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Emergency AND Prehospital

Bridie Angela Evans, Alan Brown, Jenna Bulger, Greg Fegan, Simon Ford, Katy Guy, SIan Jones, Leigh Keen, Ashrafunnesa Khanom, Mirella Longo, Ian Pallister, Nigel Rees, Ian T Russell, Anne C Seagrove, Alan Watkins, Helen Snooks
OBJECTIVES: To explore paramedics' experience of delivering fascia iliaca compartment block ( FICB) to patients with suspected hip fracture at the scene of injury. DESIGN: Focus groups within a randomised controlled trial. SETTING: Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture...
February 15, 2019: BMJ Open
Steve Balian, David G Buckler, Audrey L Blewer, Abhishek Bhardwaj, Benjamin S Abella
AIM OF THE STUDY: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. METHODS: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission...
February 13, 2019: Resuscitation
Jonathan Braun Bsc, S David Gertz, Ariel Furer, Tarif Bader, Hagay Frenkel, Jacob Chen, Elon Glassberg, Dean Nachman
Unmanned aerial vehicles (UAV), commonly referred to as drones, have been made widely available in recent years leading to an exponential growth in their roles and applications. The rapidly developing field of medical drones is on the verge of revolutionizing pre-hospital medicine enabling advanced healthcare delivery to once-inaccessible patients. The aim of this review is to clarify the basic technical properties of currently available medical drones and review recent advances and their usefulness in military and civilian healthcare missions...
February 13, 2019: Journal of Trauma and Acute Care Surgery
Helen Fagerlind, Lara Harvey, Stefan Candefjord, Johan Davidsson, Julie Brown
BACKGROUND: Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
M Pape, G F Giannakópoulos, W P Zuidema, E S M de Lange-Klerk, E J Toor, M J R Edwards, M H J Verhofstad, T N Tromp, E M M van Lieshout, F W Bloemers, L M G Geeraedts
INTRODUCTION: Little evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands. METHODS: A retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Mohammad Anadani, Eyad Almallouhi, Amy E Wahlquist, Ellen Debenham, Christine A Holmstedt
INTRODUCTION: A significant proportion of acute ischemic stroke (AIS) patients who are evaluated through telestroke consultation are transferred to thrombectomy-capable stroke centers (TSCs) for concern of large vessel occlusion (LVO). Patient triage selection is commonly based on the clinical suspicion of LVO, which lacks specificity and could result in unnecessary transfers. In this study, we aimed to assess the accuracy of the most commonly used LVO recognition scales in telestroke setting...
February 13, 2019: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Kessarin Panichpisal, Maharaj Singh, Adil Chohan, Paul Vilar, Reji Babygirija, Mary Hook, Sharon Matyas, Nathaniel Kojis, Rehan Sajjad, Thomas Wolfe, Amin Kassam, Richard Adam Rovin
Background: The Stroke Network of Wisconsin (SNOW) scale, previously called the Pomona scale, was developed to predict large-vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). The original study showed a high accuracy of this scale. We sought to externally validate the SNOW scale in an independent cohort. Methods: We retrospectively reviewed and calculated the SNOW scale, the Vision Aphasia and Neglect Scale (VAN), the Cincinnati Prehospital Stroke Severity (CPSS), the Los Angeles Motor Scale (LAMS), and the Prehospital Acute Stroke Severity Scale (PASS) for all patients who were presented within 24 hours after onset at AHCS (14 hospitals) between January 2015 and December 2016...
November 2018: Journal of Vascular and Interventional Neurology
Waleed M Sweileh
BACKGROUND: Worldwide, natural disasters have caused a large number of deaths and considerable morbidity. Nevertheless, limited information is available on how the health-related literature on natural disasters has evolved. The current study aims to assess the growth and pattern of health-related literature on natural disasters. METHOD: A bibliometric method was implemented using Scopus database for the period from 1900 to 2017. Keywords used in the search strategy were obtained from the classifications of natural disasters presented by the Centre for Research on the Epidemiology of Disasters...
February 11, 2019: Health Research Policy and Systems
Jessica Friedman, Marcus Hoof, Alison Smith, Danielle Tatum, Kareem Ibraheem, Chrissy Guidry, Rebecca Schroll, Juan Duchesne, Patrick McGrew
BACKGROUND: Previous epidemiological studies on pediatric firearm mortality have focused on overall mortality rather than on-scene mortality. Despite advances in trauma care, the number of potentially preventable deaths remains high. This study utilized the National Emergency Medical Services Information Systems database (NEMSIS) to characterize patterns of on-scene mortality in order to identify patients who may benefit from changes to prehospital care practices. METHODS: NEMSIS was searched for all pediatric firearm incidents from 2010-2015...
February 7, 2019: Journal of Trauma and Acute Care Surgery
Eveline A J van Rein, Rogier van der Sluijs, Frank J Voskens, Koen W W Lansink, R Marijn Houwert, Rob A Lichtveld, Mariska A de Jongh, Marcel G W Dijkgraaf, Howard R Champion, Frank J P Beeres, Luke P H Leenen, Mark van Heijl
Importance: Prehospital trauma triage protocols are used worldwide to get the right patient to the right hospital and thereby improve the chance of survival and avert lifelong disabilities. The American College of Surgeons Committee on Trauma set target levels for undertriage rates of less than 5%. None of the existing triage protocols has been able to achieve this target in isolation. Objective: To develop and validate a new prehospital trauma triage protocol to improve current triage rates...
