Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Antiarrhythmic drugs currently recommended in the American Heart Association's Advanced Cardiac Life Support (ACLS) guidelines for the treatment of cardiac arrest have not been proved in controlled clinical trials to improve survival in patients with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Intravenous amiodarone is a promising agent for the treatment of VF and VT. Based on available evidence, amiodarone should be considered for use in patients with shock-refractory ventricular arrhythmias.
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Review Practice Guideline Guideline
Indications for prehospital spinal immobilization. National Association of EMS Physicians Standards and Clinical Practice Committee.
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Review
Ensuring the chain of recovery for stroke in your community. Chain of Recovery Writing Group.
Until recently, the prehospital and emergency department management of nonhemorrhagic stroke was largely supportive care. Studies now have demonstrated the potential of certain therapeutic interventions to reverse the debilitating consequences of such strokes. But despite the potential benefit, there exists a clear time dependency for such interventions, not only to ensure therapeutic efficacy, but also to diminish the likelihood of significant therapeutic complications. ⋯ The links include: identification of the onset of stroke symptoms by the patient or bystanders; dispatch life support services, which preferably include enhanced 9-1-1 and medically supervised and trained dispatchers who can rapidly deploy the closest responders and transport units; emergency medical services (EMS) personnel who can rapidly assess and transport the stroke patient to the closest appropriate center capable of providing advanced stroke diagnostics and interventions; en route notification of the receiving facility so that appropriate personnel can be readied for rapid diagnosis and intervention; and receiving facilities capable of providing rapid diagnosis and advanced treatment of stroke, including the availability of specialists who can evaluate underlying etiologies as well as plan future therapies and rehabilitation. To ensure that the chain of recovery is in place, aggressive public education campaigns should be implemented to increase the probability that stroke symptoms and signs will be recognized as soon as possible by patients and bystanders. In addition, because most of the current training programs for EMS dispatchers and prehospital care personnel are lacking with regard to stroke, it is recommended that such personnel and their EMS system managers be updated on current management and treatment strategies for stroke.
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During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. ⋯ They are integration of health services, EMS research, legislation and regulation, system finance, human resources, medical direction, education systems, public education, prevention, public access, communication systems, clinical care, information systems, and evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.