Articles: emergency-medical-services.
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This study prospectively determined the feasibility and accuracy of prehospital thrombolytic therapy candidate selection by base station emergency physicians. During a 6-month period, paramedics acquired and transmitted prehospital 12-lead electrocardiograms (ECGs) and then applied a thrombolytic therapy contraindication checklist. Emergency physicians interpreted prehospital ECGs and prospectively selected candidates for thrombolytic therapy. ⋯ The estimated average time saved if prehospital thrombolytic therapy had been available was 101 +/- 81 minutes. The safety committee concluded that acceptable accuracy of emergency physician prehospital electrocardiographic interpretation, checklist and case selection was achieved. It is concluded that emergency physicians can accurately identify candidates for prehospital thrombolytic therapy.
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Comparative Study
Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?
To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). ⋯ We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.
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Critical care medicine · Apr 1992
Role of a prehospital medical system in reducing heroin-related deaths.
The mortality rate from heroin overdose in Italy between 1977 and 1987 increased significantly. However, in the same period, a significant increase was not observed in Tuscany, an administrative region in Italy. This study was performed to determine if the prehospital emergency medical system of Florence, the capital of Tuscany (the only one operating in Italy during the study period), affected this lower mortality rate. ⋯ We suggest that an emergency medical system can play an important role in reducing the mortality rate from heroin overdose.