Articles: emergency-medical-services.
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Emergency medical services with advanced life support systems were implemented in the Minneapolis-St. Paul, Minnesota, area in the mid-1970s. To assess the impact of emergency medical services on coronary heart disease mortality, the authors reviewed ambulance records and hospital emergency room logs for possible out-of-hospital cardiac arrest cases in the period 1972-1982. ⋯ Coronary heart disease mortality rates declined in that period by 34.9% for men (from 527.5 per 100,000 to 343.3 per 100,000) and by 41.7% for women (from 168.6 per 100,000 to 98.3 per 100,000). The authors estimate that improved survival from out-of-hospital cardiac arrest contributed 5.4% (9.9 of 184.2) of the mortality decline for men and 4.3% (3.0 of 70.3) of the decline for women. This was a significant contribution to the decline in coronary heart disease mortality, but it explains only a small part of it.
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Dtsch. Med. Wochenschr. · Oct 1991
Comparative Study[The results of resuscitations in an emergency service].
In a prospective study 166 consecutive cases of prehospital resuscitation by emergency doctors were analysed to ascertain those factors which affect the ultimate outcome. Cardiac causes were most frequent (69%): primary ventricular fibrillation was the most common ECG diagnosis (47%). ⋯ Favourable factors were: primary ventricular fibrillation and start of resuscitation manoeuvres within 10 minutes. These results highlight the need for training first-aid personnel so that the number of successful resuscitations can be increased.
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Pacing Clin Electrophysiol · Oct 1991
Comparative Study Clinical Trial Controlled Clinical TrialPrehospital transcutaneous cardiac pacing for symptomatic bradycardia.
We studied patients with symptomatic bradycardia to determine the importance of presenting hemodynamic status and prehospital transcutaneous cardiac pacing (TCP) upon patient survival. Of 51 patients with witnessed cardiovascular decompensation and initial bradycardia, 27 (53%) received TCP. There were no significant differences between the paced patients and those without TCP for mean times from collapse until cardiopulmonary resuscitation, paramedic arrival and a paceable rhythm, or from paramedic arrival until a paceable rhythm. ⋯ No patient without a palpable pulse on paramedic arrival survived to leave the hospital. Of patients with a palpable pulse upon paramedic arrival, survival to hospital discharge was greater for the paced group (80% in paced vs 0% in nonpaced group; P = 0.024). TCP appears to be most beneficial in those patients with bradycardia who have a palpable pulse when first seen.
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There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10,493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. ⋯ Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.