Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
To determine whether the interval between the arrival of basic life support (BLS) providers and the arrival of advanced life support (ALS) providers is associated with patient outcome after cardiac arrest. ⋯ We found that a shorter BLS-to-ALS arrival interval increased the likelihood of survival to hospital discharge after a witnessed, out-of-hospital VF cardiac arrest. We conclude that ALS interventions may provide additional benefits over BLS interventions alone when utilized in a well-established, two-tiered emergency medical services (EMS) system already optimized for rapid defibrillation. The highest priorities in any EMS system should still be early CPR and early defibrillation, but timely ALS services can supplement these crucial interventions.
-
To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services. ⋯ EMS provides an invaluable opportunity to connect the elderly with social services at the time of contact. In this study, paramedics appeared to refer more social service-related complaints compared with other categories such as fall assistance. This highlights a difference in perception of social service needs among paramedics and represents an area for further training and education.
-
Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems. ⋯ Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.
-
Little is known about how effectively information is transferred from emergency medical services (EMS) personnel to clinicians in the emergency department receiving the patient. Information about prehospital events and findings can help ensure expedient and appropriate care. The trauma literature describes 16 prehospital data points that affect outcome and therefore should be included in the EMS report when applicable. ⋯ Even in the controlled setting of a single-patient handover with direct verbal contact between EMS providers and in-hospital clinicians, only 72.9% of the key prehospital data points that were transmitted by the EMS personnel were documented by the receiving hospital staff. Elements such as prehospital hypotension, GCS score, and other prehospital vital signs were often not recorded. Methods of "transmitting" and "receiving" data in trauma as well as all other patients need further scrutiny.
-
This article is a support paper for the National Association of EMS Physicians' position paper on induced therapeutic hypothermia in resuscitated cardiac arrest patients. Induced hypothermia is one of the newest treatments aimed at increasing the dismal neurologically intact survival rate for out-of-hospital cardiac arrest patients. Two landmark studies published in 2002 by the New England Journal of Medicine led to the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care IIa recommendation of cooling unconscious adult patients with return of spontaneous circulation after out-of-hospital cardiac arrest due to ventricular fibrillation to 32 degrees C to 34 degrees C for 12 to 24 hours. ⋯ Finally, the literature provides no evidence to support mandating induced hypothermia in the prehospital setting. Given limited prehospital resources, sometimes consisting of only two providers, attention first needs to be given to providing the basic care with the utmost skill. Once the basics are being delivered expertly, consideration can be given to the use of prehospital cooling for the resuscitated cardiac arrest patient in the setting of continued cooling in the hospital.