Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Review
Prehospital management of cardiac arrest: how useful are vasopressor and antiarrhythmic drugs?
Out-of-hospital resuscitation protocols for patients suffering cardiac arrest have historically included cardiopulmonary resuscitation, defibrillation, and rapid transport to a hospital. For many years, use of drugs to improve myocardial perfusion or to correct arrhythmias that occur during cardiac arrest has been part of prehospital efforts to revive patients in ventricular tachycardia or ventricular fibrillation. ⋯ They found little clinical data supporting the prehospital use of lidocaine in cardiac arrest, and despite a great deal of laboratory and clinical data addressing the efficacy of epinephrine, there is no large, randomized, controlled clinical trial supporting its use. Data on amiodarone and vasopressin support the use of these drugs in out-of-hospital resuscitation efforts.
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There are approximately 500,000 hospice patients in the United States. While hospice patients may desire only palliative care, they often access the emergency medical services (EMS) system, unaware that many EMS systems do not have specific palliative care protocols. This study was undertaken to determine the prevalence of palliative care protocols among EMS agencies in the United States, and to estimate the percentage of the U.S. population covered by such protocols. ⋯ Most of the U.S. population is not served by an EMS agency with specific palliative care protocols. Until more EMS systems enact specific palliative care protocols, physicians treating the terminally ill should educate patients and families about appropriate use of the EMS system, and that EMS professionals may be required to provide more than supportive care.
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Review
A systematic review of the evidence supporting the use of priority dispatch of emergency ambulances.
Systematic reviews of the literature assist in the location, appraisal, and synthesis of available evidence. This systematic review aimed to 1) assess the existing literature evaluating the effect of the priority dispatch of emergency ambulances on clinical outcome and ambulance utilization and 2) assess the relative effectiveness of sources of literature relevant to prehospital care. ⋯ There is very little evidence to support the effect of the prioritization of emergency ambulances on patient outcome. Electronic databases identify only approximately half of all relevant prehospital literature. Future systematic reviews in this area should use electronic databases, supplemented by contact with appropriate experts.
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To describe the impact of a rapidly deployable, automated external defibrillator (AED)-equipped first-responder service at Boston's Logan International Airport on the rate of survival to hospital discharge after cardiac arrest. ⋯ A rapidly deployable first-responder service permits early defibrillation minutes before arrival of EMS personnel. This rapid response positively impacts the return of spontaneous circulation and survival to hospital discharge after cardiac arrest.
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In the summer of 1998, a series of wildfires swept across Florida. Firefighters and support personnel were imported and based in a central camp in Flagler County, Florida. Local residents were evacuated. Disaster medical assistance teams (DMATs) were deployed to provide medical support. Similar large-scale fire disasters occur frequently, but the illnesses and injuries seen have not been described. ⋯ In this setting the majority of illnesses and injuries are minor. Visits related to preventive care and hygiene are common. This information can help in planning medical support operations in similar situations.