Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time. Therefore, the aim of this project is to establish a consensus guideline for prehospital care of patients with exposures to HZ and HZ-Ds. ⋯ The consensus guideline for clinical care of patients with exposure to HZ/HZ-Ds is as follows: Prior to decontamination, use appropriate personal protective equipment, and when necessary, support ventilation using a bag-valve-mask and administer midazolam intramuscularly for seizures. After decontamination, provide supplemental oxygen; consider selective advanced airway management when indicated; administer inhaled beta-agonists for wheezing; and, for seizures unresponsive to multiple doses of benzodiazepines that occur during pre-planned, high-hazard activities, such as spacecraft recovery, consider intravenous or intraosseous pyridoxine.
-
Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process. ⋯ This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negative impacts on receiving hospitals and EMS operations. Our findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.
-
Case Reports
Prehospital whole blood administration for pediatric gastrointestinal hemorrhage: A case report.
The management of gastrointestinal (GI) hemorrhage in a prehospital setting presents significant challenges, particularly in arresting the hemorrhage and initiating resuscitation. This case report introduces a novel instance of prehospital whole blood transfusion to an 8-year-old male with severe lower GI hemorrhage, marking a shift in prehospital pediatric care. The patient, with no previous significant medical history, presented with acute rectal bleeding, severe hypotension (systolic/diastolic blood pressure [BP] 50/30 mmHg), and tachycardia (148 bpm). ⋯ Upon hospital admission, a Meckel's diverticulum was identified as the bleeding source, and it was successfully surgically resected. The patient's recovery was ultimately favorable, highlighting the importance of rapid, prehospital intervention and the potential role of whole blood transfusion in managing acute pediatric GI hemorrhage. This case supports the notion of advancing EMS protocols to include interventions historically reserved for the hospital setting that may significantly impact patient outcomes from the field.
-
Extracorporeal cardiopulmonary resuscitation (eCPR) is a promising treatment that could improve survival for refractory out-of-hospital (OHCA) patients. Healthcare systems may choose to start eCPR in the prehospital setting to optimize time to eCPR initiation and decrease low-flow time. We used geospatial modeling to evaluate different eCPR catchment strategies for a forthcoming prehospital eCPR program in Houston, Texas. ⋯ Using geospatial modeling, we demonstrated a process to estimate potential eCPR patient volumes for a geographic region. Geospatial modeling represents a viable strategy for healthcare systems to delineate eCPR catchment areas.
-
This study sought to evaluate performance indicators to assist a static-based 9-1-1 agency in defining its response efficiency. ⋯ These findings suggest a way to evaluate the efficiency of static-based ambulance deployment and potentially identify strategies for redeployment.