Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Case Reports
Field airway management of a construction worker with an impaling rebar injury to the neck and brain.
This article discusses a case of airway management by air ambulance emergency medical services (EMS) providers in a 22-year-old man impaled through the neck into the brain with 0.5-inch rebar. Penetrating neck injuries (PNIs) with impalement are extraordinarily rare. It is important for EMS providers and emergency medicine physicians to have an understanding of the initial management of an impaled patient with PNI, including having an organized approach to establishing a definitive airway and recognizing the airway complications that PNI may cause. This article discusses out-of-hospital management of impaled patients.
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As attention to, and motivation for, emergency medical services (EMS)-related research continues to grow, particularly exception from informed consent (EFIC) research, it is important to understand the thoughts, beliefs, and experiences of EMS providers who are actively engaged in the research. ⋯ The EMS providers in our study valued research and were willing to participate in studies. Support for research was balanced with concerns and challenges regarding the role of providers in the research process.
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This paper describes the methodology of a large emergency medical services (EMS) data linkage research project currently under way in the statewide EMS system of New South Wales, Australia. The paper is intended to provide the reader with an understanding of how linkage techniques can be used to facilitate EMS research. This project, the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project, links data from six statewide sources (computer-assisted dispatch, EMS patient health care reports, emergency department data, inpatient data, and two death registries) to enable researchers to examine the patient's entire journey through the health care system, from the emergency 0-0-0 call to the emergency department and inpatient setting, through to discharge or death, for approximately 2.6 million patients transported by the Ambulance Service of New South Wales to emergency departments between June 2006 and July 2009. Manual, deterministic, and probabilistic data linkages are described, and potential applications of linked data in EMS research are outlined.
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Comparative Study
Potential adverse effects of spinal immobilization in children.
The purpose of our study was to describe potential adverse effects associated with spinal immobilization following trauma among children. ⋯ Despite presenting with comparable PTSs and GCSs, children who underwent spinal immobilization following trauma had a higher degree of self-reported pain, and were much more likely to undergo radiographic cervical spine clearance and be admitted to the hospital than those who were not immobilized. Future studies are warranted to determine whether these differences are related to spinal immobilization or differences in the mechanisms of injury, injury patterns, or other variables.
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We sought to identify barriers and facilitators to ambulance communications officers' (ACOs') recognition of abnormal breathing and administration of cardiopulmonary resuscitation (CPR) instructions. ⋯ This qualitative study found that control beliefs are most influential on ACOs' intention to recognize abnormal breathing and provide CPR instructions over the phone. Training and policy changes should target these beliefs to increase the frequency of ACO-administered CPR instructions to callers reporting a patient in cardiac arrest.