Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To characterize transport times for the interfacility air ambulance transport of patients with acute ST-segment elevation myocardial infarction (STEMI), to estimate the proportion of patients at risk of in-transport clinical decompensation, and to explore associated risk factors for such. ⋯ The majority of interfacility rotor-wing air ambulance transfers of patients with STEMI achieved a total transfer time of < or = 2 hours. Clinical decompensation requiring ALS treatment occurred in a small percentage of patients. Diabetes, prior arrest or decompensation, and delays to transport were associated with clinical decompensation in the air. Efforts to reduce delays to transport may reduce this risk in transported patients.
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To examine the effects of adding close concurrent and retrospective physician oversight, consistent with National Association of EMS Physicians (NAEMSP) recommendations, to an existing regional prehospital rapid-sequence intubation (RSI) program. ⋯ Close concurrent and retrospective physician oversight consistent with recommendations from the NAEMSP is associated with improved cognitive skills in paramedics, including appropriate patient selection for RSI. Further research is warranted to validate this model and optimize where resources are best used to enhance patient safety and improve clinical management for this controversial paramedic skill.
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Emergency medical services (EMS) is an important component of emergency medicine residency curricula. For over 20 years, residents at a university-affiliated program have staffed a physician response vehicle and responded to selected calls in an urban EMS system with online faculty backup. ⋯ Our prehospital training program incorporates emergency medicine residents as in-field physicians and allows hands-on opportunity to provide patient care for a variety of conditions in the EMS environment, as well as extensive experience in online medical direction. The trainees believed it had a strong positive impact on their acquisition of important emergency medicine abilities.
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Medical oversight is a fundamental component of every emergency medical services (EMS) system. The quality of physician medical direction has a significant impact upon the system and patient outcome. ⋯ This resource document provides a snapshot of the status of state EMS medical direction in our nation in 2007 and a projection of the achievable benchmarks for the role of the state EMS medical director in the future. As an informational resource, this tool will assist state EMS officials, legislators, laypersons, and partners within the emergency care system to comprehend, create or improve, and support the state EMS medical director position within their jurisdictions.
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Comparative Study
Neurologically intact survival in a porcine model of cardiac arrest: manual cardiopulmonary resuscitation vs. LifeBelt cardiopulmonary resuscitation.
To compare the LifeBelt (Deca-Medica, Inc., Columbus, OH), a novel cardiopulmonary resuscitation (CPR) device, with manual CPR on the outcome of neurologically intact survival in a porcine model of cardiac arrest. ⋯ In this porcine model of cardiac arrest, we did not detect significant differences in neurologically intact survival between LifeBelt CPR and manual CPR.