Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The American Heart Association (AHA) suggests emergency medical service (EMS) providers transporting ST-segment elevation myocardial infarction (STEMI) patients to a percutaneous coronary intervention (PCI) center require advanced life support (ALS) skills. ⋯ Substantial time savings may occur if EMT-Ds/PCPs bypass non-PCI center EDs with only a small predicted increase (about 7 minutes) in the transport time to the PCI center ED. EMT-P/ACP rendezvous does not appear to substantially increase transport time. Given the relatively low occurrence of clinically important events, our findings suggest that EMT-D/PCP bypass to a PCI center ED may be safe and effective for selected STEMI patients.
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Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures. ⋯ For parenteral administration, midazolam demonstrated superior first-dose seizure suppression. This study demonstrates how periods of drug scarcity can be utilized to study prehospital medication effectiveness.
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In disasters, paramedics often triage victims, including children. Little is known about obstacles paramedics face when performing pediatric disaster triage. ⋯ Paramedics report particular difficulty triaging multiple child disaster victims due to emotional obstacles, unfamiliarity with pediatric physiology, and struggles with triage rationale and efficiency.
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This country has witnessed a steady increase in the number of active shooter incidents in recent years. The traditional emergency medical services (EMS) response to such incidents has been to stage at a safe distance until the scene has been secured by law enforcement. Such an approach may lead to unnecessary delays in medical care and potentially needless loss of life. ⋯ These included initial and ongoing training and funding sources; buy-in from risk management, labor, and the individual providers; whether only paramedics should be included in the RAMS program or if the PFD's firefighter-EMTs should be included as well; the potential for mission creep as police recognized the value of this asset and its potential application to other scenarios; and how to involve the many nonmunicipal ambulance services that are not involved in the routine operation of Philadelphia's 9-1-1 system. To date, RAMS teams have been activated on multiple occasions, but fortunately the incidents were resolved without injury or loss of life. However, the program provides another valuable tool with which the City of Philadelphia can respond should another active shooter incident occur.
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The National Emergency Medical Services Information System (NEMSIS) is a federally funded project designed to standardize emergency medical services (EMS) patient care reporting and facilitate state and national data repositories for the assessment of EMS systems of care. The purpose of this assessment is to characterize the annual NEMSIS 2012 Public-Release Research Dataset, detailing the strengths and limitations associated with use of these data for EMS quality assurance and/or research purposes. ⋯ The annual NEMSIS Public-Release Research Dataset is a valuable resource for evaluating the U.S. EMS activation population and can be used to conduct in-depth descriptions of the care of specific populations. However, the utility of the data are limited until the number of null values can be diminished and reporting becomes universal.