Articles: emergency-medical-services.
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Critical care medicine · Dec 1993
Cardiac arrest presenting with rhythms other than ventricular fibrillation: contribution of resuscitative efforts toward total survivorship.
The medical literature portrays a bleak prognosis for out-of-hospital cardiac arrest cases presenting with asystole, idioventricular rhythms with pulselessness, or primary electromechanical dissociation. In view of evolving philosophies to waive resuscitation attempts in such cases, we sought to delineate the actual contribution toward overall survivorship that is provided by resuscitation efforts for patients who have these electrocardiographic presentations. ⋯ Despite poor survival "rates," resuscitative efforts for patients presenting with asystole, electromechanical dissociation, and idioventricular rhythms with pulselessness all contribute significantly toward a community's total survivorship from out-of-hospital cardiac arrest. Initial, aggressive attempts at resuscitation still should be emphasized in such patients.
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Pediatric emergency care · Dec 1993
Emergency medical services preparedness for pediatric emergencies.
The study objective was to examine emergency medical services (EMS) equipment and training preparedness for pediatric emergencies in Oklahoma. The participants were 202 administrators of licensed EMS agencies in the state of Oklahoma. A mailed questionnaire was used to obtain data from EMS agencies regarding emergency ambulance run characteristics, medical control, equipment, and personnel training. ⋯ Most services provided intraagency continuing education, but only 71 (54%) included pediatric topics in continuing education. Deficiencies in equipment and training for pediatric emergencies are a common problem for EMS agencies in Oklahoma. Barriers to preparedness include: 1) relative infrequency of pediatric runs and difficulty with maintenance of technical skills, 2) costs associated with increased equipment and training, and 3) hesitancy to allow personnel to perform advanced life support procedures on children.
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To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. ⋯ Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.
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To determine the speed and characteristics of patient response to urban first-responder defibrillation and to determine whether amplitude of ventricular fibrillation (VF) can predict outcome in these patients. ⋯ Patients in VF who were treated by early countershock refibrillated much more frequently than previously reported. Refibrillations occur both early and late. Initial VF maximum amplitude is strongly predictive of outcome. Future reports of VF cardiac arrest should control for this previously neglected variable. Increased amplitude of VF during repeated refibrillation episodes is associated with increased hospital discharge, so future studies of advanced cardiac life support interventions should explore changes in VF amplitude as an outcome variable.