy exerted during the course of an injury, and may be modified to include unrestrained equipment that contributes to the injury. The physical environment refers to the characteristics of the setting in which the injury takes place, such as the roadway or the physical design of the ambulance. Finally, the social environment refers to the social, legal, and cultural norms and practices in the society, such as peer pressure and a culture that discourages the use of safety equipment.
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The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. ⋯ EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time. Key words: ambulance; EMS; diversion; bypass; offload; delay.