Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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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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Multicenter Study Comparative Study
Variation in prehospital use and uptake of the national Field Triage Decision Scheme.
The Field Triage Decision Scheme is a national guideline that has been implemented widely for prehospital emergency medical services (EMS) and trauma systems. However, little is known about the uptake, modification, or variation in field application of triage criteria between trauma systems. ⋯ There is large variation between regions in the frequency and type of field triage criteria used. Field uptake of guideline revisions appears to be slow and variable, suggesting opportunities for improvement in dissemination and implementation of updated guidelines.
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Multicenter Study
Diagnostic accuracy of a rapid checklist to identify delirium in older patients transported by EMS.
The presence of delirium in elderly patients is common and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. Early recognition of delirium in the prehospital setting has the potential to improve outcomes, but is not feasible without valid assessment tools. ⋯ A rapid delirium checklist can identify 63% of patients with delirium, but performed no better than the GCS. Future research should determine whether a rapid test of cognition improves early identification of elderly patients with delirium.
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Multicenter Study
The role of calling EMS versus using private transportation in improving the management of stroke in France.
To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation. ⋯ The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.