Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Internet-accessible emergency department workload information reduces ambulance diversion.
To determine the effect of pre-emptive ambulance distribution based on the implementation of a real-time, Internet-accessible emergency department (ED) workload schematic and prehospital Australasian Triage Scale (ATS) allocations on ambulance diversion in Western Australia. ⋯ The implementation of pre-emptive ambulance distribution using Internet-accessible ED information and prehospital ATS allocations was associated with reduced ambulance diversion, probably consequent upon the redistribution of ambulances from inner to outer metropolitan EDs. The rise in ED cubicle occupancy between the study periods suggests that this approach to reducing ambulance diversion should be viewed only as complementary to direct efforts to reduce ambulance diversion by improving hospital inpatient flow and the balance between acute and elective hospital inpatient accommodation.
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This preliminary investigation represents the first step in developing a clinical decision rule (CDR) to assist out-of-hospital providers in caring for older patients in respiratory distress. The specific aims of the study were: 1) to identify up to ten candidate clinical indicators of severe respiratory distress in older out-of-hospital patients and 2) to determine the feasibility of obtaining data on these indicators from out-of-hospital treatment records, and of obtaining a measure of severe respiratory distress from the emergency department (ED) medical record. ⋯ Medical record data were available on seven out-of-hospital clinical indicators and an ED measure of severe distress. Further work needs to be done to refine the operational definitions of the indicators and to standardize the way they are documented in the out-of-hospital medical record.
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The Cincinnati Prehospital Stroke Scale (CPSS) is a three-item examination that has been effective in the identification of stroke victims by health care professionals. However, assessment of the patient earlier in the chain of care, specifically by a 9-1-1 telecommunicator, may improve stroke outcomes. ⋯ Untrained adults can use the CPSS to accurately identify stroke symptoms and can relay these findings to an investigator. Telecommunicator administration of the CPSS may allow for expedited prehospital triage of the stroke patient and delivery of resources in a timely manner and, given the limited time window for efficacious treatment, may lead to improved patient outcome.
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Comparative Study
An interventional study to improve paramedic diagnosis of stroke.
The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention and the use of a prehospital stroke tool on the paramedic diagnosis of stroke. ⋯ Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.
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To describe the utilization and findings with a statewide, prehospital spine-assessment protocol for emergency medical services (EMS) providers in a rural state. ⋯ Use of this prehospital spine-assessment protocol resulted in an EMS provider decision not to immobilize approximately 40% of EMS trauma patients. Few spine fracture patients were encountered during the investigational period, though all were immobilized.