Articles: emergency-medical-services.
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Regionalization of health care for trauma has become commonplace, and the same concept for critically ill medical/surgical patients is developing. Recent evidence suggests that current stabilization measures used by transport teams can be inadequate for this critically ill patient population. In trauma, speed has been considered a necessity to get the patient to a facility which cannot be carried out to the field, eg, an operating room. ⋯ Accumulating evidence supports the premise that speed of transport is not as important as stabilization before transport, knowledge of hemodynamics during transport, and early use of critical care monitoring systems. Other reports identify the need for initial evaluation and stabilization of critically ill patients by physicians at the critical care level of expertise. Accordingly, critical care transportation teams have evolved, creating new notions of pretransport stabilization not applicable to previous transport systems.
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Randomized Controlled Trial Clinical Trial
Prehospital prophylactic lidocaine does not favorably affect outcome in patients with chest pain.
The purpose of our study was to determine the morbidity and mortality in initially stable patients presenting to paramedics with chest pain; to examine possible beneficial effects of its use, including reduction of sudden death syndrome in the prehospital and emergency department setting; and to determine if prophylactic lidocaine is associated with adverse effects in this patient population. ⋯ There are no benefits from the administration of prehospital prophylactic lidocaine in stable patients with chest pain; therefore, routine use in this setting appears unwarranted.
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Emergency Medical Services are an area of special interest in emergency medicine. Many emergency physicians are called upon to direct, train, or manage emergency medical services. Residents training in emergency medicine have a need for a defined curriculum in emergency medical services. ⋯ The resident must gain experience through on-scene observation, EMT/Paramedic education, medical direction, and quality assurance activities. This paper is one in a continuing series of goals and objectives to direct resident training in off-service rotations. Specific resources, learning objectives, and experiences are suggested.
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Historical Article
The beginnings of urban ambulance service in the United States and England.
Urban ambulance systems emerged in the second half of the 19th century as an outgrowth of military experiences in both Europe and America. Developing first in cities such as Cleveland and New York, these systems quickly adapted to the urban environment, and modifications in ambulance construction and procedures soon followed. Since first-aid texts for urban ambulances were rare, military texts on battlefield medicine were adapted to emergency medicine in civilian accidents.