Articles: emergency-medical-services.
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Pediatric emergency care · Oct 1993
The educational value of pediatric emergency transport: by design or by default?
Pediatric emergency transport teams provide an important and challenging clinical experience in many residency training programs. However, the educational value of this experience has not been carefully examined. A 32-item questionnaire was developed to assess curricular components of the three phases of the transport experience in residency training: phase 1 included pretransport training and qualifications and curricular planning, phase 2 addressed intratransport phone backup for the team analogous to online medical command, and phase 3 included posttransport feedback and performance evaluation. ⋯ Thirty percent routinely provide feedback within one week of the transport. Sixty-three percent of chief residents view the experienced transport nurse as an equal member of the transport team. The study found that the educational structure of transports is largely unplanned and that basics such as preservice training and timely performance feedback are not usually addressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Helicopter retrieval of primary trauma patients by a paramedic helicopter service.
All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. ⋯ Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non-intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortality), which was not significantly different from the predicted mortality of 17%.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene. ⋯ Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS does not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to cease efforts in the field.