Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Comparison of traditional versus video laryngoscopy in out-of-hospital tracheal intubation.
Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure. ⋯ The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.
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Prompt reperfusion in ST-segment elevation myocardial infarction (STEMI) saves lives. Although studies have shown that paramedics can reliably interpret STEMI on prehospital 12-lead electrocardiograms (p12ECGs), prehospital activation of the cardiac catheterization laboratory by emergency medical services (EMS) has not yet gained widespread acceptance. ⋯ Important reductions in time to reperfusion seem possible by activation of the catheterization laboratory by EMS from the scene, with an acceptably low false-positive rate in this small sample. This type of clinical research can inform multidisciplinary policies and bring about meaningful clinical practice changes.
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The American Heart Association's (AHA's) Advanced Cardiac Life Support guidelines act as the national standards for termination of resuscitation (TOR) in cases of refractory out-of-hospital cardiac arrest. However, local emergency medical services (EMS) implementation of these guidelines has been nonuniform. ⋯ We have identified operational barriers that may impede implementation of TOR guidelines. Three influential stakeholder groups will need to work with national organizations to overcome these local barriers.
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To describe requirements of physicians wishing to function as primary field emergency medical services (EMS) providers and variation of these requirements among states. ⋯ Most states allow physicians to become certified prehospital care providers, although few states require physicians wishing to work as a primary EMS provider to do so, or even to undergo any specific EMS training. There is no national standardization of the preparatory requirements of physicians wishing to provide in-field EMS.
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We investigated 9-1-1 telecommunicators' perceptions of communication difficulties with callers who have limited English proficiency (LEP) and the frequency and outcomes of specific communication behaviors. ⋯ Our study shows that 9-1-1 telecommunicators believe language barriers with LEP callers negatively impact communication and care outcomes. More research needs to be conducted on "best practices" for phone-based emergency communication with LEP callers. Additionally, LEP communities need to better understand the 9-1-1 system and how to effectively communicate during emergencies.