Articles: emergency-medical-services.
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The prehospital index (PHI) is a triage-oriented trauma severity scoring system. This prospective multicenter validation of the PHI was undertaken in response to a favorable pilot study. ⋯ The curves were generated for PHI versus emergency surgery, mortality, surgery and mortality, injury severity score, and ICU admission rate. These data compare favorably with those from previously published, prospectively tested, triage-oriented trauma severity scoring systems.
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The ability of paramedics to deliver advanced trauma life support (ATLS) in an expedient fashion for victims of trauma has been strongly challenged. In this study, the records of 114 consecutive victims of blunt trauma who underwent laparotomy or thoracotomy were reviewed. Prehospital care was rendered by paramedics operating under strict protocols. ⋯ On-scene times were analyzed according to the number of ATLS procedures performed: insertion of one IV line (n = 46), 14.8 +/- 1.03 minutes; two IV lines (n = 28), 13.4 +/- 0.92; one IV line plus intubation (n = 7), 14.0 +/- 2.94; two IV lines plus intubation (n = 9), 17.0 +/- 2.38; and two IV lines plus intubation plus PASG (n = 13), 12.4 +/- 1.36. Of the 161 IV attempts, 94% were completed successfully. Of 36 attempts at endotracheal intubation, 89% were successful.(ABSTRACT TRUNCATED AT 250 WORDS)
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Despite the maturing of prehospital emergency care over the last 25 years, many controversies still persist. Although EMS personnel now widely recognize that medical cardiac arrest patients and traumatic cardiac arrest patients require different amounts of field stabilization and treatment, there is still no clear answer as to how much stabilization using what treatments is necessary. Similarly, although it is widely accepted that out-of-hospital cardiac arrest with ventricular fibrillation should be rapidly defibrillated, there is no consensus as to who should deliver the countershock and with the use of what equipment. These and many other controversies of prehospital care arise because this field is new and rapidly growing.
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Acute, critical patients require a rapidly applied, highly refined diagnostic approach if their chances for survival are to be maximized. EMS systems have made great strides in addressing the management challenges confronting them, especially via the development and refinement of severity assessment instruments. ⋯ The methodology for the development of the latter has not yet even been explored in the EMS literature. It is hoped that this sharing of Port Worth's recent experiences will help other EMS professionals who find themselves either in the early stages of major system redesign or the initiation of a new EMS system.