Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The National Association of EMS Physicians (NAEMSP) supports out-of-hospital termination of resuscitation for adult, nontraumatic cardiac arrest patients who have not responded to full resuscitative efforts. The following factors should be considered in establishing termination of resuscitation protocols: 1) Termination of resuscitation may be considered for any adult patient who suffers sudden cardiac death that is likely to be medical. 2) Unwitnessed cardiac arrest with delayed initiation of cardiopulmonary resuscitation (CPR) beyond 6 minutes and delayed defibrillation beyond 8 minutes has a poor prognosis. 3) In the absence of "do not resuscitate" or advanced directives, a full resuscitative effort including CPR, definitive airway management, medication administration, defibrillation if necessary, and at least 20 minutes of treatment following Advanced Cardiac Life Support (ACLS) guidelines should be performed prior to declaring the patient dead. 4) A patient whose rhythm changes to, or remains in, ventricular fibrillation or ventricular tachycardia should have continued resuscitative efforts. Patients in asystole or pulseless electrical activity should be strongly considered for out-of-hospital termination of resuscitation. 5) Logistic factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public. 6) Online medical direction should be established prior to termination of resuscitation. The decision to terminate efforts should be a consensus between the on-scene paramedic and the online physician. 7) The on-scene providers and family should have access to resources, such as clergy, crisis workers, and social workers. 8) Quality review is necessary to ensure appropriate application of the termination protocol, law enforcement notification, medical examiner or coroner involvement, and family counseling.
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Intraosseous (IO) infusion provides an alternative route for the administration of fluids and medications when difficulty with peripheral or central lines is encountered during resuscitation of critically ill and injured patients. ⋯ These early data indicate that sternal IO infusion using the new F.A.S.T.1 IO system may provide rapid, safe vascular access and may be a useful technique for reducing unacceptable delays in the provision of emergency treatment.
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A prototype of the laryngeal tube was tested for simple and reliable use for ventilation in a mannequin. One possible use of this tube will be the management of the difficult airway. In spite of blind insertion, an inadvertent tracheal positioning should not occur due to the form of the tube. A pharyngeal cuff provides a proximal seal of the airway, while an esophageal cuff seals the airway distally and prevents aspiration of gastric contents. A ventral opening between both cuffs is used for ventilation. ⋯ The laryngeal tube may be a fast, reliable, and easy device for airway management. Further research is necessary.
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To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management. ⋯ This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance.
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To determine whether implementation of an emergency medical dispatch (EMD) system would reduce the rate of inappropriate advanced life support (ALS) utilization, and enable more accurate identification of those patients requiring ALS care. ⋯ Implementation of an EMD system significantly decreased inappropriate ALS dispatching, as defined by decreased rate of ALS cancellations and BLS releases. Further study is needed to see whether other EMD dispatch models may further refine ALS dispatch.