Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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EMS was recognized as a subspecialty of Emergency Medicine in 2010. Accreditation of EMS fellowship programs started in 2013. Despite increasing numbers of programs and a decade since recognition, little has been written about the characteristics and offerings of these programs. ⋯ Despite some commonality, especially in required experiences, considerable differences exist between programs in how education is delivered. However, none of them correlate with filling or the size of the program. Involvement in unique areas such as ultrasound or community paramedicine was not universal. It is unclear what if any impact these differences have on career preparation and satisfaction. Programs may wish to consider sharing resources to offer future EMS physicians more comprehensive experiences.
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Given that the benefits of helicopter transport vary with geography and healthcare systems, we assessed transport times for rotor wing versus ground transport over a 10 year period in an urban setting. ⋯ In over 25,000 transports over 10 years, in a compact metropolitan area with relatively short transport distances and times, the use of the helicopter was associated with substantial time savings.
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Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. This study aimed to describe treatment patterns and the odds of a favorable patient outcome (e.g., return of spontaneous circulation (ROSC) or being presumptively alive at the end of the incident) among rural OHCA patients in the U.S. ⋯ In this national sample of EMS-treated OHCAs, rural patients had lower odds of a favorable outcome (e.g., ROSC or presumptively alive) compared to those in urban settings.
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Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. ⋯ In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly.
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The duration of low flow prior to initiation of extracorporeal cardiopulmonary resuscitation (eCPR) appears to influence survival. Strategies to reduce the low-flow interval for out-of-hospital cardiac arrest have been focused on expediting patient transport to the hospital or initiating extracorporeal support in the prehospital setting. To date, a direct comparison of low-flow interval between these strategies has not been made. ⋯ It would be rare to successfully initiate eCPR by either strategy in fewer than 30 minutes from the time of patient collapse. Using a prehospital cannulation strategy, the entire coverage area could be eligible for eCPR within 60 minutes of patient collapse. The use of predictive modeling can be a low-cost solution to assist with strategic deployment of prehospital resources and may have potential for real-time decision support for prehospital clinicians.