Articles: emergency-medical-services.
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Early detection and treatment of sepsis improves chances of survival; however, sepsis is often difficult to diagnose initially. This is especially true in the prehospital setting, where resources are scarce, yet time is of great significance. Early warning scores (EWS) based on vital signs were originally developed to guide medical practitioners in determining the degree of illness of a patient in the in-patient setting. These EWS were adapted for use in the prehospital setting to predict critical illness and sepsis. We performed a scoping review to evaluate the existing evidence for use of validated EWS to identify prehospital sepsis. ⋯ All studies demonstrated inconsistency for the identification of prehospital sepsis. The variety of available EWS and study design heterogeneity suggest it is unlikely that new research can identify a single gold standard score. Based on our findings in this scoping review, we recommend future efforts focus on combining standardized prehospital care with clinical judgment to provide timely interventions for unstable patients where infection is considered a likely etiology, in addition to improving sepsis education for prehospital clinicians. At most, EWS can be used as an adjunct to these efforts, but they should not be relied on alone for prehospital sepsis identification.
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To determine the effect of video and direct laryngoscopy on first-pass success rates for out-of-hospital orotracheal intubation. ⋯ We found substantial heterogeneity among out-of-hospital studies comparing video laryngoscopy to direct laryngoscopy on first-pass success, overall success, or intubation time. This heterogeneity was not explained with stratification by study design, clinician type, video laryngoscope blade geometry, or leave-one-out meta-analysis. A majority of studies showed that video laryngoscopy was associated with improved first pass success in all subgroups, but only for paramedics and not physicians when looking at overall success. This improvement was more common in studies that used Macintosh blades than those that used hyperangulated blades. Future research should explore the heterogeneity identified in our analysis with an emphasis on differences in training, clinical milieu, and specific video laryngoscope devices.
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Practice Guideline
Evidence-Based Guideline for Prehospital Airway Management.
Airway management is a cornerstone of emergency medical care. This project aimed to create evidence-based guidelines based on the systematic review recently conducted by the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel was assembled to review the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. ⋯ The recommendations address the use of ventilation with bag-valve mask ventilation alone vs. supraglottic airways vs. endotracheal intubation for adults and children with cardiac arrest, medical emergencies, and trauma. Additional recommendations address the use of video laryngoscopy and drug-assisted airway management. These recommendations, and the associated good practice statements, offer EMS agencies and clinicians an opportunity to review the available evidence and incorporate it into their airway management strategies.
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In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD "peer to peer" consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures. ⋯ The introduction of a novel "peer-to-peer" consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied.
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The dynamic and uncontrolled nature of paramedic work frequently exposes these workers to physical and psychological injury. Often paramedic injury rates are estimated based on national injury surveillance data or compensation databases. These data sources tend to only capture cases of a more serious nature and overlook the broader factors that contribute to injury. This limits our understanding of the true burden of paramedic injury and the characteristics associated with increased injury severity. ⋯ Paramedics working in Victoria have a higher rate of work-related injury than other Australian workers. Injury-related factors that are often overlooked, such as time, shift type, location, and injury characteristics, all contribute to an increased risk of lost time injury. An understanding of the factors that contribute to an increase in injury severity may facilitate the development and targeting of appropriate interventions.