Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Thermal protective clothing (TPC) worn by firefighters provides considerable protection from the external environment during structural fire suppression. However, TPC is associated with physiologic derangements that may have adverse cardiovascular consequences. These derangements should be treated during on-scene rehabilitation periods. ⋯ No clear advantage was identified when active cooling devices and cold intravenous saline were compared with passive cooling in a moderate temperature after treadmill exercise in TPC.
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Thirst perception involves neurochemical signals attributed to acute elevation of arginine vasopressin (AVP) and angiotensin II (AT2) levels, and may accompany acute hemorrhage. ⋯ The results of this study imply that thirst severity and AVP and AT2 plasma levels are not reliable predictors of impending hemorrhagic shock, injury severity, or outcome. The presence or absence of severe thirst should not be employed as a primary marker for dismissing or suspecting incipient shock.
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Emergency medical services (EMS) is an important component of emergency medicine residency curricula. For over 20 years, residents at a university-affiliated program have staffed a physician response vehicle and responded to selected calls in an urban EMS system with online faculty backup. ⋯ Our prehospital training program incorporates emergency medicine residents as in-field physicians and allows hands-on opportunity to provide patient care for a variety of conditions in the EMS environment, as well as extensive experience in online medical direction. The trainees believed it had a strong positive impact on their acquisition of important emergency medicine abilities.
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Emergency medical services (EMS) responses to some scenes are potentially more dangerous than others, requiring EMS systems to develop policies that stage medical responders away from the scene until law enforcement has the area secured. ⋯ The practice of staging ambulances while police secure potentially dangerous scenes added approximately 4.5 minutes to the response time. We were unable to demonstrate a difference in RLS return to the hospital (our proxy for patient acuity) between SC and NSC.
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Medical oversight is a fundamental component of every emergency medical services (EMS) system. The quality of physician medical direction has a significant impact upon the system and patient outcome. ⋯ This resource document provides a snapshot of the status of state EMS medical direction in our nation in 2007 and a projection of the achievable benchmarks for the role of the state EMS medical director in the future. As an informational resource, this tool will assist state EMS officials, legislators, laypersons, and partners within the emergency care system to comprehend, create or improve, and support the state EMS medical director position within their jurisdictions.