Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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OBJCTIVE: The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting. ⋯ Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM, or oral route. When available to paramedics, ondansetron is used frequently.
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Comparative Study
Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest.
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. ⋯ This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.
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This study was undertaken to characterize the carbon emissions from a broad sample of North American emergency medical services (EMS) agencies, and to begin the process of establishing voluntary EMS-related emission targets. ⋯ EMS operations produce substantial carbon emissions, primarily from vehicle-related fuel consumption. The 75th percentiles from our data suggest 106.5 pounds of CO(2)e per unit response and/or 11.2 pounds of CO(2)e per service-area resident as preliminary maximum emission targets. Air medical services can anticipate higher per-flight but lower population-based emissions.
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In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. ⋯ Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.
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Comparative Study
Prevalence of depression and cognitive impairment in older adult emergency medical services patients.
To characterize the proportion of older adult emergency department (ED) patients with depression or cognitive impairment. To compare the prevalences of depression or cognitive impairment among ED patients arriving via emergency medical services (EMS) and those arriving via other modes. ⋯ Consent was obtained from 1,342 eligible older adults; 695 (52%) arrived via EMS. The median age for those arriving via EMS was 74 years (interquartile range 65, 82), 52% were female, and 81% were white. Fifteen percent of EMS patients had moderate or greater depression, as compared with 14% of patients arriving via other modes (p = 0.52). Thirteen percent of the EMS patients had cognitive impairment, as compared with 8% of those arriving via other modes (p < 0.01). The depressed EMS patients frequently reported a history of depression (47%) and taking antidepressants (51%). The cognitively impaired EMS patients infrequently reported a history of dementia (16%) and taking medications for dementia (14%). Conclusions. In this cohort of community-dwelling older adult ED patients, depression and cognitive impairment were common. As compared with ED patients arriving by other transport means, patients arriving via EMS had a similar prevalence of depression but an increased prevalence of cognitive impairment. Screening for depression and cognitive impairment by EMS providers may have value, but needs further investigation.