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
Ensuring the chain of recovery for stroke in your community. Chain of Recovery Writing Group.
Until recently, the prehospital and emergency department management of nonhemorrhagic stroke was largely supportive care. Studies now have demonstrated the potential of certain therapeutic interventions to reverse the debilitating consequences of such strokes. But despite the potential benefit, there exists a clear time dependency for such interventions, not only to ensure therapeutic efficacy, but also to diminish the likelihood of significant therapeutic complications. ⋯ The links include: identification of the onset of stroke symptoms by the patient or bystanders; dispatch life support services, which preferably include enhanced 9-1-1 and medically supervised and trained dispatchers who can rapidly deploy the closest responders and transport units; emergency medical services (EMS) personnel who can rapidly assess and transport the stroke patient to the closest appropriate center capable of providing advanced stroke diagnostics and interventions; en route notification of the receiving facility so that appropriate personnel can be readied for rapid diagnosis and intervention; and receiving facilities capable of providing rapid diagnosis and advanced treatment of stroke, including the availability of specialists who can evaluate underlying etiologies as well as plan future therapies and rehabilitation. To ensure that the chain of recovery is in place, aggressive public education campaigns should be implemented to increase the probability that stroke symptoms and signs will be recognized as soon as possible by patients and bystanders. In addition, because most of the current training programs for EMS dispatchers and prehospital care personnel are lacking with regard to stroke, it is recommended that such personnel and their EMS system managers be updated on current management and treatment strategies for stroke.
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Randomized Controlled Trial Clinical Trial
The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects.
To compare the incidences and severities of pain experienced by healthy volunteers undergoing spinal immobilization in the neutral position with and without occipital padding. To compare the incidence of pain when immobilized in the neutral position with the incidence in a nonneutral position. ⋯ Pain is frequently reported by healthy volunteers following spinal immobilization. Occipital padding does not appear to significantly decrease the incidence or severity of pain. Alignment of the cervical spine in the neutral position may reduce the incidence of pain, but further studies should be conducted to substantiate this observation.
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To determine the effect of needle thoracostomy (NT) in the prehospital setting, its frequency of use, and its complication rate. ⋯ Prehospital NT is a procedure infrequently performed by paramedics, even in a busy urban area. While there is a risk of the procedure's being done without proper indication, NT may improve outcomes in a small subset of chest-injured patients.
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Comparative Study
A comparison of paramedic didactic training hours and NREMT-P examination performance.
The didactic hours required by paramedic training programs differ tremendously throughout the country. The authors hypothesized that a correlation exists between paramedic didactic training hours and pass/fail performance on the National Registry Examination. ⋯ There is no correlation between paramedic didactic training hours and pass/fail performance on the NREMT-P examination.
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Rates of resuscitation from cardiac arrest are directly tied to time to defibrillation. To maximize results, the first arriving care provider should be equipped and trained to defibrillate. This would include police in those systems where they serve this function; to date, no training program has been examined for effectiveness in this group. The purpose of this study was to evaluate a training program designed to train police first responders in the use of an automated external defibrillator (AED). ⋯ Police first responders trained in the use of AEDs performed at a level equivalent or superior to that in other reported studies. Future training strategies should stress proper integration of airway and CPR skills.