Emergency medicine journal : EMJ
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Comparative Study
Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians.
Emergency medical services in the UK are facing the challenge of responding to an increasing number of calls, often for non-emergency care, while also providing critical care to the few severely ill or injured patients. In response, paramedic training in the UK has been extended and there are regional strategies to improve prehospital critical care (PHCC). We describe the clinical competencies of three groups of prehospital providers in the UK with the aim of informing future planning of the delivery of PHCC. ⋯ Paramedics possess a considerable number of competencies which allow them to diagnose and treat a variety of conditions. CCPs and PHCC physicians possess a few additional critical care competencies which are potentially life-saving but are required infrequently and can carry significant risks. Concentration of training and clinical exposure for a small group of providers in critical care teams can help optimising benefits and reducing risks of PHCC.
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Randomized Controlled Trial
Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): results from the pilot randomised controlled trial.
High blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited. ⋯ http://www.clinicaltrials.gov. Unique identifier: NCT01066572.
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Data from emergency departments (EDs) in England describe the epidemiology of violent assaults. However, the potential of such data to inform hospital-based public health interventions remains unknown. ⋯ The results highlight the notable contribution of domestic violence to assaults presenting to hospital ED. Such findings can be used to plan interventions such as screening hospital patients for domestic violence. ED data have the potential to inform hospital-based initiatives to address issues such as assaults in the local population.
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Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. ⋯ In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.