Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The elderly utilize emergency medical services (EMS) at a higher rate than younger patients, yet little is known about the influence of injury on subsequent EMS utilization and costs. ⋯ An injury hospitalization in the elderly serves as a sentinel marker for an abrupt increase in EMS utilization and costs, even after accounting for confounders.
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Comparative Study
Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting.
To compare the effectiveness of intravenous (IV) morphine, intranasal (IN) fentanyl, and inhaled methoxyflurane when administered by paramedics to patients with moderate to severe pain. ⋯ Inhaled methoxyflurane, IN fentanyl, and IV morphine are all effective analgesic agents in the out-of-hospital setting. Morphine and fentanyl are significantly more effective analgesic agents than methoxyflurane. Morphine appears to be more effective than IN fentanyl; however, the benefit of IV morphine may be offset to some degree by the ability to administer IN fentanyl without the need for IV access.
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Several different methods for emergent airway management are feasible in the tactical environment. Current studies fail to identify which method minimizes the exposure of the tactical medic or which is most rapid with the greatest chance of first-attempt success. ⋯ In a simulated tactical airway management scenario, use of the King LT provided less exposure than digital or standard endotracheal intubation techniques. Digital intubation behind the simulated barricade was the least successful by all measures. Although direct laryngoscopy was the most successful on the first attempt, use of the King LT in our scenario provided the least exposure of the medic and was as effective as direct laryngoscopy with regard to time to ventilation. Key words: TEMS; airway management; simulation; tactical environment; combat medicine.
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To describe current prehospital airway management practices for adults and children and barriers to adoption of evidence-based airway management practices in California. ⋯ The results of our study suggest that in areas of EMS where robust evidence exists, medical directors (100%) will discontinue or not adopt skills that potentially harm patients, such as RSI, but are unlikely (12%) to discontinue procedures that show no benefit to patients (such as pediatric ETI). Barriers to adoption of evidence-based practice include difficulty in generalizing results of studies across diverse EMS systems and perceived lack of evidence that the procedure should be abandoned.
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This is the official position statement of the National Association of EMS Physicians on the role of emergency medical services (EMS) in disaster response.