Articles: emergency-medical-services.
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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.
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To enhance comparability in reports on survival from out-of-hospital cardiac arrest, an international task force recently developed a set of guidelines for uniform terminology, definitions, and data collection for outcome research on cardiac arrest--the Utstein style. Because the data collection recommended is limited to information available through emergency medical services systems, the potential for bias in comparisons of cardiac arrest outcomes remains. By expanding data collection to include the identification of all cases of cardiac arrest in the community, including patients who do not present for care by an emergency medical services system, a population-based approach can be achieved. We review the strengths and limitations of both emergency medical services-based and population-based data collection to assess outcomes of cardiac arrest, outline practical steps required to implement a population-based approach, and suggest that extension of the Utstein style guidelines to include all cardiac arrest cases within a defined population is needed to minimize potential bias in comparisons of cardiac arrest outcomes across communities or over time.
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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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Review Comparative Study
The complexity of comparing different EMS systems--a survey of EMS systems in Europe.
In Europe, emergency medical care has developed since the Middle Ages in each country, even within regions of a country, resulting in a patchwork of definitions, legislations, and systems. As a consequence, emergency medical care was implemented differently according to sociocultural, geographic, political, and religious differences between and within individual European countries. The objective of this survey was to describe the emergency medical services (EMS) systems in place throughout Europe, the type and qualification of the personnel, citizen-CPR knowledge, and experiences with automated external defibrillator programs. ⋯ To describe the EMS system, a uniform nomenclature is required. The Utstein "template" style could be proposed as the guideline to describe individual systems. The European Resuscitation Council could contribute in coordinating and standardizing the various aspects of emergency medical care in Europe, with detailed registration, medical coordination, and medical regulation being the principal working rules.