Paramedic

Background : The care required for patients at times necessitates they be transferred to another hospital capable of providing specialized care, a process known as an interfacility transfer. Delays to appropriate care for critically ill patients are associated with increased morbidity and mortality. Improving efficiencies in interfacility transport process can thus expedite the time to critical treatment. Traditionally paramedics would patch to a transport medicine physician (TMP) after initial patient contact to discuss the case and expected management during transport...

INTRODUCTION: Patients experiencing a large vessel occlusion stroke (LVOS) may require endovascular-capable centers and benefit from direct transport to such facilities, creating a need for an accurate prehospital assessment. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a secondary scale to identify LVOS. Currently, there is limited prospective evidence validating the use of the FAST-ED in the prehospital environment. This study aimed to evaluate the inter-rater reliability of the FAST-ED between patient care providers in the prehospital setting...

Toxic epidermal necrolysis is a life-threatening dermatological emergency with high mortality if not treated in time. Here we report a case of toxic epidermal necrolysis due to carbamazepine in rural Nepal in COVID-19 pandemic who was successfully treated with the help of mobile teledermatology. The clinical impression of toxic epidermal necrolysis was made from "WhatsApp" video calls using a smart phone. The supportive features were the history of starting of carbamazepine 2 weeks prior for seizure disorder, clinical findings in serial photographs of skin with 40 percent body surface area involvement of necrotic skin lesions and bulla, and involvement of oral mucosa and eyes...

Healthcare professionals can play a significant role in the prevention of lifestyle-related diseases. Yet there is still relatively little attention to lifestyle counseling, partly because of limited available time and doubts about its effectiveness. During so-called 'teachable moments', patients may be more receptive towards lifestyle advices and more motivated to change their lifestyle. For example during pregnancy, disease diagnoses, abnormal test results or even the corona crisis, patients may suddenly face lifestyle change differently...

OBJECTIVE: The primary goal of this study was to determine if ultrasound (US) use after brief point-of-care ultrasound (POCUS) training on cardiac and lung exams would result in more paramedics correctly identifying a tension pneumothorax (TPTX) during a simulation scenario. METHODS: A randomized controlled, simulation-based trial of POCUS lung exam education investigating the ability of paramedics to correctly diagnose TPTX was performed. The US intervention group received a 30-minute cardiac and lung POCUS lecture followed by hands-on US training...

OBJECTIVE: To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries. METHODS: A cross-sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital...

Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva's dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva's EMCC (Switzerland) from 1 January 2014 to 1 July 2019...

OBJECTIVE: Paramedics may perform endotracheal intubation (ETI) while treating patients with out-of-hospital cardiac arrest (OHCA). The gum elastic Bougie (Bougie) is an intubation adjunct that may optimize intubation success. There are few reports of Bougie-assisted intubation in OHCA nor its association with outcomes. We compared intubation success rates and OHCA outcomes between Bougie-assisted and non-Bougie ETI in the out-of-hospital Pragmatic Airway Resuscitation Trial (PART). METHODS: This was a secondary analysis of patients receiving ETI enrolled in the Pragmatic Airway Resuscitation Trial (PART), a multicenter clinical trial comparing intubation-first vs...

Introduction: Emergency decompression is needed in patients with tension pneumothorax, a life-threatening condition. The catheter-based needle thoracostomy was suggested using a 5 cm catheter inserted into the 2nd intercostal space (ICS) and 5th ICS according to the ninth and tenth editions of Advanced Trauma Life Support, respectively. A catheter of suitable length may not be available immediately or the muscle structure of the chest wall may be modified in pneumothorax. Furthermore, alternative sites for needle thoracostomy and reference values of chest wall thickness (CWT) should be explored and warranted...

