Articles: emergency-medical-services.
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An essential feature of the trauma center concept is the rapid delivery of patients with complicated injuries to a regional trauma center directly from the site of injury. A variety of triage instruments have been proposed to aid the prehospital personnel in making this difficult triage decision. We used a combination of prospective and retrospective analysis to evaluate and compare the performance of 11 recommended triage instruments on the same trauma population. ⋯ Of the triage instruments with a sensitivity greater than 70%, the respiratory/systolic pressure/Glasgow Coma Scale (RSG) score provided the largest improvement in odds for needing a trauma center when the triage instrument is positive. Although no triage instrument performed ideally, the patients missed by the triage instruments having a sensitivity greater than 70% were hemodynamically stable. Transfer of such patients to a trauma center following determination of the extent of underlying injury at a referring emergency department should be possible.
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This study evaluated the efficacy of prehospital external cardiac pacing in cardiac arrest patients. From October 1984 to June 1985, 91 patients were paced. Mean time from cardiac arrest to advanced life support (ALS) intervention in this metropolitan-rural ALS system was 14.5 minutes. ⋯ There was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving pharmacologic intervention before or after pacing. Likewise there was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving ALS therapy within or after ten minutes of their arrest. Although we found that external cardiac pacing was easily used in the prehospital setting, pacing did not result in any increase in survival in cardiac arrest patients.
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To identify patients likely to be admitted to a critical care unit as well as those at high risk of deterioration, we studied all patients admitted to the medical service. Cardiac patients had a high likelihood of unit admission even if they were rated as not ill and stable, whereas ill and unstable noncardiac patients went to the floor. ⋯ If the goal is to admit patients at highest risk, the optimal strategy is to admit unstable, severely ill, and moribund patients in both the cardiac and noncardiac groups. By doing this, it is possible to decrease unit admission of patients likely to do well, increase the admission of patients likely to do poorly, while decreasing the number of patients admitted.
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Trauma kills more Americans from age 1 to 34 than all diseases combined. Until recently, trauma care in the United States was delivered in a nonorganized, nonintegrated fashion, with trauma victims being transported to the medical facility closest to the scene of the accident. Many recent studies confirm an unacceptably high incidence--up to 75% in some studies--of preventable deaths in trauma victims treated under the nearest hospital system. ⋯ The decision on whether to take a patient to the closest hospital or to the regional trauma center is a form of triage, with far-reaching consequences medically, ethically, and financially. Various triage instruments have been developed to try to identify those patients who would benefit from the resources of a trauma center, and to avoid overcrowding those centers with patients having less serious injuries. These triage tools are based on a combination of mechanism of injury, anatomic criteria, physiologic criteria, and co-morbidity factors.