Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Meta Analysis
Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.
To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system. ⋯ Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.
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Controlled Clinical Trial
An experimental predeployment training program improves self-reported patient treatment confidence and preparedness of Army combat medics.
To develop and assess impact of a focused review of International Trauma Life Support (ITLS) and combat casualty care with hands-on procedure training for U.S. Army medics deploying to Iraq. ⋯ This experimental program increased combat medic confidence and perceived level of preparedness in treating several patient severity levels. Further research is warranted to determine if the experimental intervention objectively improves patient care quality and translates into lives saved early in deployment.
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Competency is affected by skill exposure, skill complexity, and training program quality. The purpose of this study was to reevaluate the biennial (24-month) critical care skill and experience benchmark thresholds established by the Milwaukee County Emergency Medical Services (MCEMS) system in 1997. ⋯ These data show a decreased opportunity and a wide variability in the frequency of successfully completed paramedic technical skills and experiences in this EMS system. Limited exposure to critically ill adult and pediatric patients reaffirms that high-risk skills are performed infrequently. A multifaceted approach should be considered for maintaining provider competency.
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Endogenous adenosine (ADO) is cardioprotective during ischemia and its myocardial concentration increases during untreated ventricular fibrillation (VF). We have previously shown that ADO A1 receptor (ADOA1R) antagonism hastens the time-dependent decay in VF waveform morphology during the circulatory phase of cardiac arrest. ⋯ In this study, ADOA1R antagonism had no effect on outcome whether given before induction of VF or upon resuscitation after 8 minutes of untreated VF. The role of endogenous ADO in prolonged VF remains unclear.
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To derive and internally validate a simple prediction rule, using routinely collected prehospital patient data, that discriminates between hospital admission and emergency department (ED) discharge for adult patients who arrive by ambulance. ⋯ Routinely collected EMS patient information can help predict hospital admission for certain ED patients.