Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Pediatric prehospital research has been limited, but work in this area is starting to increase particularly with the growth of pediatric-specific research endeavors. Given the increased interest in pediatric prehospital research, there is a need to identify specific research priorities that incorporate the perspective of prehospital providers and other emergency medical services (EMS) stakeholders. ⋯ emergency medical technician; research; emergency medical services; priorities.
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In this article, we present a notable case that illustrates a novel partnership between a United States Coast Guard small boat station and a civilian paramedic response unit. Patients who experience medical emergencies in remote environments are at particularly high risk for morbidity and mortality. For the most serious conditions, delayed contact with Advanced Life Support (ALS) has grave results. ⋯ Since October 2013, a paramedic from Maui County EMS co-responds aboard the Coast Guard boat with a full complement of ALS equipment. This partnership has resulted in some significant improvements in patient outcome, and strengthened a collaborative emergency services system. The experience has also indicated the need for continued improvement in early activation and communication, as well as reinforcing the importance of primary prevention.
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Observational Study
Needle Thoracostomy in the Prehospital Setting: A Retrospective Observational Study.
The use of needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma; however, controversy surrounds its use. The purpose of this study is to compare outcomes, effectiveness, and complications of NT in an Emergency Medical Services (EMS) system that includes urban, rural, and wilderness environments. ⋯ NT can safely be performed by paramedics in an EMS system that includes urban, rural, and wilderness settings. Its efficacy does not differ between patients suffering from blunt versus penetrating trauma; however, it appears most beneficial for patients who are unstable but still have vital signs.
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Rapid, accurate evaluation and sorting of victims in a mass casualty incident (MCI) is crucial, as over-triage of victims may overwhelm a trauma system and under-triage may lead to an increase in morbidity and mortality. At this time, there is no validation tool specifically developed for the pediatric population to test an MCI algorithm's inherent capabilities to correctly triage children. ⋯ pediatric; disaster; validation tools; triage algorithms; emergency.
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Despite experimental evidence supporting the use of resuscitation drugs in the treatment of sudden cardiac arrest (CA), there are no good human clinical data to support the decades-old practice of giving these medications during out-of-hospital CA resuscitation. We hypothesized that the lack of efficacy in clinical practice in ventricular fibrillation (VF) is the failure-based manner in which resuscitation drugs have historically been administered (one at a time interspersed with chest compressions and a defibrillation attempt, giving the next only if the previous one was ineffective). The aim of this study was to determine if giving and circulating a combination of commonly available, historically used resuscitation drugs together, prior to the first defibrillation attempt after prolonged VF, might improve short-term outcomes compared with the failure-based serial drug approach used in the past. ⋯ Termination of VF was statistically similar in the two groups: 88.7% (47/53) versus 85.2% (23/27) p = 0.66, with an adjusted relative risk ratio (RRR) of 0.94 (0.37, 1.15). However, ROSC was higher in the SERIES group (56.6% [30/53] versus 22.2% [6/27], adjusted RRR = 2.83; [1.16, 3.84] p = 0.029) as was 20-minute survival (52.8% [28/53] versus 18.5% [5/27], adjusted RRR = 3.15 [1.14, 4.54] p = 0.032). The combination of drugs studied, at these dosages, inexplicably worsened short-term outcomes after prolonged untreated VF.