Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Approximately 40% of Hennepin County Medical Center's (HCMC's) ambulance runs are for minor medical conditions as defined by billing criteria ["ALS minor," i.e., no advanced life support (ALS) procedures done in the field]. Current metropolitan guidelines mandate that all such patients must be transported to a hospital unless they refuse this service. It has been proposed that some patients with minor medical conditions could be better served by treatment in the field by paramedics and referred to a clinic or hospital for early follow-up care. It is proposed that this approach would save costs and improve paramedic availability for patients with more serious conditions. ⋯ None of the 15 most frequently encountered problem groups consisted of a high enough proportion of "potentially treatable" cases to serve as a high-volume, low-complexity category for paramedic treatment in the field with early follow-up. Without any identified high-volume, low-complexity categories, a treatment and referral program as proposed in this article would require a substantial investment in development of appropriate criteria and in training paramedics to apply the criteria for numerous clinical entities. This would limit any cost saving, and require great care to avoid compromising patient safety accompanied by substantial professional liability exposure.
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A paramedic may be unprepared to practice alone or with an inexperienced partner immediately following completion of training. Emergency medical services systems have not generally set standards to ensure that a newly-licensed paramedic is competent to practice alone. ⋯ This paper summarizes mentoring requirements for other clinical professions and reviews studies from the out-of-hospital and hospital literature that demonstrate a positive correlation between experience and outcome and/or competence. The author recommends specific benchmarking and supervision by a training officer or an experienced paramedic to ensure competence in new and inexperienced paramedics.
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To determine whether the prehospital administration of adenosine to adults with stable and unstable paroxysmal supraventricular tachycardia (PSVT) influences conversion rate (CR) to sinus rhythm, scene time, use of synchronized electrical cardioversion (SEC), and accuracy of rhythm strip interpretation by paramedics. ⋯ The introduction of adenosine was associated with a significant increase in the prehospital CR of stable and unstable PSVT, while the SEC and spontaneous conversion rates were similar in each group; however, scene times were longer in the TG and paramedic accuracy in rhythm strip interpretation remained fair to moderate.
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The chain of survival emphasizes the importance of the four links associated with survival after cardiac arrest (CA). The involvement of laypersons has been increasing over the years. They have been contributing toward "early access," "early cardiopulmonary resuscitation" (CPR), and, of late, "early defibrillation," with the advent of automated external defibrillators (AEDs). Bystander CPR rates are difficult to assess due to the lack of formal documentation. ⋯ The bystander CPR rate for prehospital CA was 20.0%. About 12.9% (4 patients) of those who had bystander CPR were admitted to the ICU, compared with none from the group that did not receive any form of bystander CPR. Three patients (1.9% of all prehospital CAs) were discharged alive from the hospital.
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Using hospital outcomes, this study evaluated emergency medical technicians' (EMTs') ability to safely apply protocols to assign transport options. ⋯ These protocols led to a 9% undertriage rate. Patients with psychiatric complaints and dementia were at high risk for undertriage.