Articles: emergency-medical-services.
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The hospital emergency department (ED) has become an important means of access to health care for the elderly. Inadequacies in the current health care system for the elderly are reflected in their high utilization rates of the ED, continuing questions about the appropriateness of elderly ED patients, differences in the ED care offered the elderly versus the young, and poor coordination of care to and from the ED. ⋯ Economic, legal, and ethical issues that have changed the way medicine is practiced in other settings are finally reaching the sector of emergency services. The current and future roles of emergency medicine services, and the impact these issues will have on the practice of emergency medicine, are discussed.
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The study objective was to determine if pulse oximetry readings obtained during helicopter transport were indicative of subsequent arterial blood-gas measured saturations. A prospective study design was chosen. Data were gathered on a convenience sample of patients 18 years and older not under cardiopulmonary resuscitation; 101 patients were used for the study. ⋯ There was also no significant difference between the patient's heart rate sensed by the pulse oximeter and the simultaneous palpated pulse rate. Percent saturation readings by repeated measures were statistically different (p < 0.05) showing a minimal improvement in saturation over time. Based on this study's findings, the authors feel the pulse oximeter can be a valuable adjunct to patient care during helicopter transport.
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To examine the effect of fire department first-responder defibrillation on time to defibrillation in a mid-sized community with two tiers of emergency medical services (EMS) ambulance response. ⋯ In our EMS system, fire first-responders were able to provide defibrillation in significantly shorter times than ambulance attendants. Other EMS systems should review their response times and consider instituting first-responder defibrillation as one means of reducing defibrillation intervals.
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Prehosp Disaster Med · Apr 1993
Ethical challenges in emergency medical services. A special contribution of the Ethics Committee, National Association of Emergency Medical Services Physicians.
Patient autonomy, beneficence, and justice are the fundamental ethical principles of an emergency medical service. Ethical conflicts are present in the daily practice of prehospital care. These conflicts surround issues of resuscitation, futile therapy, consent, and refusal of care, duty, and confidentiality. ⋯ Many learn by experience, some are guided by clear policy. Ideally, medical control personnel will be educated, interested, and available to address dilemmas which arise. Where possible, policies and procedures should be developed to address ethical issues which are likely to be faced by EMS personnel.
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It is evident that AEDs may be used by minimally trained first responders to terminate VF safely and rapidly in victims of out-of-hospital cardiac arrest. To enhance patient survival of out-of-hospital VF, there must be coordination between AED-trained first responders and ACLS providers.