Articles: emergency-medical-services.
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To improve patient outcome and reduce time at the scene, treatment protocols for specific injuries and rapid transport should be established with individual systems. These standards should be based on such parameters as history, mechanism of injury, physiologic status of the patient on arrival, triage criteria, and predicted transport times. Ensuring airway patency and stability is a vital function that must be rapidly and carefully performed. ⋯ Indeed, more research is necessary in order to confirm, perfect, or dispute the many traditional theories that have been a part of prehospital technology. As the field of emergency medicine continues to develop and expand, so too will the specialty of prehospital medicine. Napoleon would be proud!
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The methods of obtaining data and assessing protocol compliance in prehospital research can present difficulties. The Norwalk Hospital Mobile Emergency Medical Service paramedics use a minicassette recorder carried in the monitor-defibrillator pack during their participation in a cardiac arrest study. ⋯ With this recorder, the investigator is able to accurately identify when interventions occurred and the patients' response to therapy. The use of a minicassette recorder can facilitate data collection for prehospital research with minimal disruption for the paramedic providing care.
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Prehosp Disaster Med · Jan 1993
Multicenter StudyThe prehospital use of nitroglycerin according to standing medical orders in an urban EMS system.
The purposes of this study are to quantify the use of nitroglycerin (NTG) in prehospital care, to detect deviations from the Standing Medical Orders (SMO), to determine the effectiveness of its administration, and the incidence of clinically significant adverse reactions (hypotension, bradycardia). ⋯ In this EMS system, NTG is under-utilized based on the indications delineated by this system's SMOs. Reassessment is documented infrequently, but when completed, clinically significant adverse reactions are rare. Since the incidence of hypotension and bradycardia are rare, the inability to establish an IV line should not preclude the administration of NTG.
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Prehosp Disaster Med · Jan 1993
ReviewDo-not-resuscitate orders. Where are they in the prehospital setting?
Without a well-functioning, prehospital, do-not-resuscitate (DNR) system in place, emergency medical service (EMS) providers must resuscitate all patients who access the system, regardless of the patients' wishes and regardless of what makes ethical or economic sense. In lieu of valid documentation, it is not appropriate to withhold resuscitative measures in this critical, time-dependent situation. ⋯ This review includes: 1) the basis and requirements of a DNR system; 2) legal and physical forms for DNR orders; 3) eligibility for DNR status; 4) reversal of DNR orders; and 5) inappropriate use of EMS systems for DNR patients. Finally, a more general discussion of overall resource utilization in prehospital resuscitations is presented to emphasize that implementing prehospital DNR systems is only one piece of a larger issue.