Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Despite the supporting published evidence for prehospital fibrinolysis (PHF) for ST-elevation myocardial infarction (STEMI) patients by paramedics, the complexity of the process has not been rigorously explored in a stepwise approach. The objectives of this study were to (1) map the process of care that occurs during EMS management of STEMI with administration of PHF from 911 call to transfer of care to the emergency department and (2) to identify steps that could adversely affect patient safety or clinical outcome. ⋯ In this mapping study of STEMI calls in which paramedics administer fibrinolytics, the process was found to be complex, containing many steps, but relatively few individual steps were highly hazardous to patient care or safety. This study has enabled specific actions to target the highest scoring hazard modes, in an effort to improve paramedic practice and patient safety for EMS STEMI patients. Key words: emergency medical services; myocardial infarction; fibrinolytic agents; ambulances; process map.
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This position statement with accompanying resource document is the result of a collaborative effort of a writing group comprised of members of the Air Medical Physician Association (AMPA), the American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the American Academy of Emergency Medicine (AAEM). This document has been jointly approved by the boards of all four organizations. Patients benefit from the appropriate utilization of helicopter emergency medical services (HEMS). ⋯ National guidelines for appropriate utilization of HEMS must be developed. These guidelines should be national in scope yet allow local, regional, and state implementation. A National HEMS Agenda for the Future should be developed to address HEMS utilization and availability and to identify and support a research strategy for ongoing, evidence-based refinement of utilization guidelines.
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The purpose of this study is to describe the short-term outcomes (during air transport) of patients managed by the United States Air Force Critical Care Air Transport Teams (CCATT). ⋯ CCATTs are a successful platform in transporting critically injured/ill patients with minimal short-term complications.
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Achieving successful peripheral intravenous (PIV) vascular access in children can be difficult. In the prehospital setting, opportunities are rare. Obtaining access becomes vital in emergent and life-threating conditions, such as seizures, hypoglycemia, and cardiac arrest. This study examines prehospital pediatric PIV attempts, success rates, and the impact of patient age. ⋯ Prehospital PIV attempts are uncommon (2% of emergent responses). Success rates are significantly associated with patient age in the pediatric population and lowest in those aged 2 years or less. Consideration of alternative forms of vascular access in this population may be beneficial.
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Although EMS agencies have been designed to efficiently provide medical assistance to individuals, the overuse of 9-1-1 as an alternative to primary medical care has resulted in the need for new methods to respond to this increasing demand. Our study analyzes the efficacy of classifying specific low-acuity calls that can be transferred to an advice-line nurse for further medical instruction. The objectives of our study were to analyze the impact of implementing this protocol and resultant patient feedback regarding the transfer to an advice-line nurse. ⋯ We identified an average of two patients per day as eligible for transfer to the nurse advice line, with less than one patient successfully completing the Omega protocol per day. While impact was limited, there was a decrease in ambulance response.