Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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We report our use of noninvasive ventilation (NIV) during pediatric interhospital ground transport. ⋯ Though the use of NIV during pediatric interhospital ground transports was not associated with serious out-of-hospital complications, advanced pediatric airway skills were frequently required.
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Activation of the cardiac catheterization laboratory prior to patient arrival at the hospital, based on a prehospital 12-lead electrocardiogram (ECG), reduces door-to-balloon time by 10-55 minutes for patients with ST-segment elevation myocardial infarction (STEMI). In emergency medical services (EMS) systems where transmission of the ECG to the emergency department (ED) is not feasible, the ability of paramedics to accurately read 12-lead ECGs is crucial to the success of a prehospital catheterization laboratory activation program. Objective. To determine whether paramedics can accurately diagnose STEMI on a prehospital 12-lead ECG and decide to activate the cardiac catheterization laboratory appropriately. ⋯ Paramedics in an urban/suburban EMS system can diagnose STEMI and identify appropriate cardiac catheterization laboratory activations with a high degree of accuracy, and an acceptable false-positive rate, when tested using paper-based scenarios.
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Seizure patients are frequently encountered in the prehospital environment and have the potential to need advanced interventions, though the utility of advanced life support (ALS) interventions in many of these patients has not been proven. ⋯ This study showed a lower-than-anticipated level of compliance with an ALS-based prehospital seizure protocol, though patient-specific care appeared appropriate. Prehospital seizure patients have the potential for seizure recurrence and may benefit from focused ALS interventions, but their heterogeneity makes uniform protocols difficult to develop and follow.
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Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.
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Effective mass casualty triage requires rapid and accurate decision making. First responders need to be trained, but opportunities to practice triage and receive individualized feedback during traditional mass casualty (MC) exercises are uncommon. It was hypothesized that novice learners would improve in speed, accuracy, and self-efficacy after deliberate practice triaging multiple simulated casualties in a MC exercise using high-fidelity manikins. ⋯ Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, multimanikin MC training experience.