Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?
Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice. ⋯ Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.
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To evaluate emergency medical technicians' (EMTs') ability to estimate spilled blood volume and to determine whether limited training improves estimate accuracy and whether there is a difference in improvement comparing two different training methods. ⋯ Prehospital care providers are not accurate at estimating spilled blood volumes. This ability can be improved with limited education. Slides appear to be as effective as viewing actual spill sites.
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To determine the magnitude of prehospital delay and how much time elapses between emergency department (ED) presentation and ED clinical investigations in ischemic stroke patients. Factors associated with prehospital delay were also correlated with demographic characteristics and clinical variables. ⋯ This study reveals that delayed management of stroke patients is mainly due to delayed ED presentation and to difficulties in obtaining neurologic consultation. Ideally, a stroke center may be incorporated within the EMS system to overcome delays due to interhospital transfer and to difficulties in obtaining neurologic consultation.
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Endotracheal intubation (ETI) remains the "gold standard" for securing a patient's airway. In recent years, the use of pharmacologic agents to assist paramedics achieve successful intubation of problematic airways has become more common. This study was done to determine the efficacy of intravenous midazolam, a short-acting benzodiazepine, as a drug to facilitate intubation in patients resistant to conventional ETI. ⋯ The prehospital use of single-dose IV midazolam is generally effective in accomplishing facilitated ETI in patients resistant to conventional (nonpharmacologic) ETI.
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To identify deficiencies in stroke knowledge among prehospital providers. ⋯ Most EMS providers are knowledgeable about the symptoms of stroke but are unaware of the therapeutic window for thrombolysis and the recommended avoidance of prehospital blood pressure reduction. In addition, further education is needed regarding TIAs.