Articles: emergency-medical-services.
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American heart journal · Jan 1991
Multicenter Study Clinical TrialPrehospital diagnosis and treatment of acute myocardial infarction: a north-south perspective. The Cincinnati Heart Project and the Nashville Prehospital TPA Trial.
Intravenous thrombolytic therapy improves left ventricular function and reduces mortality in patients with acute myocardial infarction (AMI). In European and Middle Eastern trials, prehospital delivery of thrombolytic agents by physician-directed mobile intensive care units has been successful. This report describes two independently conceived and performed trials that used cellular telephone transmission of 12-lead ECGs to deliver recombinant tissue plasminogen activator (r-tPA) in the field to patients with AMI. ⋯ Combining the Nashville and Cincinnati experiences, only 27 of 562 total patients with chest pain (4.8%) were candidates for prehospital thrombolysis. We conclude that few patients evaluated in the prehospital setting are actual candidates for thrombolytic therapy. Substantial allocation of financial and human resources for prehospital delivery of intravenous thrombolytic therapy does not appear warranted.
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A music festival was held in July 1989 near Liskeard in Cornwall. This paper comments on some of the organisational problems, and documents the workload of voluntary workers and professional medical agencies serving the festival. ⋯ There were two deaths and one birth at the site. It is suggested that, in addition to the services provided by voluntary agencies, organisers of mass gatherings should provide suitably qualified medical and nursing personnel on site.
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The Three Rivers Regatta accident occurred on August 7, 1988 when a Formula I racing craft collided with shore, injuring 24 spectators. The authors retrospectively examined the prehospital-based response for this multiple-casualty incident that used emergency medical service (EMS) physicians and 32 paramedics stationed at water and land-based posts to triage and evacuate 24 patients in 32 minutes. Patients were transported to 5 hospitals including 4 Level I trauma centers; this was accomplished in 53 minutes. ⋯ This was a prehospital-based rescue with the entire triage and stabilization phase accomplished by River Rescue units that transported paramedic divers, EMS physicians, and trauma supplies for 30 patients. Also of significance was the inordinate proportion of pediatric patients that accounted for 50% (12/24) of the cases. Successful medical care was the result of planning based on "Daily Routine Doctrine" or escalation of existing treatment protocol; adequate supplies, personnel and transport adapted to local geography and patient population; communications, including all services--EMS, police, and fire; and prehospital physician input to ensure correct triage order and patient disposition.
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During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. ⋯ Among the survivors a psychological assessment in form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2.