February 6, 2019: JAMA Surgery
Dabor Resiere, Hossein Mehdaoui, Bruno Megarbane
Ingestion of large amounts of cocaine packages is a well-known method for cross-border transportation. Intestinal obstruction and life-threatening sympathomimetic toxidrome including seizures, ventricular dysrhythmia, and cardiac arrest resulting from the rupture of cocaine packages may occur. Here, we report a case of a 34-year-old pregnant woman who had a sudden cardiac arrest while waiting for her bags at Paris-Charles de Gaulle Airport, France. According to the flight attendants, the patient travelled from Brazil and complained of abdominal pain during the flight...
2019: Case Reports in Medicine
Gitte Valentin, Lotte Groth Jensen
OBJECTIVES: The aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement. METHODS: The Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non-physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response. RESULTS: Ten reviews published from 2009 to 2017 were included...
February 6, 2019: International Journal of Technology Assessment in Health Care
Andersson Jan-Otto, Nasic Salmir, Herlitz Johan, Hjertonsson Erik, Axelsson Christer
BACKGROUND: In order to treat pain optimally, the Emergency Medical Service (EMS) clinician needs to be able to make a reasonable estimation of the severity of the pain. It is hypothesised that various physiological parameters will change as a response to pain. AIM: In a cohort of patients who were seen by EMS clinicians, to relate the patients' estimated intensity of pain to various physiological parameters. METHODS: Patients who called for EMS due to pain in a part of western Sweden were included...
January 21, 2019: American Journal of Emergency Medicine
Kelsey Billups, Ashley Larrimore, Junan Li, Howard Werman, Mary Beth Shirk
OBJECTIVE: The aim of this study was to evaluate the difference in the time to postintubation sedation between patients receiving etomidate and either succinylcholine or rocuronium in the prehospital setting. SETTING: Patients who received rapid sequence intubation medications from transport service personnel and were subsequently intubated were included. The critical care transport agency operates 8 helicopter- and 3 ground-based emergency medical service units...
January 2019: Air Medical Journal
Stefan J Schaller, Felix P Kappler, Claudia Hofberger, Jens Sattler, Richard Wagner, Gerhard Schneider, Manfred Blobner, Karl-Georg Kanz
BACKGROUND: Although pain treatment is an important objective in prehospital emergency medicine the incidence of oligoanalgesia is still high in prehospital patients. Given that prehospital emergency medicine in Germany is open for physicians of any speciality, the prehospital pain treatment may differ depending on the primary medical education. Aim of this study was to explore the difference in pain treatment between surgeons and anaesthesiologists in a physician staffed emergency medical service...
January 31, 2019: BMC Anesthesiology
Yohei Kamikawa, Hiroyuki Hayashi
OBJECTIVE: To prevent misjudgment of the severity of patients in the emergency department who initially seem non-severe but are in a critical state, methods that differ from the conventional viewpoint are needed. We aimed to determine whether vital sign changes between prehospital and in-hospital could predict in-hospital mortality among non-trauma patients. METHODS: This observational cohort study was conducted in two tertiary care hospitals. Patients were included if they were transported by ambulance for non-trauma-related conditions but were excluded if they experienced prehospital cardiopulmonary arrest, were pregnant, were aged <15 years, had undergone inter-hospital transfer, or had complete missing data regarding prehospital or in-hospital vital signs...
2019: PloS One
Yusuke Katayama, Tetsuhisa Kitamura, Kosuke Kiyohara, Junya Sado, Tomoya Hirose, Tasuku Matsuyama, Takeyuki Kiguchi, Junichi Izawa, Yuko Nakagawa, Takeshi Shimazu
OBJECTIVE: Although it is important to assess prehospital factors associated with traffic crash fatalities to decrease them as a matter of public health, such factors have not been fully revealed. METHODS: Using data from the Japanese Trauma Data Bank, a large hospital-based trauma registry in Japan, we retrospectively analysed traffic crash patients transported to participating facilities that treated patients with severe trauma from 2004 to 2015. This study defined registered emergency patients whose systolic blood pressure was 0 mm Hg or heart rate was 0 bpm at hospital arrival as being in prehospital cardiopulmonary arrest (CPA)...
January 29, 2019: BMJ Open
Zi Wang, Yuchuan Ding, Paul Fu
Stroke is a leading cause of disability in the United States and current treatment for stroke is limited to two modalities with well-defined time restraints. The prehospital setting is a significant and relatively easy setting for innovation in stroke care, as the most clinical decisions are made within the first several hours of symptom onset. In this review, we look at recent innovations in improving prehospital care for acute stroke including the conception of mobile stroke units, the ongoing development of stroke models for emergency providers, barriers to prehospital care, and the innovation of new telephone applications...
October 2018: Brain Circulation
Catherine E Sharoky, Niels D Martin, Brian P Smith, Jose L Pascual, Lewis J Kaplan, Patrick M Reilly, Daniel N Holena
BACKGROUND: Failure to rescue (FTR) refers to death after a major complication. Defining the optimal context in which to reduce FTR after injury requires knowledge of where and when FTR events occur. MATERIALS AND METHODS: Retrospective observational study of patients >16 y with a minimum Abbreviated Injury Score ≥2 at all 30 level I and II Pennsylvania trauma centers (2007-2015). Location and timing of the first major complication were collected. Complication, mortality, and FTR rates were calculated by location (prehospital, emergency department, operating room, stepdown unit, interventional radiology, intensive care unit (ICU), radiology, and the surgical ward) and by postadmission day...
March 2019: Journal of Surgical Research
Matthew Thomas, Sarah Voss, Jonathan Benger, Kim Kirby, Jerry P Nolan
BACKGROUND: Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. METHODS: A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments...
January 25, 2019: BMC Emergency Medicine
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