Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Patient refusal of paramedic transport against medical advice (AMA) has significant medical-legal implications. Previous studies have investigated patient outcomes after refusal of transport, but none has focused on these events in minors. This study was performed to evaluate the outcomes of this patient population after refusal of transport as well as the significance of base hospital physician discussion with parents in the decision to refuse transport. ⋯ Children whose parents refused EMS transport received medical follow-up in the majority of cases, with a small group requiring admission.
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There is little published evidence to support the benefits of prehospital drug administration by ambulance personnel in reducing subsequent hospital utilization by the medical patients receiving such drugs. The authors studied the outcome of patients treated by Ontario's Emergency Health Services "Symptom Relief Drug Program," which was developed to relieve patient symptoms in the field for specific medical emergencies. ⋯ The lower rate of admissions for chest pain patients is the first published evidence of prehospital drug treatment's reducing hospital utilization in a sub-group of such medical patients. The "Symptom Relief Drug Program" is effective in improving patients' field conditions and can decrease ED LOS in hypoglycemic persons receiving glucagon injections. More outcome research pertaining to ambulance-administered prehospital drug treatment is warranted.
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To evaluate the effectiveness of the local emergency medical services system in resuscitation of out-of-hospital cardiac arrest and identify areas for improvement. ⋯ The prognosis of out-of-hospital cardiac arrest in Hong Kong was dismal. Every link in the chain of survival has to be improved.
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Emergency medical services for children, or EMSC, is still a relatively underdeveloped component of most state and local EMS systems. Advocacy and funding for EMSC from the federal EMSC Program, availability of many useful EMSC products, and the rapidly enlarging literature in EMSC have created heightened awareness and interest in improving systems for pediatric emergency, trauma, and critical care. The new National Highway Traffic Safety Administration (NHTSA) EMS Technical Assistance (TA) re-assessment program, the second version of the successful original TA Program from 1988 to 1996, provides an ideal opportunity for state EMS professionals to evaluate EMSC capabilities and to integrate new EMSC products and services. ⋯ In order to facilitate state-of-theart reviews of EMSC within state EMS systems, a pediatric survey for the NHTSA re-assessments is presented. The survey, developed with the input of EMS administrators and physicians and approved by the National Association of State EMS Directors, follows the original ten-component model for EMS system review. It is intended for optional use within the overall EMS review process.
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The study was conducted to understand the prehospital system in Karachi, the mode of transport that adult inpatients use to reach the emergency departments (EDs), and the barriers to the use of ambulances. ⋯ In case of a medical emergency, most people in Karachi do not use ambulances. The reasons for this low usage include not only poor accessibility, but also cultural barriers and lack of education in recognition of danger signs.