Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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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.
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In emergency medical services (EMS), it has been accepted that continued cognitive competency can be impacted through continuing education (CE). ⋯ This study assessed the cognitive competency of currently state-certified EMT-Basics in a low-frequency practice environment using the current NREMT-Basic cognitive examination. Variables commonly assumed to be associated with continued cognitive competence, hours of CE and practice frequency, were not significantly associated with success on the cognitive examination.
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Little is known about mechanical ventilation practices during patient transport outside of hospital in the civilian setting, although these practices may have clinical impact. Objective. We set out to describe ventilation practice, the use of lung-protective ventilation strategies, administration of sedation and neuromuscular blockade, and related critical events during out-of-hospital transport of ventilated patients. ⋯ In-transit mechanical ventilation practices are variable, although patient exposure to potentially injurious pressures and volumes is uncommon. The application of PEEP is modest. In-transit hypotension is common and associated with sedative administration. The extent to which these practices impact patient outcome is unclear.
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The risk of occupational death is disproportionately high for emergency medical services (EMS) personnel, largely as a consequence of the high incidence of transportation-related fatalities. The purpose of this narrative review is twofold: to raise awareness in the EMS community by examining the various factors that contribute to vehicular EMS injuries and fatalities and to outline practical strategies for mitigating these risks to EMS professionals. This review describes three main categories of factors that contribute to personnel risk during ambulance transport: the inherent risks of driving/riding in an ambulance, poor ambulance safety standards and design, and increased provider vulnerability to injury while delivering critical patient care in the back of a moving ambulance. Specific educational, technologic, regulatory, and behavioral strategies for mitigating these risks are offered in hopes of improving ambulance safety practices.
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Activated charcoal (AC) is a potentially beneficial intervention for some toxic ingestions. When administered within one hour, it can reduce absorption of toxins by up to 75%. This study evaluated whether pediatric emergency department (ED) patients arriving by ambulance receive AC more quickly than patients arriving by alternative modes of transport. ⋯ The sickest patients arriving by EMS had a faster time from triage to AC administration. However, when comparing patients of all triage categories, EMS arrival alone did not influence time to AC administration. Furthermore, the interval from triage to charcoal administration was often insufficiently long. This suboptimal timing of charcoal administration demonstrates the need for reevaluation of triage and prehospital practices.