Articles: emergency-medical-services.
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Practice Guideline Guideline
The new American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: presented by the Emergency Cardiac Care Subcommittee of the Heart and Stroke Foundation of Canada.
CPR courses (both basic and advanced) continue to evolve. The recent CPR and ECC guidelines by the AHA consolidate the research and vast experience in one document. These guidelines are helpful to lay people and health care professionals who intervene in cases of cardiac arrest. They are also excellent resources for those involved in coordinating ECC systems in the community.
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Many patients arrive at the accident and emergency (A&E) department in pain. To quantify this problem a retrospective analysis was performed of the clinical records of 502 consecutive patients arriving by ambulance at the A&E department over a 20-day period. A total of 273 (54%) of the patients had pain as a symptom on arrival and 69 (14%) were given opioid analgesia in the A&E department. ⋯ C.). There were wide variations in the attitudes of services around the country to future developments. The authors suggest that paramedics should be trained to administer intravenous opioid analgesia.
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Critical care medicine · Sep 1993
Comparative StudyEffect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.
Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system. ⋯ The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.
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The effects of dual responses [Basic Life Support (BLS) and Advanced Life Support (ALS)] on the outcomes of trauma patients were evaluated. Outcomes included changes in physiologic measurements between the scene and the emergency department (ED), and survival to hospital discharge. Data for 2394 patients with penetrating, motor vehicle crash (MVC), or other blunt injuries were included. ⋯ Survival to hospital discharge among penetrating injury patients was negatively related to dual responses, whereas that among MVC patients was positively associated with dual responses. Parallel results were found for a subset of more severely injured patients. Future research should confirm and refine these results so that protocols for the appropriate use of dual response runs can be developed.
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In a Danish suburban community the following attempts were made aimed at increasing survival of out-of-hospital cardiac arrest (CA): the citizens were offered training in diagnosis and treatment of CA and the ambulances serving the community were provided with a semiautomatic defibrillator. The results of these effects were evaluated over a two-year period. One hundred and seventy persons out of a population of 85,824 received training in CPR. ⋯ In 336 situations tape recordings of the ECG at CA were available for analysis. Ventricular fibrillation was present in all of the 129 cases where DC-conversion was advised by the apparatus. There were two additional cases, one of ventricular fibrillation of low frequency and one of ventricular tachycardia where DC-conversion was not advised, but might have been beneficial.