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 date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. ⋯ The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.
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Prehospital electrocardiograms (ECGs) have been recommended to facilitate early diagnosis of ST-segment elevation myocardial infarction (STEMI). However, prehospital ECGs can also be used to triage patients with non-ST-segment elevation acute coronary syndromes, who comprise a majority of patients with ischemic events presenting by ambulance to overcrowded emergency departments. ⋯ Our findings demonstrate a relatively high frequency (17%) of non-ST-segment elevation injury patterns on prehospital ECGs of patients who summon EMS because of chest pain. These results suggest the potential of prehospital ECGs to facilitate early triage in these high-risk chest pain patients who present to overcrowded emergency departments.
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Randomized Controlled Trial
Intraosseous devices: a randomized controlled trial comparing three intraosseous devices.
Access to the circulation is mandatory for adequate treatment in medical emergency situations. Intraosseous (IO) infusion is a safe, fast, and effective alternative for gaining access to the circulation, if intravenous access fails. In the last decade, the IO method gained renewed interest. New devices have been developed, such as the Bone Injection Gun (BIG) 15G/18G and the First Access for Shock and Trauma 1 (FAST1). ⋯ The Jamshidi 15G needle could be placed significantly faster than the FAST1. The devices had similar success rates, complication rates, and user-friendliness. Intraosseous devices provide a safe, simple, and fast method for gaining access to the circulation in emergency situations.
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We compared the effectiveness of common airway-securing techniques in preventing endotracheal tube (ETT) dislodgment in the prehospital setting. ⋯ In this multicenter observational series, the odds of ETT dislodgment were similar for face tape, neck tape, twill tape, plastic tubing, and commercial tube holders. ETT dislodgment did not occur with woven twill tape. Patients under 5 years of age are at heightened risk for ETT dislodgment.
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Comparative Study
How much force is required to dislodge an alternate airway?
Endotracheal tube (ETT) dislodgment is a potentially catastrophic adverse event. Newer alternate airway devices-esophageal-tracheal Combitube (ETC), King laryngeal tube disposable airway (King LT), and laryngeal mask airway (LMA)-are easier to insert, but their relative extubating forces remain unknown. ⋯ In a cadaver model of unintended airway dislodgment, the ETC required the most force for dislodgment. The King LT and LMA performed similarly to a standard ETT.