Articles: emergency-medical-services.
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Multicenter Study Clinical Trial
Preventable trauma deaths in The Netherlands--a prospective multicenter study.
The data of all trauma fatalities occurring in 12 Dutch hospitals during a period of 1 year were reviewed for management errors and preventable deaths by a panel of five surgeons trained in trauma care. Management errors occurred in 38% of the fatalities. There was a significantly higher percentage of management errors in small general hospitals (72%) than in large general (29%) and in university hospitals (34%). ⋯ A significantly higher preventable death rate occurred in small general hospitals (48%), than in large general (14%) and university hospitals (19%). From these results, it can be concluded that management errors and preventable deaths are general phenomena occurring in any hospital. However, they occur significantly more frequently in hospitals not especially equipped to manage severely injured patients.
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Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. ⋯ Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intraosseous infusion is an outmoded technique that is gaining new prominence in the field of emergency medicine. Although not recommended as a replacement for conventional modes of intravascular access, this alternative provides rapid venous access during life-threatening emergencies. A review of the literature indicates that the intraosseous route provides relatively safe, rapid, and reliable access to the systemic venous circulation and is associated with an acceptably low complication rate. This article offers a brief historical overview of this technique and discusses insertion methods, clinical applications, and nursing management of pediatric intraosseous infusion.
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The role of Helicopter EMS must be to improve patient care and/or to ensure the most rapid transport of critically ill or injured patients. It has been suggested by Rhee et al, that the aeromedical service can be justified when the speed of the helicopter transport, the skills of the medical crew, and/or the ability of the helicopter to overcome environmental obstacles is likely to contribute to improved patient outcome. If one adds the essentials of well-trained, professional personnel and equipment, the "helicopter" becomes an important part of the overall medical care system and an essential component in improving patient outcome. ⋯ At the same time, an apparent paradox in mortality rate has occurred at the receiving hospital. While more patients are saved by speedy transport to a hospital, the mortality rate in that hospital may actually increase. Some patients who may have died from their injuries at the scene, or in transit, now die upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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Civilian helicopters and emergency medical services in the United States have been in existence for approximately 15 years. The rapid growth of this type of health care delivery coupled with an increasing number of accidents has prompted professional and lay scrutiny of these programs. ⋯ Significant questions regarding the number of pilots in a helicopter and in a program remain to be answered. This article reviews the role of emergency medical air transport services in providing care to trauma patients, staff training and evaluation, and safety criteria and offers recommendations to minimize risks to patients and crews.