Articles: emergency-medical-services.
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Comparative Study
Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.
All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. ⋯ A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.
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A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. ⋯ The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.
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For many people who deal with medical emergencies--some human resource managers, emergency team administrators, CPR and first aid instructors, EMTs, nurses and physicians--the topic of oxygen use by nonmedical responders at the workplace is poorly understood. Workplace emergency response administrators may find it helpful to become familiar with the current emergency medical literature and learn that the previous literature may no longer apply. Furthermore, fear that use of emergency oxygen by nonmedical responders is "playing doctor," and will lead to some imagined uncontrollable catastrophe is based on statistically and medically unfounded misinformation. ⋯ Refusing to allow appropriately trained nonmedical responders to use reliable emergency oxygen when it is available is a potentially grave error and makes emergency care in the workplace less efficient and valuable. There are many cases of workplace injury or illness in which oxygen use is not only appropriate but may help save a patient's life. Ensuring that the proper emergency oxygen equipment is available where appropriate and properly training personnel are responsible for first aid can, in some cases, lessen the severity of workplace illness and injury incidents.
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Since 1985, it has become apparent that the key to survival from adult sudden cardiac death is prompt defibrillation. Any delay from the time of collapse to the initial countershock will decrease the likelihood of survival. It also has been determined that CPR performed by lay rescuers is not begun promptly and, once started, often is performed for more than one minute before the emergency medical services (EMS) system is accessed, which significantly delays the time to defibrillation. ⋯ Therefore, a rescuer should perform one minute of rescue support before activating the EMS system (a concept termed phone fast). It is recognized that this change is dependent upon a national EMS system that is still evolving. It is hoped that this change to phone first and phone fast will provide an impetus for rapid development of the EMS infrastructure.