Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Double Sequence Defibrillation or Double Simultaneous Defibrillation (DSD) is the use of two defibrillators almost simultaneously at their highest allowed energy setting to treat refractory ventricular fibrillation (RVF). One set of pads is placed in the Anterior-Posterior position and the other set of pads is placed in the Anterior-Lateral Position. Both defibrillation buttons are pressed simultaneously. We sought to determine ROSC and survival rates in a large EMS system when DSD is routinely utilized for RVF. ⋯ The correct amount of energy in joules for VF remains unknown. In this case series, significant patients converted out of VF. The reason for improved VF conversion may be several factors including additional defibrillation vectors, increased energy, more energy across myocardium, and unknown variables. Additional research is underway to determine if routine DSD will result in improved survival compared to standard defibrillation techniques.
-
The pediatric Glasgow coma scale (pGCS) is a consciousness score that, although widely applied, requires skill to apply. The AVPU scale uses four simple categories (Alert; Verbal response; response to Pain; Unresponsive), but has not been studied in a large pediatric population. We compared the performance of the AVPU and pGCS scales in a large pediatric cohort in an acute, prehospital setting. ⋯ Glasgow coma scale (GCS); Alert-verbal-pain-unresponsive-score; AVPU-score; consciousness assessment; children, pediatric emergency.
-
Randomized Controlled Trial
Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children.
The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. ⋯ In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.
-
In many industries, limiting variability in process has been associated with a reduction in errors. Hypoglycemia is a common prehospital diabetic emergency for which most EMS systems have a treatment protocol. ⋯ In the U.S., EMS protocols for the treatment of hypoglycemia vary significantly. Further studies are warranted to determine the factors underlying this variability and effects on patient outcomes.
-
New medical school educational curriculum encourages early clinical experiences along with clinical and biomedical integration. The University of South Carolina School of Medicine Greenville, one of the new expansion schools, was established in 2011 with the first class matriculating in 2012. To promote clinical skills early in the curriculum, emergency medical technician (EMT) training was included and begins in the first semester. Along with the early clinical exposure, the program introduces interprofessional health and teams and provides the opportunity for students to personally see and appreciate the wide variety of environments from which their future patients emanate. ⋯ Medical students who received their EMT training in a 6-week, non-integrated format performed similarly on the EMT State certification examination to those who received their training in a prolonged, integrated structure.