Articles: emergency-medical-services.
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Early defibrillation by emergency medical technicians or even less qualified personnel has been shown to improve survival rates for out-of-hospital cardiac arrest caused by ventricular fibrillation. It has been questioned whether these favourable results can be applied within the context of physician-attended emergency medical systems. ⋯ The first 2 years of experience with 499 technician-initiated resuscitation attempts in which the mobile intensive care unit of Klinikum Steglitz was involved, confirmed the results of the pilot study with an improved long-term survival rate (18%) for patients with ventricular fibrillation. We conclude that EMT defibrillation should be introduced in emergency physician-attended two-tiered emergency medical systems, whenever a thorough analysis of the existing rescue systems exhibits a 'relevant frequency' of resuscitation and response interval of 15 min or less.
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The Heartstart Scotland project for out-of-hospital defibrillation covers the whole of Scotland, a population of approximately 5,102,400 (14.9% > 65 years, 48.3% male). All 395 ambulances in Scotland have been equipped with an automated external defibrillator and crews are trained in basic cardiopulmonary resuscitation and defibrillator use (EMT-D). Between 1 May 1990 and 30 April 1991 a total of 1700 cardiac arrests was reported by the ambulance service. ⋯ If the cardiac arrest was witnessed by the ambulance crew and required defibrillation, survival to discharge was 39%. Of bystander witnessed arrests reached while still in VF (n = 643), 11% were discharged alive. Patients who were defibrillated within 4 min of arrest had a 43% survival rate to hospital discharge.
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To assess the quality of care delivered during first-responder defibrillation and to determine the potential efficacy of modifying existing automated external defibrillator designs to improve first-responder performance. ⋯ Current device algorithms result in effective delivery of the initial three shocks. However, firefighters often fail to interpose recommended intervals of CPR between further attempts at defibrillation. Modification of existing device algorithms to provide additional visual and auditory cues may be preferable to relying on the user to recall accurately all the steps in this infrequently performed procedure.
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To determine if the deployment of a helicopter-borne nurse/paramedic team contributed to survival of victims of nontraumatic cardiac arrest in a rural setting. ⋯ Despite providing improved availability of advanced life support care in some cases, deployment of aeromedical teams had a negligible effect on patient survival from nontraumatic cardiac arrest in a rural setting.
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On January 25, 1990, a jetliner crashed on Long Island, New York. Twenty-two children survived the crash. The purpose of this study was to evaluate the emergency medical system's response to these pediatric survivors. ⋯ Pediatric survivors were neither adequately triaged nor transported to appropriate facilities which could optimize their care. Possible explanations for this include: (1) unique features of the rescue operation, (2) limited pediatric training of prehospital personnel, and (3) deficiencies of the regional disaster plan. Emergency medical services systems and disaster plans can be made more responsive to children's needs by: (1) acknowledging that children have special needs requiring referral, (2) improving the training of prehospital personnel in pediatric emergency care, (3) classifying ill and injured children according to appropriate triage criteria, (4) recognizing existing tertiary care pediatric centers as the optimal location for the treatment of critically ill and injured children, and (5) designating these centers as the appropriate transport destination for critically ill and injured children.