Articles: emergency-medical-services.
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The Rapid Acute Physiology Score (RAPS) was developed and tested for use as a severity scale in critical care transports. RAPS is an abbreviated version of the Acute Physiology and Chronic Health Evaluation (APACHE-II) using only parameters routinely available on all transported patients (i.e. pulse, blood pressure, respiratory rate, and Glasgow Coma Scale). RAPS has a range from 0 (normal) to 16. ⋯ When pretransport RAPS was considered as a single explanatory variable, it too had significant predictive power for mortality (X2(1) = 92.53, P less than .01). Correlation analysis comparing RAPS with APACHE-II values at similar points in time revealed a significant relationship in all cases, with the highest correlation between RAPS worst values and APACHE-II worst values (r = .8472, P less than .01). It was concluded that RAPS can be applied usefully in complement with APACHE-II and may have limited utility when used alone.
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Sudden death in the emergency department occurs frequently. Intervention by ED support staff may have a significant impact on the survivor's grief response. This study was undertaken to assess sudden death survivors' perceptions and satisfaction with their ED experience, as well as to identify potential weaknesses in their management. ⋯ Participants were questioned about attitudes expressed by the ED staff. Most responses were favorable, but a significant number thought the staff cold, unsympathetic, and not reassuring. Areas of apparent survivor dissatisfaction are discussed.
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Critical care clinics · Jul 1987
ReviewSpinal cord injury--a systems approach: prevention, emergency medical services, and emergency room management.
Spinal cord injury is considered a catastrophic disease because of the significant morbidity, mortality, and costs not only in fiscal terms but in social terms. There are approximately ten thousand new spinal cord injuries per year with the national prevalence estimated at between three and five hundred thousand Americans. These authors advocate a systems approach for the comprehensive management of these devastating injuries. In all phases of care for the spinal-cord-injured person, the key is a team approach and a commitment to an optimal patient care program that can result in minimizing patient morbidity, mortality, and the cost of care as well as making neurologic function maximal.
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Randomized Controlled Trial Clinical Trial
The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma.
To determine whether the presence of a physician in the prehospital setting influences patient outcome, the predicted mortality of 258 patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight paramedic was compared with that of 316 similar patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight physician. All patients were randomized between the two treatment teams. The mortality of the patients treated by the flight nurse/flight paramedic team was that predicted by the methodology. The mortality of the patients treated by the flight nurse/flight physician team was 35% lower than that predicted, and significantly lower than that of the flight nurse/flight paramedic-staffed helicopter.
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Clinical Trial Controlled Clinical Trial
Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries.
Experimental data have suggested that pneumatic external counterpressure improves outcome in intra-abdominal hemorrhage by either a tamponade effect and/or elevation in central systemic blood pressure. As a result, the empiric use of the pneumatic antishock garment (PASG) has become a standard of care, even to the point where the device has been legislated as required equipment on emergency medical rescue vehicles. However, the effect of the PASG on intra-abdominal hemorrhage has not been evaluated in randomized clinical trials. ⋯ The resulting study populations (control, n = 104; PASG, n = 97) were found to be well matched for survival probability indices, prehospital response and transport times, and the volume of IV fluids received. The results demonstrated no significant difference in the survival rates of the control and PASG treatment groups (81 of 104 vs 67 of 97). From these data we conclude that, contrary to previous claims, the PASG provides no significant advantage in improving survival in the urban prehospital management of penetrating abdominal injuries.