Annals of emergency medicine
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Comparative Study
Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. OPALS study group.
The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group. ⋯ EMS-witnessed cases are clearly an important subset of out-of-hospital cardiac arrest and are characterized by 2 distinct symptom groups: chest pain and dyspnea. These symptoms are important predictors of survival and may also help determine underlying mechanisms before patient collapse. A later phase of the OPALS study will prospectively evaluate the impact of out-of-hospital advanced life support on the survival of victims of EMS-witnessed cardiac arrest.
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[American College of Emergency Physicians. Hospital, medical staff, and payer responsibility for emergency department patients. Ann Emerg Med. February 2000;35:210-211.].
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[American College of Emergency Physicians. Emergency physicians' patient care responsibilities outside of the emergency department. Ann Emerg Med. February 2000;35:209.].
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Comparative Study
Emergency medicine can play a leadership role in enterprise-wide clinical information systems.
At many institutions, the department of emergency medicine is uniquely suited to a leadership role in the deployment of new clinical decision support systems (computer systems that support clinical practice). Many factors favor such a leadership role, including institutional politics, organizational structure, extent of local control, clinician solidarity, openness to change, departmental size and scale, and willingness to take risks. ⋯ A leadership position with respect to new information systems entails a certain risk, but the potential benefit to an emergency department in today's competitive environment is substantial. The authors' experience with one such collaborative development project is presented.
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Estimates of time intervals by bystanders are considered critical in cardiac arrest, and are often used in other disorders such as stroke and myocardial infarction. Because they have never been previously studied, we sought to determine their accuracy. ⋯ Although many diagnostic and research conclusions are based on interval estimates from laypersons, we found no correlation between estimates and actual measured intervals in cardiac arrest. Current methodology may not be developed well enough to provide reliable data for research or quality assurance, and other clinical time estimates by patients and bystanders may be equally unreliable.