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 Meta Analysis
Paramedic determinations of medical necessity: a meta-analysis.
Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. ⋯ The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.
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Despite conflicting evidence regarding its efficacy, helicopter transportation of trauma victims is widespread. We determined the effect of adding a second helicopter to a countywide emergency medicine system on trauma-related mortality. ⋯ Introduction of a second helicopter to the east end of Long Island was associated with a significant reduction in the total trauma mortality.
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No existing mass casualty triage system has been scientifically scrutinized or validated. A recent work group sponsored by the Centers for Disease Control and Prevention, using a combination of expert opinion and the extremely limited research data available, created the SALT (sort-assess-lifesaving interventions-treat/transport) triage system to serve as a national model. An airport crash drill was used to pilot test the SALT system. ⋯ The SALT mass casualty triage system can be applied quickly in the field and appears to be safe, as measured by a low undertriage rate. There was, however, significant overtriage. Further refinement is needed, and effect on patient outcomes needs to be evaluated.
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During normal operations, public safety personnel may become injured, leading them to seek medical care and possible time off. Examining the nature and patterns of injury may help to identify preventive health measures for all public safety personnel and address specific needs of each discipline based on actual risk. Objective. To determine the types and severity of injuries encountered by public safety personnel during routine work conditions within a single urban population. ⋯ Public safety personnel are affected by both profession-specific and non-profession-specific injuries. Overall, EMS has higher rates of missed time and medical evaluations than both fire and police. These data highlight the need to make direct comparisons of various public safety personnel bureaus using a common time interval and locale in order to rationally plan interventions and apply resources.
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This case series evaluated provider use of the King LTS-D as a primary airway in patients requiring rapid-sequence intubation (RSI). ⋯ In this case series, paramedics were able to successfully place and use the King LTS-D in patients meeting our emergency medical services (EMS) system indications for RSI.