Articles: emergency-medical-services.
-
Most patients with serious illness prefer to die at home; however, for those requiring ongoing ventilatory support, this preference is often not honored due to the difficulties of arranging a palliative extubation at home. Here we present two cases of successful home palliative extubations, coordinated by a multidisciplinary team including critical care, palliative care, care management, hospice, and emergency medical services (EMS) clinicians. By exploring the operational and regulatory challenges accompanying these cases, we provide a road map for offering mechanically ventilated patients the choice of a death at home and provide truly holistic and patient-centered care.
-
Septic shock (SS) is a potential life-threatening condition in which an early identification and immediate therapy stand out as the main cornerstones to improve survival chance; in this context, emergency medical services (EMS) become key to reduce the time between diagnosis and management in the ICU or emergency department. However, guidelines for the prehospital management of SS patients remains unclear, and literature around this topic is scant. Our scoping review was conducted following the PICO framework and a search strategy related to septic shock management and diagnosis in prehospital settings was executed in PubMed, Scopus and Virtual Health Library; articles in English and Spanish from 2015, onwards, were screened by the authors and selected by mutual consensus. Our aim is to analyze the prehospital management strategies of SS reported in the literature, and to showcase and summarize the screening tools, demographic factors, clinical manifestations and prognostic factors of SS in the prehospital setting.
-
Scand J Trauma Resus · Nov 2024
Prehospital ultrasound constitutes a potential distraction from the observation of critically ill patients: a prospective simulation study.
Prehospital point-of-care ultrasound allows an unstable patient to be rapidly and accurately assessed. However, we are concerned that an excessive focus on the ultrasound device, in an already demanding emergency medical service environment, may distract from patient care, potentially leading to reduced situational awareness and the neglect of other crucial instruments, such as the patient monitor. Thus, in this study, we examined the influence of prehospital ultrasound on situational awareness, by studying the degree to which physicians were distracted from the patient monitor. ⋯ The task of performing an ultrasound examination appears to overwhelm some participants and distract them from other aspects of the scenario. Efforts to mitigate distractions and optimise the use of prehospital ultrasound, such as education, a focus on human factors aspects and standardisation, are crucial for maximising the potential benefits of prehospital ultrasound.
-
Scand J Trauma Resus · Nov 2024
Racing against time: Emergency ambulance dispatches and response times, a register-based study in Region Zealand, Denmark, 2013-2022.
The global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times. This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities. ⋯ From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards.
-
Medically complex children present a low frequency but often high acuity patient population for emergency medical services (EMS) personnel. We present a case of a 12-year-old male with Duchenne muscular dystrophy and adrenal agenesis found unresponsive. ⋯ This case highlights the importance of recognizing adrenal insufficiency-induced hypoglycemia in patients presenting with altered mental status. EMS personnel should be trained to identify and manage adrenal insufficiency, using detailed histories and on-scene medical oversight to improve outcomes.