Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Regionalization of medical resources by designating specialty receiving centers, such as trauma and stroke centers, within emergency medical services (EMS) systems is intended to ensure the highest-quality patient care in the most efficient and fiscally responsible fashion. Significant advances in the past decade such as induction of therapeutic hypothermia following resuscitation from cardiac arrest and a time-driven, algorithmic approach to management of septic patients have created compelling arguments for similar designation for specialized resuscitative interventions. Resuscitation of critically ill patients is both labor- and resource-intensive. ⋯ Just as EMS systems currently delineate criteria and monitor compliance for trauma, ST-elevation myocardial infarction (STEMI), and stroke centers, strong logic now exists to develop similar standards for resuscitation facilities. Accordingly, this discussion reviews the current applicable trends in resuscitation science and presents a rationale for resuscitation center designation within EMS systems. Potential barriers to the establishment of such centers are discussed and strategies to overcome them are proposed.
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During normal operations, public safety personnel may become injured, leading them to seek medical care and possible time off. Examining the nature and patterns of injury may help to identify preventive health measures for all public safety personnel and address specific needs of each discipline based on actual risk. Objective. To determine the types and severity of injuries encountered by public safety personnel during routine work conditions within a single urban population. ⋯ Public safety personnel are affected by both profession-specific and non-profession-specific injuries. Overall, EMS has higher rates of missed time and medical evaluations than both fire and police. These data highlight the need to make direct comparisons of various public safety personnel bureaus using a common time interval and locale in order to rationally plan interventions and apply resources.
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Multicenter Study
The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort.
The validity of using adult physiologic criteria to triage injured children in the out-of-hospital setting remains unproven. Among children meeting adult field physiologic criteria, we assessed the availability of physiologic information, the incidence of death or prolonged hospitalization, and whether age-specific criteria would improve the specificity of the physiologic triage step. ⋯ The incidence of high-risk injured children meeting adult physiologic criteria is relatively low and the findings from this sample do not support using age-specific values to better identify such children. However, the amount and pattern of missing data may compromise the value and practical use of field physiologic information in pediatric triage.
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Since the 1980s, the specialized field of tactical medicine has evolved with growing support from numerous law-enforcement and medical organizations. On-scene backup from tactical emergency medical support (TEMS) providers has not only permitted more immediate advanced medical aid to injured officers, victims, bystanders, and suspects, but also allows for rapid after-incident medical screening or minor treatments that can obviate an unnecessary transport to an emergency department. The purpose of this report is to document one very explicit benefit of TEMS deployment, namely, a situation in which a police officer's life was saved by the routine on-scene presence of specialized TEMS physicians. ⋯ Two TEMS physicians, who had been integrated into the tactical law-enforcement team, were on scene, controlled the hemorrhage, and provided a surgical airway. By the time of arrival at the hospital, the patient had begun purposeful movements and, within 12 hours, was alert and oriented. Considering the rapid decline in the patient's condition, it was later deemed by quality assurance reviewers that the on-scene presence of these TEMS providers was lifesaving.