Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Continuous positive airway pressure (CPAP) has been used effectively in the prehospital environment for a wide range of respiratory emergencies. The feasibility of CPAP when used by primary care paramedics (PCPs) has not been established. ⋯ This study found no significant difference in the compliant use of prehospital CPAP between paramedics trained to the PCP level and those trained to the ACP level. This study suggests that CPAP use by PCP-level paramedics may be feasible. Further study is required to determine whether compliance translates to safe use of prehospital CPAP by PCP-level paramedics.
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Case Reports
Prehospital chemical restraint of a noncommunicative autistic minor by law enforcement.
When responders are dealing with an agitated patient in the field, safety for all involved may sometimes only be accomplished with physical or chemical restraints. While experiences using chemical restraint in the prehospital setting are found in the medical literature, the use of this by law enforcement as a first-response restraint has not previously been described. We report a case of successful law enforcement-administered sedation of a noncommunicative, autistic, and violent minor using intramuscular droperidol and diphenhydramine. Although this case has some unique characteristics that allowed chemical restraint to be given by the law enforcement agency, it calls attention to some specific prehospital issues that need to be addressed when dealing with autistic patients with extreme agitation.
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Case Reports
Paramedic-performed digital nerve block to facilitate field reduction of a dislocated finger.
This short report describes the use of digital nerve block by a paramedic to facilitate the reduction of a dislocated finger in the prehospital setting. The finger was successfully reduced at the scene without requiring administration of parenteral opioids. ⋯ Paramedic-performed local and regional anesthesia has not been previously described in the emergency medicine or emergency medical services literature. With appropriate training, prehospital digital nerve blocks may be a feasible option to supplement existing paramedic analgesic options.
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On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. ⋯ The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.
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The Broselow tape is widely used to rapidly estimate weight and facilitate proper medication dosing in pediatric patients. ⋯ Paramedic Broselow weight correlates well with scale weight and ED Broselow weight. Paramedics can use the Broselow tape to accurately determine weight for pediatric patients in the prehospital setting.