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
A Randomized Crossover Trial of Conventional versus Modified "Koch" Chest Compressions in a Height-Restricted Aeromedical Helicopter.
Aim: Low overhead height can negatively affect chest compression performance. An adapted compression technique has been proposed by paramedic H. Koch (pron. "Cook"). ⋯ Conclusions: In a height-restricted aeromedical helicopter, the average overall quality score improved using Koch compressions, although the mean rate, mean depth, correct release and land marking were found to be similar between techniques. Qualitative feedback described Koch compressions as easier and more sustainable. In settings where the compressor is affected by reduced overhead working height, Koch compressions may be an advisable alternative.
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Randomized Controlled Trial
Layperson Ability and Willingness to Use Hemostatic Dressings: A Randomized, Controlled Trial.
Background: The Hartford Consensus and Stop the Bleed Campaign empower the public to stop bleeding. While evidence for civilian tourniquet use is mounting, there is limited evidence regarding the public's ability to use hemostatic dressings. This study seeks to determine if laypeople can apply hemostatic dressings, and which hemostatic dressing they can use most successfully. ⋯ Educators and planners should consider including injectable sponges in their Stop the Bleed programs and products. Level of Evidence: II (RCT with significant difference. One negative criterion for observer blinding).
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Randomized Controlled Trial Multicenter Study
Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial.
Objective: Older adults account for 38-48% of emergency medical service (EMS) calls, have more chronic diseases, and those with low income have lower quality of life. Mobile integrated health and community paramedicine may help address these health inequalities and reduce EMS calls. This study examines the effectiveness of the Community Paramedicine at Clinic (CP@clinic) program in decreasing EMS calls and improving health outcomes in low-income older adults. ⋯ Conclusions: CP@clinic showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adults in subsidizing public housing, suggesting this simple program should be replicated in other communities with public housing. Trial Registration: Clinicaltrials.gov, Registration no. NCT02152891.
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Randomized Controlled Trial
Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial.
Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. ⋯ Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians.
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Randomized Controlled Trial
Automated External Defibrillator Geolocalization with a Mobile Application, Verbal Assistance or No Assistance: A Pilot Randomized Simulation (AED G-MAP).
Shockable rythms are common among victims of witnessed public out-of-hospital cardiac arrest (OHCA), but bystander defibrillation with a public automated external defibrillator (PAED) is rare. Instructions from the emergency medical dispatcher and mobile applications were developed to expedite the localization of PAEDs, but their effectiveness has not been compared. ⋯ In a simulated environment, verbally providing OHCA bystanders with the nearest PAED's location appeared to be effective in reducing the time to defibrillation in comparison to no assistance and to an AED geolocalizing mobile app, but further research is required to confirm this hypothesis, ascertain the external validity of these results, and evaluate the real-life implications of these strategies.