Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To describe the characteristics of older people who fall and call an emergency ambulance, and the operational and clinical impact of the ambulance responses they receive. ⋯ In this population, ambulance services appear to provide timely responses to older people who have fallen, and "long-lies" are relatively uncommon. More than one-quarter of patients were not transported to an emergency department, and repeat use of ambulance resources appears to be common. Opportunities exist to explore alternate pathways and models of care that maximize outcomes for nontransport patients as well as improving operational efficiency of the ambulance service.
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Randomized Controlled Trial
A Comparison of ketamine and Morphine Analgesia in Prehospital Trauma Care: A Cluster Randomized Clinical Trial in Rural Quang Tri Province, Vietnam.
The use of opioid analgesics in prehospital trauma care has been reported to have negative side effects on the airway and circulation. Several studies of urban trauma management have recommend ketamine as a safe and efficient analgesic. To date, however, no controlled trials of prehospital opioid analgesics versus ketamine in rural trauma management have been published. ⋯ Ketamine had an analgesic effect similar to morphine and carried a lower risk of airway problems. The risk of hallucinations and agitation was increased in the ketamine group. These findings are of medical significance, particularly in rough and low-resource scenarios.
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Review Meta Analysis
Airways in Out-of-hospital Cardiac Arrest: Systematic Review and Meta-analysis.
To determine the differences in survival for out-of-hospital advanced airway intervention (AAI) compared with basic airway intervention (BAI) in cardiac arrest. ⋯ This meta-analysis shows decreased survival for AAIs used out-of-hospital in cardiac arrest, but are likely biased due to confounding, especially confounding by indication. A properly conducted prospective study or a controlled trial is urgently needed and are possible to do.
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Review Comparative Study
Evidence-based Prehospital Management of Severe Traumatic Brain Injury: A Comparative Analysis of Current Clinical Practice Guidelines.
This study appraised the completeness and level of evidence behind prehospital recommendations in clinical practice guidelines (CPGs) for management of severe traumatic brain injury (TBI). Differences and similarities in key recommendations for prehospital emergency care were assessed between current CPGs. ⋯ The use of current guidelines on traumatic brain injury will not always facilitate decisions about best or most appropriate practice for prehospital practitioners. The amount of recommended prehospital interventions varied considerably, and there was large content variation in prehospital recommendations in these guidelines. Not all evidence was taken into account and not all CPGs were up-to-date.
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This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. ⋯ A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage.