Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comment Comparative Study
Outcomes of cardiac arrest in the nursing home: destiny or futility? [see comment].
To compare EMS system characteristics and outcomes between nursing home (NH) patients and out-of-hospital cardiac arrest (OHCA) patients whose arrests occurred in a residence (home). ⋯ During this four-and-a-half-year study period, no NH patient survived, even though % CPR was increased. Arrest rhythm is an important factor in this finding. EMS initial care for ventricular tachycardia/fibrillation NH patients, with less application of AEDs, was identified. This different response may adversely contribute to dismal NH outcome.
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Multicenter Study
Hazardous materials preparedness in the emergency department.
This study was conducted to examine the preparedness of emergency departments (EDs) to safely receive, decontaminate, and treat chemically contaminated patients. ⋯ Hospital hazmat preparedness in this area varies tremendously. A significant proportion of hospitals lack a written plan and equipment to allow the ED to safely and effectively handle the chemically contaminated patient. There is reluctance to discuss this topic.
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To examine the ease of endotracheal intubation on the ground for various rescuer positions. ⋯ All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.
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The study was conducted to determine whether the use of prehospital instant photography of motor vehicle crashes (MVCs) by paramedics altered receiving physician (RP) perception of the magnitude of crash severity, as compared with verbal reports of vehicle damage. In addition, the study sought to determine whether altered RP perception resulted in any subsequent changes in emergency department (ED) management. ⋯ The augmentation of verbal paramedic reports with prehospital instant photographs frequently altered both physician perception of MVC severity and subsequent ED management of these trauma patients. However, cost to the patient and length of hospital stay were not significantly altered as a result of the change in physician perception.
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The American Heart Association (AHA) currently recommends two-finger (TF) chest compression for infants. A previous study demonstrated that two-thumb (TT) with lateral chest wall compression provided significantly higher arterial pressures than did the TF method. Limitations of that study included the lack of an asphyxial model and non-standardized compression forces. ⋯ The TT method produced significantly higher SBPs. The authors were unable to demonstrate that the increased SBPs were secondary to the thoracic compression component because the rescuers did not reach the predetermined SCF in the TF groups. In this swine model of infant CPR, TT chest compression is an easier and more effective method.