Prehospital and disaster medicine
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Prehosp Disaster Med · Jan 1995
Patient-initiated refusals of prehospital care: ambulance call report documentation, patient outcome, and on-line medical command.
There is a growing interest in cases in which emergency medical services (EMS) providers evaluate a patient, but do not transport the patient to a hospital. A subset of these cases, the patient-initiated refusal (PIR) in which the patient refused care and transport, was studied and evaluated. The objectives of the study were to examine the adequacy of ambulance call report documentation in PIR, to examine the clinical outcome of these patients in one hospital-based, suburban EMS system, and to assess the potential impact of on-line medical command (OLMC) on cases of PIR. ⋯ Ambulance call report documentation is better with OLMC than without. Patients who initially refuse care may be ill, and some ultimately will be hospitalized. Further research may elucidate a role for OLMC in preventing refusals by incompetent patients, convincing patients who are competent but appear ill to accept transport, and assisting paramedics with other difficult or unusual circumstances.
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Prehosp Disaster Med · Jan 1995
The effect of prehospital transport time on the mortality from traumatic injury.
To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital. ⋯ No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time < 90 minutes exerted a significant adverse effect upon survival.
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Prehospital providers regularly encounter patients with obstetrical emergencies. This study determined the frequency and outcome of out-of-hospital deliveries in an urban, all advanced life support (ALS) emergency medical services (EMS) system. ⋯ Paramedics, especially those in urban settings, are likely to encounter obstetrical and neonatal emergencies and a significant number of associated complications. Emergency medical services systems and medical directors should have in place continuing educational programs, patient-care protocols, and continuous quality improvement measures to evaluate the care rendered to patients having out-of-hospital deliveries.
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Prehosp Disaster Med · Oct 1994
Emergencies in the school setting: are public school teachers adequately trained to respond?
This study attempted to determine the extent of training and emergency care knowledge of public school teachers in midwestern states. A secondary purpose was to assess the frequency of injury and illness in the school setting requiring the teacher to first-respond. ⋯ Public school teachers represent a potentially effective first-response component during disasters and isolated emergencies in the school environment. Overall, most of public school teachers in this study were deficient in both training and knowledge of emergency care and BLS modalities. Lack of effective, formal emergency care training in teacher preparation programs coupled with no continuing education requirement is a possible explanation of these results. Emergency medical services providers should seek opportunities to help with first-responder training and continuing education in their schools.
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Prehosp Disaster Med · Oct 1994
Outcome of patients after air medical transport for management of nontraumatic acute intracranial bleeding.
Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system. ⋯ Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.