Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Review Meta Analysis
Paramedic determinations of medical necessity: a meta-analysis.
Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. ⋯ The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.
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No existing mass casualty triage system has been scientifically scrutinized or validated. A recent work group sponsored by the Centers for Disease Control and Prevention, using a combination of expert opinion and the extremely limited research data available, created the SALT (sort-assess-lifesaving interventions-treat/transport) triage system to serve as a national model. An airport crash drill was used to pilot test the SALT system. ⋯ The SALT mass casualty triage system can be applied quickly in the field and appears to be safe, as measured by a low undertriage rate. There was, however, significant overtriage. Further refinement is needed, and effect on patient outcomes needs to be evaluated.
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To describe changes in out-of-hospital cardiac arrest (OOHCA) survival before and after the release of the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). ⋯ In this large city, substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA guidelines for CPR and ECC. These changes were associated with improvements in the quality of CPR.
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In this proof-of-concept study, we evaluated the availability of emergency medical services (EMS) system energy consumption data required to calculate a carbon footprint. ⋯ These EMS systems were able to provide the data necessary to determine their carbon footprints. Future research could include broader study to establish EMS-specific norms for carbon emissions, benchmarking of these metrics between different EMS systems, and the assessment of programs designed to reduce EMS carbon emissions.
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While emergency medical technicians-basic (EMT-Bs) in select emergency medical services (EMS) agencies use the Esophageal Tracheal Combitube (ETC) for the airway management of out-of-hospital cardiopulmonary arrests, the effect of this intervention on patient outcomes is not known. We compared the associations between initial EMT ETC placement and initial paramedic endotracheal intubation (ETI) on patient survival after out-of-hospital cardiopulmonary arrest. ⋯ Compared with initial paramedic ETI, initial EMT-B ETC placement was not associated with patient survival after out-of-hospital cardiac arrest.