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
A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates.
Airway management is a key component of prehospital care for seriously ill and injured patients. Oral endotracheal intubation (OETI) is the definitive airway of choice in most emergency medical services (EMS) systems. However, OETI may not be an approved skill for some clinicians or may prove problematic in certain patients because of anatomic abnormalities, trauma, or inadequate relaxation. In these situations alternative airways are frequently employed. However, the reported success rates for these devices vary widely, and established benchmarks are lacking. ⋯ We provide pooled estimates for prehospital AAD, NCRIC, and SCRIC airway interventions. Of the AADs, the King LT demonstrated the highest insertion success rate (96.5%), although this estimate is based on limited data, and data regarding its ventilatory effectiveness are lacking; more data are available for the ETC and LMA. The ETC, LMA, and PTLA all had similar-but lower-success rates (82.1%-87.4%). NCRIC has a low rate of success (65.8%); SCRIC has a much higher success rate (90.5%) and should be considered the preferred percutaneous rescue airway.
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When cardiac arrest occurs at home, family members are likely to be present during resuscitation efforts. However, little training is provided to prehospital providers on how to best manage a family-witnessed resuscitation (FWR) and deliver the news of death in the field. ⋯ This pilot study suggests that a short educational intervention can impact prehospital providers' comfort with death notification. Future research will need to be conducted on prehospital provider skill retention and the impact this training has on family members.
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Return of spontaneous circulation (ROSC) occurs in 35.0 to 61.0% of emergency medical services (EMS)-treated out-of-hospital cardiac arrests (OHCAs); however, not all patients achieving ROSC survive to hospital arrival or discharge. Previous studies have estimated the incidence of some types of rearrest(RA) at 61.0 to 79.0%, and the electrocardiogram (ECG) waveform characteristics of prehospital RA rhythms have not been previously described. ⋯ In this sample, the incidence of RA was 38.0%. The most common type of RA was PEA. Shockability of first EMS rhythm was found to predict subsequent RA rhythm shockability.
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Workplace attitude, beliefs, and culture may impact the safety of patient care. This study characterized perceptions of safety culture in a nationwide sample of emergency medical services (EMS) agencies. ⋯ In this sample, workplace safety culture varies between EMS agencies.
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To identify emergency medical services (EMS) provider perceptions of factors that may affect the occurrence, identification, reporting, and reduction of near misses and adverse events in the pediatric EMS patient. ⋯ It appears that adverse events and near misses in the pediatric EMS environment may go unreported in a large proportion of cases. Participants attributed the occurrence of errors to the stress and anxiety produced by a lack of familiarity with pediatric patients and to a reluctance to cause pain or potential harm, as well as to inadequate practical training and experience in caring for the pediatric population. Errors of omission, rather than those of commission, were perceived to predominate. This study provides a foundation on which to base additional studies of both a qualitative and quantitative nature that will shed further light on the factors contributing to the occurrence, reporting, and mitigation of adverse events and near misses in the pediatric EMS setting.