Healthcare workers are at the highest risk of contracting novel coronavirus disease 2019 (COVID-19) and, therefore, require constant protection. This study assesses access to personal protective equipment (PPE), availability of adequate information about PPE use, self-reported ability to correctly wear and remove (donning and doffing) PPE, and risk perceptions associated with COVID-19 among frontline healthcare workers in Pakistan. Using a structured and validated questionnaire, an online survey was conducted from May 9 to June 5, 2020...

INTRODUCTION AND AIM: Delayed referral of neonatal cholestasis (NC) can result in significant morbidity and mortality. In this multi-center study, we aimed to evaluate the reliability of the stool card in the Indian population and develop an integrated NC card with (a) urine color identification and (b) stool color for early referral. METHODS: Consecutive children with NC were enrolled and divided into two groups (biliary atresia [BA] and non-BA). Normal healthy children at 6-8 weeks of age served as controls...

OBJECTIVE: A national survey found prehospital telemedicine had potential clinical applications but lacked provider opinion on its use for pediatric emergency care. We aimed to (1) estimate prehospital telemedicine use, (2) describe perceived benefits and risks of pediatric applications, and (3) identify preferred utilization strategies by paramedics. METHODS: We administered a 14-question survey to a convenience sample of 25 Massachusetts paramedics attending a regional course in 2018...

BACKGROUND: Prehospital professionals such as emergency physicians or paramedics must be able to choose and adequately don and doff personal protective equipment (PPE) in order to avoid COVID-19 infection. Our aim was to evaluate the impact of a gamified e-learning module on adequacy of PPE in student paramedics. METHODS: This was a web-based, randomized 1:1, parallel-group, triple-blind controlled trial. Student paramedics from three Swiss schools were invited to participate...

INTRODUCTION: The management of patients in functional urology is complex and requires the expertise of the medical team but also of the nurse team. The aim of this article is to detail the roles of the nurses in functional urology. METHODS: Exchanges with the nurses of our unit, analysis of the literature using the terms "nurse", "urology", "urodynamics" in the PubMed search engine, and a search for regulatory texts relating to the practice of nurses in urology units were conducted...

BACKGROUND: In resource-limited settings, prehospital trauma care and transportation from the scene to a hospital is not well developed. Critically injured patients present to the hospital via privately owned vehicles (PV), public transportation, or the police. We aimed to determine the mortality following road traffic injury based on the mode of transportation to our trauma center. METHODS: We performed a retrospective analysis of the Kamuzu Central Hospital (KCH) Trauma Registry from January 2011 to May 2018...

BACKGROUND: Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches...

BACKGROUND: As the overdose emergency continues in British Columbia (BC), paramedic-attended overdoses are increasing, as is the proportion of people not transported to hospital following an overdose. This study investigated risk of death and subsequent healthcare utilization for people who were and were not transported to hospital after a paramedic-attended non-fatal overdose. METHODS: Using a linked administrative health data set which includes all overdoses that come into contact with health services in BC, we conducted a prospective cohort study of people who experienced a paramedic-attended non-fatal overdose between 2015 and 2016...

Automated closed-loop (CL) insulin therapy has come of age. This major technological advance is expected to significantly improve the quality of care for adults, adolescents and children with type 1 diabetes. To improve access to this innovation for both patients and healthcare professionals (HCPs), and to promote adherence to its requirements in terms of safety, regulations, ethics and practice, the French Diabetes Society (SFD) brought together a French Working Group of experts to discuss the current practical consensus...

Identifying acute MI in the setting of left bundle branch block (LBBB) is challenging because ST-segment elevation is often found at baseline. When faced with LBBB and ischemic symptoms, identifying which patients require urgent reperfusion therapy is critical. Sgarbossa et al. derived three criteria that can be used to help identify these patients, Smith et al. refined these criteria creating the Smith-modified Sgarbossa criteria. We present a case of LBBB meeting the Smith-modified Sgarbossa criteria, recognized by paramedics and used to activate the catheterization laboratory after normal business hours...

OBJECTIVES: This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt...