Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Multicenter Study Clinical Trial
The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.
Traditional EMS teaching identifies mechanism of injury as an important predictor of spinal injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with "a positive mechanism" clearly capable of producing spinal injury. ⋯ Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury in this population.
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Establishing an airway is a critical first step in emergency management of comatose patients and those who have suffered head trauma, cardiac arrest, or respiratory failure. The use of succinylcholine, a paralytic, to assist with intubation is a safe and effective way to help establish an airway under difficult circumstances, in the prehospital setting. ⋯ Therefore, under the auspices of strong medical control, it is an effective way to establish adequate oxygenation and to control ventilation in some of the most critical patients encountered in the field. Additionally, because physical examination alone is not dependable for ensuring proper endotracheal tube placement, an objective confirmatory device such as an end-tidal carbon dioxide detector should be used.
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To analyze flight crew airway management in four different settings (in flight, at trauma scenes, in ambulance, and in referring hospitals) and in two different aircraft used by the same helicopter EMS (HEMS) service. The null hypothesis was that there was no association between practice setting, or aircraft, and airway practices or success rate. ⋯ While HEMS crew airway management success rates are equally high in all practice settings, airway management decision making and practice appear to be significantly influenced by practice setting and aircraft type. These data support contentions that nonphysician HEMS crews can effectively manage airways in a variety of circumstances.
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Many prehospital cardiac arrests occur in public places. Even the best EMS systems have a finite response time. Therefore, it has been recommended that automated external defibrillators (AEDs) be placed in public areas for immediate access by trained members of the general public. ⋯ Since very few locations had more than one cardiac arrest, it may be difficult to identify high-yield public places in which to place an AED. Nursing homes may want to consider AED availability.
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To determine whether paramedics and on-line physicians screen patients for use of sildenafil citrate (Viagra) prior to prehospital administration of nitrates. ⋯ In this study, on-line physicians in three EMS settings did not screen for sildenafil use prior to ordering nitrates. While some paramedics do screen for sildenafil use, practice patterns among paramedics in these three systems were inconsistent.