Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
The goal of this investigation was to describe the reasons emergency medical services (EMS) is activated when resuscitation is not desired or when patients show signs of irreversible death. ⋯ In a third of patients for whom EMS did not initiate resuscitation, resuscitation was withheld primarily because it was not desired rather than because there was evidence of irreversible death. Efforts to improve education may prevent EMS activation in these cases. An alternative EMS response could also help ensure patient autonomy and decrease costs to the EMS system.
-
Randomized Controlled Trial Comparative Study
The King LT versus the Combitube: flight crew performance and preference.
Air medical personnel frequently face the challenge of the emergency airway. The Combitube is an airway device commonly used by emergency medical services (EMS) providers as either a primary or rescue airway. ⋯ The King LT was placed significantly faster than the Combitube and was also perceived as easier to place. Ninety-six percent of the participants preferred the King LT. Limitations include using a simulator model rather than a human model.
-
Multicenter Study
A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region.
To determine 1) the success rate of prehospital endotracheal intubation; 2) the unrecognized tube malposition rate; and 3) predictors of tube malposition upon arrival to the emergency department (ED) in the setting of a large metropolitan area that includes 18 hospitals and 34 transporting emergency medical services (EMS) agencies. ⋯ Overall intubation success was low, and consistent with previously published series. The frequency of malpositioned ETT was unacceptably high, and also consistent with prior studies. Our data support the need for ongoing monitoring of EMS providers' practices of endotracheal intubation.
-
Comparative Study
Field torso-warming modalities: a comparative study using a human model.
To compare four field-appropriate torso-warming modalities that do not require alternating-current (AC) electrical power, using a human model of nonshivering hypothermia. ⋯ In subjects with shivering suppressed, greater sources of external heat were effective in attenuating core temperature afterdrop, whereas sustained sources of external heat effectively established core rewarming. Depending on the scenario and available resources, we recommend the use of charcoal heaters, chemical heating pads, or hot-water bags as effective means for treating cold patients in the field or during transport to definitive care.
-
In the last several years, the National Association of EMS Physicians (NAEMSP) has called for better reporting on prehospital endotracheal intubation (ETI) and has provided guidelines and tools for better systematic review. We sought to evaluate the success of prehospital, non-drug-assisted ETI performed by Ottawa advanced care paramedics (ACPs) based on those guidelines. ⋯ This study reported the success rate of non-drug-assisted, prehospital ETI by ACPs in the Ottawa region. Our findings emphasize the importance of quality assessment for individual emergency medical services systems, to ensure optimum performance in ETI practice over time, and for intubation skill-retention training.