Annals of emergency medicine
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To determine the time between ambulance arrival at the scene to paramedic arrival at the patient (arrival to patient contact) and the effect of barriers to paramedic movement on this time interval. ⋯ The arrival-to-patient contact interval adds a variable and potentially lengthy amount of time to the total prehospital response time interval, and barriers impeding paramedic movement to the patient prolong this time interval. In 25% of all observed paramedic calls, the arrival-to-patient contact interval was more than four minutes. Measurement of the time from ambulance arrival on the scene to paramedic arrival at the patient is necessary to appropriately determine the relationship among total prehospital response time, paramedic interventions, and patient outcome.
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Multicenter Study Comparative Study
Effect of first-responder automated defibrillation on time to therapeutic interventions during out-of-hospital cardiac arrest. The Multicenter High Dose Epinephrine Study Group.
The effect of automated defibrillation provided by basic emergency medical technician (EMT) first-responder units on the time intervals to other critical interventions in the management of out-of-hospital cardiac arrests is unknown. The purpose of this study was to define and compare elapsed time intervals to basic CPR, paramedic arrival, initial countershock, endotracheal intubation, IV access, and initial adrenergic drug therapy in first-responder automated defibrillation/paramedic versus basic EMT/paramedic emergency medical services systems. ⋯ First-responder automated defibrillation/paramedic systems provide not only shorter times to initial countershock, as compared with basic EMT/paramedic systems, but by having delegated initial countershock to first-responders, they also allow for significantly shorter times from paramedic arrival to IV access, endotracheal intubation, and initial adrenergic drug therapy interventions.
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To estimate the frequency of violence directed toward prehospital providers; to identify the methods used to manage violent patients in the prehospital setting; and to identify the educational, medical, and legal issues in the prehospital management of violent patients. ⋯ The potential for injury to prehospital providers from violent patients is probably widespread, and no mechanism for identifying injuries or exposure to violent patients currently exists. All systems should have protocols for managing violent patients and for restraint application. Educational sessions for self-defense and assessment of the scene for violence may be indicated.
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Randomized Controlled Trial Clinical Trial
Atropine for the treatment of biliary tract pain: a double-blind, placebo-controlled trial.
To compare the efficacy of IM atropine with placebo for the treatment of pain caused by biliary tract disease. ⋯ Atropine is no better than placebo in the treatment of biliary tract pain.
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To delineate the topics discussed with families during the death notification process and to identify which of these topics are stressful to the physician. Also, the survey served as a needs assessment in designing an educational program for emergency medicine residents in death notification. ⋯ Factual information is discussed most often, and emotional issues are considered most stressful. Therefore, a program in death notification must address those issues that must be handled during a notification and provide mechanisms for residents to feel comfortable with emotional responses from the family.