Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Tranexamic acid (TXA) is being administered already in many prehospital air and ground systems. Insufficient evidence exists to support or refute the prehospital administration of TXA, and results are pending from several prehospital studies currently in progress. We have created this document to aid agencies and systems in best practices for TXA administration based on currently available best evidence. This document has been endorsed by the American College of Surgeons-Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.
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Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport. ⋯ In this sample, the majority of patients receiving blood products during air-medical transport were transfused for medic conditions; gastrointestinal hemorrhage was the most common chief complaint. The pRBC transfusions were associated with emergent surgery and in-hospital transfusion. Transfusions of >700 mL were associated with mortality.
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Early administration of tranexamic acid (TXA) has been shown to reduce all-cause mortality and death secondary to trauma. Our objective was to develop a collaborative prehospital TXA administration protocol between a ground EMS and academic medical center. ⋯ Prehospital TXA protocol based on the CRASH-2 trial is safe and feasible. The first dose of TXA administered under this protocol marks the first ground EMS administration in the USA. Conceivably, this will pose as a model to other trauma centers that receive patients from outlying areas without immediate access to care. Large multi-institutional analyses need to be performed to evaluate survival benefits of prehospital TXA administration protocol.
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A simulation-based course, Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPs), was developed to optimize pediatric prehospital care. Seizures are common in Emergency Medical Services (EMS), and no studies have evaluated pediatric outcomes after EMS simulation training. ⋯ seizure; emergency medical services; simulation; pediatrics.
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New medical school educational curriculum encourages early clinical experiences along with clinical and biomedical integration. The University of South Carolina School of Medicine Greenville, one of the new expansion schools, was established in 2011 with the first class matriculating in 2012. To promote clinical skills early in the curriculum, emergency medical technician (EMT) training was included and begins in the first semester. Along with the early clinical exposure, the program introduces interprofessional health and teams and provides the opportunity for students to personally see and appreciate the wide variety of environments from which their future patients emanate. ⋯ Medical students who received their EMT training in a 6-week, non-integrated format performed similarly on the EMT State certification examination to those who received their training in a prolonged, integrated structure.