Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Early, high-quality, minimally interrupted bystander cardio-pulmonary resuscitation (BCPR) is essential for out-of-hospital cardiac arrest survival. However, rates of bystander intervention remain low in many geographic areas. Community CPR programs have been initiated to combat these low numbers by teaching compression-only CPR to laypersons. This study examined bystander CPR and the cost-effectiveness of a countywide CPR program to improve out-of-hospital cardiac arrest survival. ⋯ Cost-effectiveness analysis demonstrates that a community CPR outreach program is a cost-effective means for saving lives when compared to other healthcare-related interventions. Bystander CPR showed a clear trend toward improving the neurologic outcome of survivors. The findings of this study indicate a need for additional research into the economic effects of bystander CPR.
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Abstract Objective. Earlier use of plasma and red blood cells (RBCs) has been associated with improved survival in trauma patients with substantial hemorrhage. We hypothesized that prehospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival. ⋯ Conclusions. Prehospital plasma and RBC transfusion was associated with improved early outcomes, negligible blood products wastage, but not an overall survival advantage. Similar to the data published from the ongoing war, improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients.
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Case Reports
Immediate Lower Extremity Tourniquet Application to Delay Onset of Reperfusion Injury after Prolonged Crush Injury.
Reperfusion after severe crush injury is an infrequent, but life-threatening condition. It is a unique aspect of prehospital medicine that occurs in the presence of emergency responders attempting to extricate and treat patients who have suffered a crushing injury. These events are unlikely to occur in the hospital setting and, as a result, remain poorly studied. ⋯ The use of commercial tourniquets to delay the onset of reperfusion injury has previously been described in theory. Extensive literature now exists supporting the safety of tourniquet use in limb trauma and this potential life-saving measure requires further study in patients with crush injury. We present a case of prehospital tourniquet application to delay reperfusion injury after crush injury that resulted in a reduction in morbidity and complete limb salvage.
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Abstract Objective. Emergency medical services (EMS) often transports patients who suffer simple falls in assisted-living facilities (ALFs). An EMS "falls protocol" could avoid unnecessary transport for many of these patients, while ensuring that patients with time-sensitive conditions are transported. ⋯ In this cohort, two-thirds of patients with falls in ALFs did not require TSI. An EMS protocol may have sufficient sensitivity to safely allow for nontransport of these patients with falls in ALFs. Prospective validation of the protocol is necessary to test this hypothesis.
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Abstract Objective. Nearly 200,000 pediatric and neonatal transports occur in the United States each year with some patients requiring tracheal intubation. First-pass intubation rates in both pediatric and adult transport literature are variable as are the factors that influence intubation success. ⋯ There were higher rates of tracheal intubation failure in transported neonates when compared to pediatric patients. This risk may be related to the lack of benzodiazepine and neuromuscular blocking agents used to facilitate intubation. The presence of a comorbid condition is associated with a higher risk of tracheal intubation failure.