Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Objective: Firefighter first responders and other emergency medical services (EMS) personnel have been among the highest risk healthcare workers for illness during the SARS-CoV-2 pandemic. We sought to determine the rate of seropositivity for SARS-CoV-2 IgG antibodies and of acute asymptomatic infection among firefighter first responders in a single county with early exposure in the pandemic. Methods: We conducted a cross-sectional study of clinically active firefighters cross-trained as paramedics or EMTs in the fire departments of Santa Clara County, California. ⋯ Twenty-five participants (2.54%, 95% CI 1.65-3.73) tested positive for IgG antibodies and 9 (0.92%, 95% CI 0.42-1.73) tested positive for SARS-CoV-2 by RT-PCR. Our cumulative incidence, inclusive of self-reported prior positive PCR tests, was 34 (3.46%, 95% CI 2.41-4.80). Conclusion: In a county with one of the earliest outbreaks in the United States, the seroprevalence among firefighter first responders was lower than that reported by other studies of frontline health care workers, while the cumulative incidence remained higher than that seen in the surrounding community.
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We report a rare but serious complication of needle thoracostomy, penetration of the myocardium. Needle thoracostomy is typically performed in the prehospital setting or upon arrival in the emergency department for suspected tension pneumothorax. ⋯ Our case supports prior literature that the anterior MCL location has a low rate of efficacy to decompress the chest, as well as a high rate of complications. We recommend performing needle decompression laterally at the AAL whether in the field or in the emergency department.
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Increasing naloxone access has been identified as a primary strategy to reduce opioid overdose deaths. To supplement community naloxone training and distribution access points, EMS systems have instituted public safety-based naloxone leave behind (NLB) programs that allow emergency medical responders to distribute "leave behind" naloxone kits on the scene of an overdose. This model presents an opportunity to expand naloxone access for individuals at high risk for future overdoses. ⋯ The fully adjusted logistic regression model revealed that those whose kit was left with a family member on the scene were 5.16 times more likely to be connected to peer support specialists (OR = 5.16, CI= 2.35 - 11.29, p = 0.000) while those whose kit was left with a friend or given directly to the patient were 3.69 times (OR = 3.69, CI= 1.13 - 12.06, p < 0.05) and 2.37 times (OR = 2.37, CI= 1.10 - 5.14, p < 0.05) more likely, respectively, to be connected to follow up services as compared to those who did not accept a kit, controlling for other variables in the model. Conclusion: This study highlights the importance of engaging an individual's family and social network when offering connections to treatment and recovery resources. NLB initiatives can potentially augment existing community-based naloxone training structures, thus widening the scope of the life-saving drug and reaching those most at risk of dying from an opioid overdose.
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In continued support of establishing and maintaining a foundation for standards of care, our organizations remain committed to periodic review and revision of this position statement. This latest revision was created based on a structured review of the National Model EMS Clinical Guidelines Version 2.2 in order to identify the equipment items necessary to deliver the care defined by those guidelines. ⋯ Some items may be considered optional at the local level as determined by agency-defined scope of practice and applicable clinical guidelines. In addition to the items included in this position statement our organizations agree that all EMS service programs should carry equipment and supplies in quantities as determined by the medical director and appropriate to the agency's level of care and available certified EMS personnel and as established in the agency's approved protocols.
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Randomized Controlled Trial
Verbal Motivation vs. Digital Real-Time Feedback During Cardiopulmonary Resuscitation: Comparing Bystander CPR Quality in a Randomized and Controlled Manikin Study of Simulated Cardiac Arrest.
The use of smartphone applications increases bystander CPR quality as well as the use of telephone CPR protocols. The present prospective, randomized, controlled manikin trial analyses the effects of a smartphone application (PocketCPR©) on CPR quality in a bystander CPR scenario compared to a dispatcher-assisted telephone CPR with the additional use of a metronome and verbal motivation. Methods: 150 laypersons were included to perform 8-minute CPR on a manikin. ⋯ Median compression rate in the telephone + app-group was significantly elevated (108 min-1 [IQR 96-119 min-1]) compared to the telephone-group (78 min-1 [IQR 56-106 min-1]; p < 0.001) and the telephone + motivation-group (99 min-1 [IQR 91-101 min-1]; p < 0.001). Conclusions: The use of a smartphone application as well as verbal motivation by a dispatcher during telephone CPR leads to higher CPR quality levels compared to standard telephone CPR. Thereby, the use of the smartphone application mainly shows an increase in compression rate, while increased compression rate with simultaneously increased compression depth was only apparent in the telephone + motivation-group.