Articles: emergency-medical-services.
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A triage system was established as the initiating mechanism for a trauma team response to assist the assessment and early management of patients presenting to an accident and emergency department. A checklist of triage criteria was used. During a 6-month period, 342 patients (29.7% of trauma admissions) satisfied the triage criteria, which should have resulted in an average of 1.9 trauma team calls per day. ⋯ Using data from 564 patients from both series, logistic regression analysis of the power of the triage criteria to predict serious injury contributed to a revision of the triage criteria. This trauma triage tool and trauma team response constitute a valid approach to the early hospital management of trauma patients. This system may be more appropriate or achievable in many hospitals than the construction of dedicated trauma reception units or permanent surgical staffing of general Accident and Emergency departments.
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Observation units (OBS) are becoming a common addition to the emergency department. The diagnostic and socioeconomic categories of patients admitted to the OBS unit resemble those seen in the emergency department. There are many advantages and disadvantages in establishing such a unit. Although OBS units provide improved patient care, current difficulties in reimbursement may delay their widespread acceptance.
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The occupational injury profile of emergency medical technicians (EMTs) and paramedics is not well described. We retrospectively studied 254 injuries over a 3.5-year period in a busy urban EMS system. Low back strain was the most common injury (93/254, 36%), with EMTs suffering a significantly higher injury rate than paramedics (0.33 v 0.17 injuries/person-years at risk, P = .03). ⋯ Approximately 96 injuries accounted for 481 compensation days with low back strain the cause of 375 days (78%). Our findings suggest a high incidence of occupational injury in EMS personnel with EMTs and persons under 30 years of age at higher risk. Guidelines for prevention programs are suggested.
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The optimal extent of prehospital care, including intravenous (IV) therapy for critically ill patients, remains unclear. The authors evaluated the success rate for IV cannulation in a moving ambulance by trained emergency medical technicians and paramedics in 641 adult medical- and trauma-related cases. ⋯ In hypotensive patients, the success rates for at least one IV in medical and trauma patients were 80% and 95%, respectively. These data suggest that IV lines can be secured with a high degree of success en route to the hospital by trained personnel, and that prompt transport of unstable patients should not be delayed solely to obtain IV access.