Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI. If NTBP is common and if brain trauma RSI evidence is not valid for NTBP then a sizable proportion of NTBP receive this treatment without evidence of benefit. This study calculated the out-of-hospital NTBP prevalence in patients that had received RSI and explored factors that predicted survival. ⋯ Non-traumatic brain pathologies are seven times more prevalent than traumatic brain injuries in patients that underwent out-of-hospital RSI in Victoria, Australia. Since the mechanisms through which RSI impacts mortality might differ between traumatic brain injuries and NTBP, and given that NTBP is very prevalent, it follows that the use of RSI in NTBP could be unsupported.
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Medical insurers have clearly defined which ambulance services will be reimbursed and which will not. Thus, ambulance agencies that provide emergency 9-1-1 services must be highly cognizant of their organization's revenue needs. This presents a distinction between publicly funded and privately funded organizations. This study seeks to identify any differences in the transport decision among agency ownership types. ⋯ Given the reimbursement practices of medical insurers, private ambulance services are incentivized towards patient transport. Operational revenue for these services is not generated through public budgeting processes but through user fees. Thus, private agencies are more reliant on billable services than are their publicly funded counterparts.