Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To determine paramedics' understanding of and accuracy using SALT (sort-assess-lifesaving interventions-treatment/transport) triage, a proposed national guideline for primary triage during mass-casualty incidents, immediately and four months after training. ⋯ Following a short didactic course, paramedics were able to accurately perform SALT triage during a written scenario. Four months after the training, they had retained their understanding of and accuracy using SALT triage. It appears that a brief educational tool was effective for training EMS providers in SALT triage.
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Little is known about the types of injuries and medical problems encountered by fire department personnel during suppression of large campaign-type wildland fires. Such information could help to plan for response to medical incidents during future wildfires. ⋯ Most firefighter injuries and illnesses encountered during the Los Angeles Station Fire were minor. The prevalence of injuries observed should be taken into consideration in creation of protocols and mandatory equipment lists for fireline paramedics. Furthermore, advanced training for paramedics in the diagnosis and treatment of minor medical conditions may be useful.
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Few systems worldwide have achieved the benchmark time of less than 90 minutes from emergency medical services (EMS) contact to balloon inflation (E2B) for patients sustaining ST-segment elevation myocardial infarction (STEMI). We describe a successful EMS systems approach using a combination of paramedic and 12-lead electrocardiogram (ECG) software interpretation to activate a STEMI bypass protocol. ⋯ The proportion of patients with E2B times less than 90 minutes significantly improved through the implementation of a paramedic-activated STEMI bypass protocol. Further study is required to determine whether these benefits are reproducible in other EMS systems.
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With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS provider-initiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. ⋯ Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.