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 characterize transport times for the interfacility air ambulance transport of patients with acute ST-segment elevation myocardial infarction (STEMI), to estimate the proportion of patients at risk of in-transport clinical decompensation, and to explore associated risk factors for such. ⋯ The majority of interfacility rotor-wing air ambulance transfers of patients with STEMI achieved a total transfer time of < or = 2 hours. Clinical decompensation requiring ALS treatment occurred in a small percentage of patients. Diabetes, prior arrest or decompensation, and delays to transport were associated with clinical decompensation in the air. Efforts to reduce delays to transport may reduce this risk in transported patients.
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Elderly patients use emergency medical services (EMS) at a high rate. Objectives. To test the hypothesis that EMS use for emergency department (ED) transports increases across the life span and to estimate changes in the EMS volume in North Carolina (NC) during the next 20 years due to the aging of the population. ⋯ The proportion of patients using EMS to reach NC EDs increases steadily with age. By 2030, older patients will account for approximately half of EMS transports to NC EDs. The changes likely exemplify national trends and highlight the growth of EMS service needs for the elderly and the importance of emphasizing geriatric care in EMS training.
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Review Meta Analysis
A meta-analysis of prehospital airway control techniques part I: orotracheal and nasotracheal intubation success rates.
Airway management is a key component of prehospital care for seriously ill and injured patients. Although endotracheal intubation has been a commonly performed prehospital procedure for nearly three decades, the safety and efficacy profile of prehospital intubation has been challenged in the last decade. Reported intubation success rates vary widely, and established benchmarks are lacking. ⋯ We provide pooled estimates of placement success rates for prehospital airway interventions. For some patient and clinician characteristics, OETI has relatively low success rates. For nonarrest patients, DFI and RSI appear to increase success rates. Across all clinicians, NTI has a low rate of success, raising questions about the safety and efficacy of this procedure.
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Multicenter Study
Airway management success and hypoxemia rates in air and ground critical care transport: a prospective multicenter study.
To assess critical care transport (CCT) crews' endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation. ⋯ CCT crews' ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO(2) derangement. CCT crews' ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews.
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In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA). ⋯ ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.