Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Critically ill children undergo painful procedures during resuscitation and stabilization before and during interfacility transport. The literature supporting pain management in this unique environment focuses predominantly on isolated traumatic injuries. Timely administration of analgesia can improve patient well-being by attenuating stress responses and reducing severe adverse events. To determine the prevalence of analgesia administration among pediatric patients undergoing mechanical ventilation during transport and to identify associated factors. ⋯ This study's findings highlight the need for improved pain evaluation in caring for mechanically ventilated pediatric patients during transport. Factors such as transport, duration, the reason for transport, pre-transport opiate or ketamine administration, and paralytics increase the likelihood of analgesia administration. At the same time, the presence of comorbidities decreases the likelihood. The study underscores the importance of improved documentation of pain to inform analgesic choices and administration with the ultimate goal of reducing adverse events.
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Acutely injured trauma patients may develop shock from several potential mechanisms, including hypovolemic shock from hemorrhage, neurogenic shock from traumatic brain injury (TBI) or spinal cord injury, obstructive shock from tension pneumothorax or pericardial tamponade, or a mix of several of these mechanisms. Regardless of the cause, restoration of adequate perfusion is of critical importance to reduce the morbidity and mortality of trauma patients with shock. ⋯ The prehospital use of vasopressors to augment organ perfusion pressures seems theoretically appealing for settings where trauma patients have hemorrhagic shock that is refractory to volume resuscitation strategies alone, where blood products are not available, in cases of hypoperfusion caused by neurogenic shock, or to address mean arterial pressure (MAP) goals in severe spinal cord injury. The National Association of Emergency Medical Services Physicians (NAEMSP) reviewed the available evidence surrounding the prehospital use of vasopressors in shock related to trauma to develop the following recommendations as supported by the evidence summarized in the subsequent resource document.
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Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics' likelihood of leaving EMS. ⋯ Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.
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In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD). ⋯ Grounded in evidence-based practices and informed by collaborative expertise, this framework represents a pivotal step toward enhancing the effectiveness and responsiveness of EMS in combating the multifaceted challenges posed by OUD.
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Emergency Medical Services (EMS) patient care reports (PCRs) are an important component for the transfer of patient care from EMS systems to hospitals and a foundational element of EMS quality improvement (QI). The PCR may serve as the only objective source of information for EMS patient presentation. Surprisingly little data, either objective or anecdotal, exists regarding the reliability of this process. Our objective is to describe the frequency of missing PCRs and the time of their receipt following EMS transport to hospital emergency departments (EDs). ⋯ Many PCRs are missing after EMS transport, with marked variation in submission rates and time to upload by agency and hospital. Many PCRs were infrequently available for use in a timely manner. Further assessment is needed to quantify the degree to which the lack of transfer of documentation of EMS patient care exists across emergency care systems.