Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The prehospital electrocardiogram (ECG) allows earlier identification of acute ST-segment elevation myocardial infarction (STEMI). Its utility for detection of other acute cardiac events, as well as for transient ST-segment abnormalities no longer present when the first hospital ECG is performed, is not well characterized. ⋯ Beyond identifying ST-segment elevation earlier, prehospital ECGs detect important transient abnormalities, information not otherwise available from the first emergency department ECG. These data can expedite diagnosis and clinical management decisions among patients suspected of having an acute cardiac event. The prehospital ECG should be fully integrated into emergency medicine practice.
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Multicenter Study
Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms.
Identifying ST-segment elevation myocardial infarctions (STEMIs) by paramedics can decrease door-to-balloon times. While many paramedics are trained to obtain and interpret electrocardiograms (ECGs), it is unknown how accurately they can identify STEMIs. ⋯ Despite training and a high level of confidence, the paramedics in our study were only able to identify an inferior STEMI and two normal ECGs. Given the paramedics' low sensitivity and specificity, we cannot rely solely on their ECG interpretation to activate the cardiac catheterization laboratory. Future research should involve the evaluation of training programs that include assessment, initial training, testing, feedback, and repeat training.
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Most duties performed by firefighters require the use of personal protective equipment, which inhibits normal thermoregulation during exertion, creating an uncompensable heat stress. Structured rest periods are required to correct the effects of uncompensable heat stress and ensure that firefighter safety is maintained and that operations can be continued until their conclusion. While considerable work has been done to optimize firefighter cooling during fireground operations, there is little consensus on when or how cooling should be deployed. ⋯ Cooling during work thus far has been limited primarily to cooling vests and liquid- or air-cooled suits. In general, liquid-perfused suits appear to be superior to air-cooled garments, but both add weight to the firefighter, making current iterations less desirable. There is still considerable work to be done to determine the optimal cooling strategies for firefighters and hazardous materials operators during work.
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Comparative Study
A quantile regression analysis of ambulance response time.
Shorter ambulance response time (ART) contributes to improved clinical outcomes. Various methods have been used to analyze ART. ⋯ The quantile regression model is more useful than the OLS model for estimating ART, revealing that in Singapore, ART is influenced heterogeneously by the volume of emergency calls in the past one hour.
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Identifying ST-segment elevation myocardial infarctions (STEMIs) in the field can decrease door-to-balloon times. Paramedics may use a computer algorithm to help them interpret prehospital electrocariograms (ECGs). It is unknown how accurately the computer can identify STEMIs. ⋯ Prehospital computer interpretation is not sensitive for STEMI identification and should not be used as a single method for prehospital activation of the cardiac catheterizing laboratory. Because of its high specificity, it may serve as an adjunct to interpretation.