Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Activation of the cardiac catheterization laboratory prior to patient arrival at the hospital, based on a prehospital 12-lead electrocardiogram (ECG), reduces door-to-balloon time by 10-55 minutes for patients with ST-segment elevation myocardial infarction (STEMI). In emergency medical services (EMS) systems where transmission of the ECG to the emergency department (ED) is not feasible, the ability of paramedics to accurately read 12-lead ECGs is crucial to the success of a prehospital catheterization laboratory activation program. Objective. To determine whether paramedics can accurately diagnose STEMI on a prehospital 12-lead ECG and decide to activate the cardiac catheterization laboratory appropriately. ⋯ Paramedics in an urban/suburban EMS system can diagnose STEMI and identify appropriate cardiac catheterization laboratory activations with a high degree of accuracy, and an acceptable false-positive rate, when tested using paper-based scenarios.
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Rates of compliance with evidence-based treatment guidelines are commonly used to evaluate hospital quality of care. This method of quality assessment has not been widely extended to the prehospital environment. Previous studies have shown that the prehospital care of chest pain patients is often incomplete. ⋯ There was generally good compliance with each individual metric, yet compliance with the comprehensive metric was poor. This manner of quality assessment, utilizing a bundle score, can be successfully applied to the prehospital arena, although future work is needed to establish criteria for measuring optimal quality of care.
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Randomized Controlled Trial
Video laryngoscopy with the macintosh video laryngoscope in simulated prehospital scenarios by paramedic students.
To investigate the effectiveness of the Karl Storz BERCI DCI Macintosh video laryngoscope (MVL) via the TELE PACK system for facilitating intubation by novice paramedic students in a simulation environment. We assessed the laryngeal view, measured by percentage of glottic opening (POGO), when intubating the SimMan manikin airway in different settings. The primary endpoint was the best POGO achieved by the student. Secondary endpoints included intubation times and success rate. ⋯ The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting, and this improvement is greatest in simulated difficult scenarios.
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Pain management in the U. S. Military, particularly in combat, shares many of the same principles found in civilian heath care organizations and institutions. ⋯ Pain management research, education, and treatment strategies have been created to try to achieve adequate battlefield analgesia, and these lessons learned may aid civilian health care providers if the circumstances arise. This article presents a brief history and current overview of pain management for combat casualties on today's battlefield. Recent natural disasters and increased threats for terrorist acts have proven the need for civilian health care providers to be properly trained in pain management principles in an austere or tactical environment.
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Randomized Controlled Trial Multicenter Study
Emergency medical service providers' attitudes and experiences regarding enrolling patients in clinical research trials.
The purpose of this study was to evaluate Emergency Medical Services (EMS) providers' attitudes and experiences about enrolling patients in clinical research trials utilizing the federal rules for exception from informed consent. We hypothesized that Emergency Medical Technicians (EMTs) would have varied attitudes about research using an exception from informed consent which could have an impact on the research. ⋯ The majority of EMS personnel in one community support EMS research and this specific out-of-hospital clinical trial being conducted under an exception from informed consent. Potential barriers to enrollment were identified. Further study in other systems is warranted to better understand EMS provider perspectives about exception from informed consent research.