Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Prehospital post-resuscitation hypotension and hypoxia have been associated with adverse outcomes in the context of out-of-hospital cardiac arrest (OHCA). We aimed to investigate the association between clinical outcomes and post-resuscitation hypoxia alone, hypotension alone, and combined hypoxia and hypotension. ⋯ In this large dataset, hypotension and hypoxia were independently associated with mortality both alone and in combination. Compared to patients without documented hypotension and hypoxia, patients with documented hypotension and hypoxia had nearly five-fold greater odds of mortality.
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The objective of this study was to determine the effect of transitioning from direct laryngoscopy (DL) to video laryngoscopy (VL) on endotracheal intubation success overall and with enhanced precautions implemented during the COVID-19 pandemic. ⋯ VL is designed to improve glottic visualization. The use of VL by a large, U.S. multistate ALS ambulance service was associated with increased odds of successful first-pass and overall attempted intubation, which was mediated by better visualization of the glottis. COVID-19 protocols were not associated with success rates.
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Studies of out-of-hospital cardiac arrest generally document the presenting (pulseless electrical activity [PEA], ventricular fibrillation/tachycardia (VF/VT), asystole), and the final states (resuming stable spontaneous circulation [s-ROSC], being declared dead). Only a few studies described the transitions between clinical states during advanced life support (ALS). The aim of this study was to describe and analyze the dynamics of state transitions during ALS. ⋯ An understanding of the dynamic course of clinical state transitions during ALS may allow treatment strategies to be tailored in patients affected by OHCA.
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Introduction: Emergency medical services (EMS) fellowship program accreditation in the United States began in 2013, and the number of available programs has rapidly expanded since then with a corresponding increase in the number of fellows. Despite this increase in program number and attendance, there is a paucity of data in the literature reviewing personal and professional characteristics of the fellows, their experiences during fellowship, or understanding of their intended desires from fellowship. Methods: This study surveyed 2020-21 and 2021-22 EMS fellows regarding their personal and professional characteristics, motivations for program choice, remaining school debt, and the effects of COVID-19 on their training. ⋯ Conclusions: The demographics and graduate's level of preparedness appear similar to those reported from 2016, and reflect the demographics of emergency medicine residents. Other new information including desired program qualities and offerings is potentially useful for program directors. COVID-19 did appear to have a small effect on fellow's actions and possibly on ease of post-graduation employment.
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Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. ⋯ This study has identified challenges faced by the EMS system in Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the timely locating of emergencies.