Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2025
Adverse events and paramedic interventions during extended ground transport in a rural pharmaco-invasive STEMI program.
Although guidelines recommend angiography and coronary intervention occur within 24 h of thrombolysis when percutaneous coronary intervention (PCI) is not available within 120 min, this target is difficult to achieve in rural and remote areas of New South Wales (NSW), Australia. ⋯ The primary study showed a significant reduction in time from first clinical contact to arrival at the PCI hospital. In this secondary analysis, we demonstrate that the rate of adverse events during long-distance road transport is low, the adverse events are mostly minor in nature and are within the scope of paramedic practice to manage.
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Emerg Med Australas · Feb 2025
Effect of case identification changes on pre-hospital intubation performance indicators in an Australian helicopter emergency medical service.
A 45-min interval from injury to intubation has been proposed as a performance indicator for severe trauma patient management. In the Sydney pre-hospital system a previous change in case identification systems was associated with activation delay. We aimed to determine if this also decreased the proportion of patients intubated within this benchmark. ⋯ Time from emergency call to intubation was significantly shorter in the HEMS screening period where all non-trapped cases less than 50 km distant were intubated within the 45-min benchmark. There was no distance where intubation within 45 min could be assured for non-trapped patients in the central control period due to dispatch delays.
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Emerg Med Australas · Feb 2025
Prisoners in the emergency department: Lessons from a recent inquest.
The recent coronial finding in Victoria into the death of Joshua (Josh) Kerr highlights some of the challenges of treating patients who are in custody and under the supervision of custodial staff (prison officers or police) in the ED. Issues include ED clinicians' duty of care, roles and responsibilities of ED staff and custodial staff and the need for processes that facilitate collaboration and communication between ED clinicians and custodial staff.
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Emerg Med Australas · Feb 2025
The determinants for death in hospital following moderate to severe traumatic brain injury in Australia.
To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia. ⋯ Among people presenting to a major trauma hospital in Australia following moderate to severe TBI, there were multiple factors independently associated with death in hospital. The potentially modifiable determinants of in-hospital death included out-of-hours access to emergency care, mode of transfer from the scene of the injury, prior facility care and pre-definitive hospital endotracheal intubation.
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Emerg Med Australas · Feb 2025
Observational StudyThe diagnostic utility of prehospital hyperglycaemia in major trauma patients: An observational study.
Stress-induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in-hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been established. To investigate the role of prehospital SIH as a predictor of in-hospital mortality following major trauma. ⋯ The present study demonstrated an association between prehospital SIH and in-hospital mortality following major trauma. Further prospective research is warranted to examine the utility and integration of prehospital SIH into predicting models of trauma care.