Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Multicenter Study
Airway management success and hypoxemia rates in air and ground critical care transport: a prospective multicenter study.
To assess critical care transport (CCT) crews' endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation. ⋯ CCT crews' ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO(2) derangement. CCT crews' ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews.
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We compared the effectiveness of common airway-securing techniques in preventing endotracheal tube (ETT) dislodgment in the prehospital setting. ⋯ In this multicenter observational series, the odds of ETT dislodgment were similar for face tape, neck tape, twill tape, plastic tubing, and commercial tube holders. ETT dislodgment did not occur with woven twill tape. Patients under 5 years of age are at heightened risk for ETT dislodgment.
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Multicenter Study
The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort.
The validity of using adult physiologic criteria to triage injured children in the out-of-hospital setting remains unproven. Among children meeting adult field physiologic criteria, we assessed the availability of physiologic information, the incidence of death or prolonged hospitalization, and whether age-specific criteria would improve the specificity of the physiologic triage step. ⋯ The incidence of high-risk injured children meeting adult physiologic criteria is relatively low and the findings from this sample do not support using age-specific values to better identify such children. However, the amount and pattern of missing data may compromise the value and practical use of field physiologic information in pediatric triage.
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Multicenter Study
A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region.
To determine 1) the success rate of prehospital endotracheal intubation; 2) the unrecognized tube malposition rate; and 3) predictors of tube malposition upon arrival to the emergency department (ED) in the setting of a large metropolitan area that includes 18 hospitals and 34 transporting emergency medical services (EMS) agencies. ⋯ Overall intubation success was low, and consistent with previously published series. The frequency of malpositioned ETT was unacceptably high, and also consistent with prior studies. Our data support the need for ongoing monitoring of EMS providers' practices of endotracheal intubation.
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Randomized Controlled Trial Multicenter Study
Emergency medical service providers' attitudes and experiences regarding enrolling patients in clinical research trials.
The purpose of this study was to evaluate Emergency Medical Services (EMS) providers' attitudes and experiences about enrolling patients in clinical research trials utilizing the federal rules for exception from informed consent. We hypothesized that Emergency Medical Technicians (EMTs) would have varied attitudes about research using an exception from informed consent which could have an impact on the research. ⋯ The majority of EMS personnel in one community support EMS research and this specific out-of-hospital clinical trial being conducted under an exception from informed consent. Potential barriers to enrollment were identified. Further study in other systems is warranted to better understand EMS provider perspectives about exception from informed consent research.