Articles: emergency-medical-services.
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To determine the time between ambulance arrival at the scene to paramedic arrival at the patient (arrival to patient contact) and the effect of barriers to paramedic movement on this time interval. ⋯ The arrival-to-patient contact interval adds a variable and potentially lengthy amount of time to the total prehospital response time interval, and barriers impeding paramedic movement to the patient prolong this time interval. In 25% of all observed paramedic calls, the arrival-to-patient contact interval was more than four minutes. Measurement of the time from ambulance arrival on the scene to paramedic arrival at the patient is necessary to appropriately determine the relationship among total prehospital response time, paramedic interventions, and patient outcome.
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To evaluate the ability of paramedics in a nonurban emergency medical services system to use the Combitube, a combined endotracheal and esophageal obturator airway adjunct, in prehospital cardiac arrest patients. ⋯ Although visualized endotracheal intubation remains the preferred method of airway control, the Combitube may be an effective prehospital airway device as both a backup to the endotracheal tube and a primary airway. Although the Combitube does not require visualization with a laryngoscope, comprehensive training and continuing education are key factors affecting skill retention.
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To estimate the frequency of violence directed toward prehospital providers; to identify the methods used to manage violent patients in the prehospital setting; and to identify the educational, medical, and legal issues in the prehospital management of violent patients. ⋯ The potential for injury to prehospital providers from violent patients is probably widespread, and no mechanism for identifying injuries or exposure to violent patients currently exists. All systems should have protocols for managing violent patients and for restraint application. Educational sessions for self-defense and assessment of the scene for violence may be indicated.
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Prehosp Disaster Med · Jul 1993
Accuracy of the Prehospital Index in identifying major hemorrhage in trauma victims.
To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility. ⋯ The data suggest that patients with PHI scores greater than 3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.
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On January 25, 1990, a jetliner crashed on Long Island, New York. Twenty-two children survived the crash. The purpose of this study was to evaluate the emergency medical system's response to these pediatric survivors. ⋯ Pediatric survivors were neither adequately triaged nor transported to appropriate facilities which could optimize their care. Possible explanations for this include: (1) unique features of the rescue operation, (2) limited pediatric training of prehospital personnel, and (3) deficiencies of the regional disaster plan. Emergency medical services systems and disaster plans can be made more responsive to children's needs by: (1) acknowledging that children have special needs requiring referral, (2) improving the training of prehospital personnel in pediatric emergency care, (3) classifying ill and injured children according to appropriate triage criteria, (4) recognizing existing tertiary care pediatric centers as the optimal location for the treatment of critically ill and injured children, and (5) designating these centers as the appropriate transport destination for critically ill and injured children.