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 conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds. ⋯ Prehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.
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Opioids kill tens of thousands of patients each year. While only a fraction of people with opioid use disorder (OUD) have accessed treatment in the last year, 30% of people who died from an overdose had an Emergency Medical Services (EMS) encounter within a year of their death. Prehospital buprenorphine represents an important emerging OUD treatment, yet limited data describe barriers to this treatment. Our objectives were to quantify the number of patients encountered by EMS who were eligible for prehospital buprenorphine, and to examine characteristics of patients who did or did not receive treatment. ⋯ One-in-three EMS patients with suspected opioid use disorder were ineligible for treatment with buprenorphine due to altered mental status. The second largest group consisted of patients who were eligible but not offered buprenorphine, highlighting potential gaps in paramedic training, logistical challenges in field administrations, and other factors that warrant further exploration.
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While ambulance transport decisions guided by artificial intelligence (AI) could be useful, little is known of the accuracy of AI in making patient diagnoses based on the pre-hospital patient care report (PCR). The primary objective of this study was to assess the accuracy of ChatGPT (OpenAI, Inc., San Francisco, CA, USA) to predict a patient's diagnosis using the PCR by comparing to a reference standard assigned by experienced paramedics. The secondary objective was to classify cases where the AI diagnosis did not agree with the reference standard as paramedic correct, ChatGPT correct, or equally correct. ⋯ In this study, overall accuracy of ChatGPT to diagnose patients based on their emergency medical services PCR was 75.0%. In cases where the ChatGPT diagnosis was considered less likely than paramedic diagnosis, most commonly the AI diagnosis was more critical than the paramedic diagnosis - potentially leading to over-triage. The under-triage rate was less than 1%.
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Out-of-hospital births are associated with a 2- to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS. There is a need for tailored NRP training to meet EMS clinicians' specific needs, context, and systems. ⋯ A virtual EMS-tailored, NRP-based educational curriculum improved neonatal resuscitation knowledge immediately and was sustained at 3 months compared to baseline. The curriculum is feasible and acceptable to EMS clinicians.
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Emergency medical services (EMS) clinicians express dissatisfaction with the quality and quantity of clinical feedback received from hospitals, which is exacerbated by the absence of standardized feedback processes. A reported lack of regular feedback impedes their ability to learn and improve care. We evaluated a newly implemented feedback tool's utilization and perceived impact on EMS clinicians and our health system. ⋯ The standardized feedback mechanism implemented for EMS clinicians showed engagement, especially among ground responders caring for high-acuity patients, highlighting its importance in patient care. The preference for email emphasizes the need for efficient communication channels. Clinicians found the system accessible and user-friendly. The feedback tool was perceived as crucial for professional development and personal growth, allowing clinicians to gain closure on patient cases and potentially improve future patient care practices.