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 Multicenter Study
Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial.
Hemorrhage and trauma induced coagulopathy remain major drivers of early preventable mortality in military and civilian trauma. Interest in the use of prehospital plasma in hemorrhaging patients as a primary resuscitation agent has grown recently. Trauma center-based damage control resuscitation using early and aggressive plasma transfusion has consistently demonstrated improved outcomes in hemorrhaging patients. ⋯ S. Food and Drug Administration utilizing a multipronged community consultation process. It is one of three ongoing Department of Defense-funded trials aimed at expanding our understanding of the optimal therapeutic approaches to coagulopathy in the hemorrhaging trauma patient.
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Case Reports Randomized Controlled Trial Comparative Study
Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics.
There is a lack of definitive evidence that preventative, in-home medical care provided by highly trained community paramedics reduces acute health care utilization and improves the overall well-being of patients suffering from chronic diseases. The Expanding Paramedicine in the Community (EPIC) trial is a randomized controlled trial designed to investigate the use of community paramedics in chronic disease management (ClinicalTrials.gov ID: NCT02034045). This case of a patient randomized to the intervention arm of the EPIC study demonstrates how the added layer of frequent patient contact by community paramedics and real-time electronic medical record (EMR) correspondence between the paramedics, physicians and other involved practitioners prevented possible life-threatening complications. The visiting community paramedic deduced the need for an electrocardiogram, which prompted the primary care physician to order a stress test revealing abnormalities and thus a coronary artery bypass graft was performed without emergency procedures, unnecessary financial expenditure or further health degradation such as a myocardial infarction.
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Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial of Aspirin and Exertional Heat Stress Activation of Platelets in Firefighters during Exertion in Thermal Protective Clothing.
Platelet aggregation is enhanced in firefighters following short bouts of work in thermal protective clothing (TPC). We sought to determine if aspirin therapy before and/or following exertion in TPC prevents platelet activation. ⋯ Daily aspirin therapy blunts platelet activation during exertional heat stress and single-dose aspirin therapy following exertional heat stress reduces platelet activation within 60 minutes.
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Randomized Controlled Trial Comparative Study
Randomized Trial Comparing Two Mass Casualty Triage Systems (JumpSTART versus SALT) in a Pediatric Simulated Mass Casualty Event.
Several field triage systems have been developed to rapidly sort patients following a mass casualty incident (MCI). JumpSTART (Simple Triage and Rapid Transport) is a pediatric-specific MCI triage system. SALT (Sort, Assess, Lifesaving interventions, Treat/Transport) has been proposed as a new national standard for MCI triage for both adult and pediatric patients, but it has not been tested in a pediatric population. This pilot study hypothesizes that SALT is at least as good as JumpSTART in triage accuracy, speed, and ease of use in a simulated pediatric MCI. ⋯ SALT appears to be at least as good as JumpSTART in overall triage accuracy, overtriage, or undertriage rates in a simulated pediatric MCI. Both systems were considered easy to use. However, JumpSTART was 8 seconds faster per patient in time taken to assign triage designations.
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Randomized Controlled Trial
A Comparison of ketamine and Morphine Analgesia in Prehospital Trauma Care: A Cluster Randomized Clinical Trial in Rural Quang Tri Province, Vietnam.
The use of opioid analgesics in prehospital trauma care has been reported to have negative side effects on the airway and circulation. Several studies of urban trauma management have recommend ketamine as a safe and efficient analgesic. To date, however, no controlled trials of prehospital opioid analgesics versus ketamine in rural trauma management have been published. ⋯ Ketamine had an analgesic effect similar to morphine and carried a lower risk of airway problems. The risk of hallucinations and agitation was increased in the ketamine group. These findings are of medical significance, particularly in rough and low-resource scenarios.