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
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.
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Multicenter Study
Accuracy of stroke recognition by emergency medical dispatchers and paramedics--San Diego experience.
Prehospital personnel in Emergency Medical Service (EMS) systems have varying levels of accuracy in stroke recognition. Identifying the accuracy of emergency medical dispatcher using Medical Priority Dispatch Systems (MPDS) stroke protocol and paramedics may help understand the accuracy of stroke recognition in about 3000 emergency medical dispatch systems and prehospital systems world wide. ⋯ In our EMS system, EMD using MPDS Stroke protocol with a high compliance has a higher sensitivity than paramedics using CSS.
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Multicenter Study Comparative Study
Hospital variability of out-of-hospital cardiac arrest survival.
Previous literature has identified patient and emergency medical services (EMS) system factors that are associated with survival of out-of-hospital cardiac arrest patients. ⋯ Survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients may vary by receiving hospital. A hospital's ratio of beds to nurse and several patient/case f actors are correlated with survival. Further research is warranted to investigate how this may affect resuscitation care, EMS transport policy, and research design.
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Multicenter Study
Derivation of clinical predictors of failed rescue shock during out-of-hospital ventricular fibrillation.
Failed rescue shocks have been shown to decrease the likelihood of survival in the treatment of out-of-hospital ventricular fibrillation (VF). Avoidance of failed shocks may improve survival. ⋯ Unwitnessed collapse, response time>6 minutes, and absence of BCPR may be useful in predicting which VF patients are likely to have failed first shocks and would thereby benefit from a CPR-first strategy. Stacked rescue shocks most often fail, and this outcome can also be predicted.