Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Use of emergency medical services for suspected acute cardiac ischemia among demographic and clinical patient subgroups: the REACT trial. Rapid Early Action for Coronary Treatment.
Barriers to the use of emergency medical services (EMS) and patient delay in seeking care can limit the receipt or effectiveness of reperfusion therapies and the availability of prehospital emergency cardiac care. The Rapid Early Action for Coronary Treatment (REACT) trial was designed to determine the impact of a community intervention on use of EMS among demographic and clinical subgroups of patients with suspected acute cardiac ischemia. ⋯ The REACT trial demonstrated a significant impact on the use of EMS among patients admitted to the hospital for suspected acute myocardial infarction, with greater increases among patients with chronic or other cardiac ICD-9 discharge diagnoses, those presenting with lower SBP, and retired persons.
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To investigate emergency medical services (EMS) providers' experience with weapons encountered while working, and evaluate the training they have received regarding searching for and confiscating weapons in the field. ⋯ These data suggest that weapons encountered in the field are a widespread problem for EMS providers. Although many EMS providers search for and find weapons on their patients, most of them feel they have been inadequately trained in this area. Prospective studies are needed to document the actual incidence of weapon encounters in the prehospital setting. Multidisciplinary discussions are needed to address the above issues.
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Multicenter Study
Medication calculation skills of practicing paramedics.
To assess the medication calculation skills among a group of practicing paramedics, the types of computations they find most difficult, and the relationship between drug calculation skills and various demographic characteristics. ⋯ Similar to findings among other allied health professions, medication calculation skills were found to be lacking among a group of practicing paramedics. In addition, the paramedics reported infrequent opportunities to perform this skill in the clinical setting and that medication calculations were not a routine part of EMS continuing education programs.
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Multicenter Study Clinical Trial
The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.
Traditional EMS teaching identifies mechanism of injury as an important predictor of spinal injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with "a positive mechanism" clearly capable of producing spinal injury. ⋯ Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury in this population.
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Multicenter Study
Difficulties with portable suction equipment used for prehospital advanced airway procedures.
Airway management is the highest priority for prehospital personnel. While different modalities for airway management are under investigation, endotracheal intubation remains the standard for definitive airway protection. Currently, airway adjuncts such as portable suction remain relatively unstudied. ⋯ The results of this study suggest that suction equipment is carried to the scene infrequently and, when employed, is often found to be functioning suboptimally. Suggestions for improvement and further investigation are provided.