Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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A challenge for emergency medical service (EMS) is accurate identification of acute coronary syndromes (ACS) and ST-segment elevation myocardial infarction (STEMI) for immediate treatment and transport. The electrocardiograph-based acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) and the thrombolytic predictive instrument (TPI) have been shown to improve diagnosis and treatment in emergency departments (EDs), but their use by paramedics in the community has been less studied. ⋯ In a wide range of EMS systems, use of electrocardiographs with ACI-TIPI and TPI decision support using a 75% ACI-TIPI cutoff improves paramedic diagnostic performance for ACS, AMI, and STEMI and increases the proportions of patients who receive PCI.
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The Centers for Disease Control and Prevention (CDC) published its Guidelines for Field Triage of Injured Patients in 2009. These CDC guidelines define criteria for the triage of trauma patients to trauma centers, and include physiologic, anatomic, and high-risk mechanism-of-injury criteria. One of the mechanism criteria used for motor vehicle crashes (MVCs) is intrusion >12 inches at the occupant site or >18 inches at any site. Objective. We hypothesized that motor vehicle intrusion, as the sole criterion for transport to a trauma center, is neither sensitive nor specific for predicting which patients will utilize trauma center resources. ⋯ Motor vehicle intrusion alone is a poor predictor of the need for trauma center admission or trauma center resource utilization. A modest change to the CDC guidelines from intrusion to entrapment may reduce overtriage while maintaining a high sensitivity for serious injury.
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The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.
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This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. ⋯ The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.
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Air medical transport has had problems with its safety record, attributed in part to human error. Flight crew members (FCMs) must be able to focus on critical safety tasks in the context of a stressful environment. Flight crew members' cognitive readiness (CR) to perform their jobs may be affected by sleep deprivation, personal problems, high workload, and use of alcohol and drugs. ⋯ Performance by FCMs on a simple, rapid, computer-based psychological test correlates well with self-reported sleep, rest, life satisfaction, and irritability. Although further studies are warranted, these findings suggest that assessment of the performance of FCMs on a simple, rapid, computer-based, multitasking battery is feasible as an approach to determine their readiness to perform critical safety tasks through the SYNWIN task battery.