Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Acute stroke patients require immediate medical attention. Therefore, American Stroke Association guidelines recommend that for suspected stroke cases, emergency medical services (EMS) personnel spend less than 15 minutes on-scene at least 90% of the time. However, not all EMS providers include specific scene time limits in their stroke patient care protocols. ⋯ Protocols with specific scene time limits were associated with EMS crews spending less time at the scene while general instructions were not. These findings suggest EMS systems can modestly improve scene times for stroke by specifying a time limit in their protocols.
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Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. ⋯ Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.
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Multicenter Study
Characteristics of the Pediatric Patients Treated by the Pediatric Emergency Care Applied Research Network's Affiliated EMS Agencies.
To describe pediatric patients transported by the Pediatric Emergency Care Applied Research Network's (PECARN's) affiliated emergency medical service (EMS) agencies and the process of submitting and aggregating data from diverse agencies. ⋯ Despite advances in data definitions and increased use of electronic databases nationally, data aggregation across EMS agencies was challenging, in part due to variable data collection methods and missing data. In our sample, only a small proportion of pediatric EMS patients required prehospital medications or interventions.
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Retrospective research has shown that 19% of 12-lead prehospital electrocardiograms (prehospital ECGs) had clinically significant abnormalities that were not captured on the initial emergency department (ED) ECG and had the potential to change medical management. The purpose of this study was to prospectively determine how many prehospital ECGs had clinically significant abnormalities not present on the initial ED ECG and determine how many prehospital ECGs changed physician management. ⋯ Prehospital ECGs show clinically significant abnormalities that are not always captured on the initial ED ECG. Prehospital ECGs have the potential to change the management of patients in the ED.
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Anaphylaxis is a life-threatening systemic allergic reaction that occurs after contact with an allergy-causing substance. Timely administration of intramuscular epinephrine is the treatment of choice for controlling symptoms and decreasing fatalities. Our purpose was to investigate the prehospital management of anaphylaxis among patients receiving care in an urban tertiary care pediatric emergency department (PED). ⋯ Our evaluation revealed low rates of epinephrine administration by EMS providers and parents/patients. Education about anaphylaxis is imperative to encourage earlier administration of epinephrine.