Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Clinical Trial
Prehospital identification of acute coronary ischemia using a troponin T rapid assay.
To evaluate the performance of a rapid assay for cardiac troponin T (cTn-T) in patients with chest pain in the prehospital setting. ⋯ The cTn-T rapid-assay device may be useful in the prehospital setting to identify a small number of patients with ACI. The authors caution, however, that a negative test in the prehospital setting cannot be used to rule out significant disease.
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Comparative Study
The effectiveness of lights and siren use during ambulance transport by paramedics.
To determine whether lights and siren (L&S) use during transport in the authors' EMS system results in reduced transport time to the hospital. Second, to determine whether L&S use results in any emergency department critical interventions in the time saved. ⋯ Use of L&S significantly shortens transport time. In this series of patients transported under the care of a paramedic, the time saved by the use of L&S was not usually associated with immediately apparent clinical significance.
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To determine the safety and efficacy of succinylcholine, as an adjunct to endotracheal intubation, administered by paramedics trained in its use. ⋯ Paramedics trained to use succinylcholine, to assist the process of endotracheal intubation, can safely intubate a high percentage of patients.
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To investigate the effect of adding a ground critical care ambulance service on the utilization of the pre-existing helicopter air ambulance. ⋯ The attempt to decrease the demand for a helicopter air ambulance by initiating a parallel ground ambulance service was not successful. Programs adding a ground critical care ambulance to existing helicopter services should not expect a decrease in utilization of the helicopter. These services should be viewed as complementary but not interchangeable.
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The authors describe the 53-hour rescue of a 6-foot, 1-inch tall, 250-pound hiker in the face of harsh environmental conditions in Sequoia National Park. This 43-year-old man fell 25 feet, injured his leg, and was noted to be hypothermic and hypovolemic. ⋯ On arrival, the patient was determined to have a comminuted subtrochanteric right femur fracture, which was ultimately repaired surgically. The authors also discuss some of the unique aspects of wilderness and National Park Service EMS.