Articles: emergency-medical-services.
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Randomized Controlled Trial Clinical Trial
Automatic external defibrillation: evaluations of its role in the home and in emergency medical services.
Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. ⋯ This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.
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J. Am. Coll. Cardiol. · Sep 1984
Basic emergency medical care of patients with acute myocardial infarction: initial prehospital characteristics and in-hospital complications.
This prospective study documents the natural history of the prehospital phase of 110 patients with acute myocardial infarction transported by a basic emergency medical system during a 22 month period. Ambulances in a mixed urban-rural county were staffed by basic emergency medical technicians certified in basic life support and the administration of intravenous fluids. Systolic blood pressure, pulse rate and cardiac rhythm were noted for all patients at the time of ambulance arrival and intermittently during transport. ⋯ When initial rhythm, pulse rate and blood pressure were considered, patients with hypotension had a higher mortality rate than did those who were either normotensive or hypertensive. The 10 patients with initial sinus bradycardia but no hypotension constituted a subgroup with zero mortality. These results identify high and low risk patient subgroups that may benefit from either providing or withholding interventions directed toward hemodynamic stabilization during the prehospital phase of acute myocardial infarction.
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We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac arrest events. ⋯ We judged the quality of CPR to be comparable to the performance of individuals who have received formal training. The specific words used in the message directly determined adequacy of performance, and resulted in significantly better CPR performance than did impromptu instruction offered by professional dispatchers (P less than or equal to .02).
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A coordinated community response to cardiac arrest can be successful if the response time to administration of cardiopulmonary resuscitation (CPR) is less than four minutes and to administration of advanced cardiac life support (ACLS) is less than eight minutes. Elements needed to achieve this goal include rapid access to the emergency medical system; widespread CPR training; rapid response of first responders trained in basic life support; rapid response time to ACLS, including resuscitation at the scene; and an evaluation system to determine the effectiveness of the response and then implementation of changes to prevent future mistakes. ⋯ Most communities already have the necessary elements and simply need to coordinate the effort into a reasonable approach. Perhaps with such an approach, 80% of deaths from sudden cardiac arrest could be prevented.