Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Effectiveness of prehospital morphine, fentanyl, and methoxyflurane in pediatric patients.
To compare the effectiveness of intravenous morphine, intranasal (IN) fentanyl, and inhaled methoxyflurane for managing moderate to severe pain in pediatric patients in the out-of-hospital setting. ⋯ Intranasal fentanyl and intravenous morphine are equally effective analgesic agents in pediatric patients with moderate to severe acute pain in the out-of-hospital setting. Methoxyflurane is less effective in comparison with both morphine and fentanyl, but is an effective analgesic in the majority of children.
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The Centers for Disease Control and Prevention (CDC) published its Guidelines for Field Triage of Injured Patients in 2009. These CDC guidelines define criteria for the triage of trauma patients to trauma centers, and include physiologic, anatomic, and high-risk mechanism-of-injury criteria. One of the mechanism criteria used for motor vehicle crashes (MVCs) is intrusion >12 inches at the occupant site or >18 inches at any site. Objective. We hypothesized that motor vehicle intrusion, as the sole criterion for transport to a trauma center, is neither sensitive nor specific for predicting which patients will utilize trauma center resources. ⋯ Motor vehicle intrusion alone is a poor predictor of the need for trauma center admission or trauma center resource utilization. A modest change to the CDC guidelines from intrusion to entrapment may reduce overtriage while maintaining a high sensitivity for serious injury.
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This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. ⋯ The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.
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Air medical transport has had problems with its safety record, attributed in part to human error. Flight crew members (FCMs) must be able to focus on critical safety tasks in the context of a stressful environment. Flight crew members' cognitive readiness (CR) to perform their jobs may be affected by sleep deprivation, personal problems, high workload, and use of alcohol and drugs. ⋯ Performance by FCMs on a simple, rapid, computer-based psychological test correlates well with self-reported sleep, rest, life satisfaction, and irritability. Although further studies are warranted, these findings suggest that assessment of the performance of FCMs on a simple, rapid, computer-based, multitasking battery is feasible as an approach to determine their readiness to perform critical safety tasks through the SYNWIN task battery.
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We evaluated the benefit of emergency medical services providers' placing a second intravenous (IV) line in the prehospital trauma setting. Our hypothesis was that the placement of a second IV catheter in trauma does not result in an improvement in heart rate, blood pressure, rehospitalizaton rate, or 30-day mortality. ⋯ Redundant prehospital IV lines provided no noticeable benefit in physiologic support for trauma patients. When controlling for confounding variables, no significant outcome difference was noted, even in the hypotensive patients. The traditional approach for establishment of a secondary IV line in prehospital trauma patients should not be followed in a dogmatic fashion.