Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Observational Study
Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes.
Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures. ⋯ In this large, statewide study of major TBI, both ETs and LTs immediately following prehospital transport were independently associated with higher mortality and with increased TC LOS, ICU LOS, and total TC charges. Further study is needed to identify the causes of abnormal body temperature during the prehospital interval and if in-field measures to prevent temperature variations might improve outcomes.
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Observational Study
Improvements in Out-of-Hospital Cardiac Arrest Survival from 1998 to 2013.
Out-of-hospital cardiac arrest (OHCA) remains a major public health burden. Aggregate OHCA survival to hospital discharge has reportedly remained unchanged at 7.6% for almost 30 years from 1970 to 2008. We examined the trends in adult OHCA survival over a 16-year period from 1998 to 2013 within a single EMS agency. ⋯ Overall survival from treated OHCA has increased over the last 16 years in this community. These survival increases demonstrate that OHCA is a treatable condition that warrants further investigation and investment of resources.
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Observational Study
Intraosseous Pressure Monitoring in Healthy Volunteers.
Invasively monitoring blood pressure through the IO device has not been thoroughly demonstrated. This study attempted to establish baseline values of IO pressure in a healthy human population. ⋯ Intraosseous pressure readings can be obtained in healthy human volunteers. However, absolute IOP values were not consistent between subjects. Future research may determine how IO pressure can be used to guide therapy in ill and injured patients.
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To identify the predictors of traumatic spinal cord injury (TSCI) and describe the differences between confirmed and potential TSCI cases in the prehospital setting. ⋯ This study identified several predictors of TSCI including meeting AV Potential Major Trauma criteria, male gender, presence of neurological deficit, presence of an altered state of consciousness, high falls (> 3 meters), diving, or motorcycle or bicycle collisions. Most of these predictors are included in NEXUS and/or CCR criteria, however, Potential Major Trauma criteria have not previously been linked to the presence of TSCI. Therefore, Emergency Medical Systems are encouraged to integrate similar Potential Major Trauma criteria into their guidelines and protocols to further improve the provider's accuracy in identifying TSCI and to be more selective in their spinal immobilization, thereby reducing unwarranted adverse effects of this practice.
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The Michigan Legislature mandated that all public schools stock epinephrine auto-injectors (EAIs). A minimal amount is known regarding the incremental value of EAIs in schools. Our primary objective was to describe the frequency of administration of epinephrine for EMS patients with acute allergic reactions in public schools. Our secondary objective was to estimate the cost of mandating public schools to stock EAIs. ⋯ In this study, few public school patients received epinephrine for anaphylaxis and the vast majority occurred in communities with rapid ALS response. The direct annual supply cost of the school EAI mandate is substantial.