Mobile satellite EMS communications Bruce P Jackson
DOI: http://dx.doi.org/10.1016/0735-6757(95)90274-0
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
Emergency Medical Services (EMS) versus non-EMS transport of critically injured patients: Cornell EE, Belzberg H, Hennigan K, et al. JAMA 2000;135:315–319
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80092-9
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Emergency medical services use by stroke patients: a population-based study Opeolu Adeoye, Christopher Lindsell, Joseph Broderick, Kathy Alwell, Edward Jauch, Charles J. Moomaw, Matthew L. Flaherty, Arthur Pancioli, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.004
The American Journal of Emergency Medicine , Vol. 27 , Issue 2 ,
Published in issue: February 2009
x Emergency medical services (EMS) use by stroke patients varies from 38% to 65%. In an epidemiological study, we determined the proportion of stroke patients who used EMS, hypothesizing that demographics, stroke severity, stroke type, and location at stroke onset would be associated with EMS use.
Sustainable emergency medical service systems: how much energy do we need? Lawrence H. Brown, Ian E. Blanchard
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 14 2014
x Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems.
The Second International Urban EMS Conference Alexander Kuehl, James T. Kerr, Jamie Fenwick
DOI: http://dx.doi.org/10.1016/0735-6757(85)90173-1
The American Journal of Emergency Medicine , Vol. 3 , Issue 6 ,
Published in issue: November 1985
Epinephrine use and outcomes in anaphylaxis patients transported by emergency medical services Veena Manivannan, Robert J. Hyde, Daniel G. Hankins, M. Fernanda Bellolio, Martin G. Fedko, Wyatt W. Decker, Ronna L. Campbell
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.014
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 19 2014
x Anaphylaxis is a potentially life-threatening allergic reaction that may require emergency medical system (EMS) transport. Fatal anaphylaxis is associated with delayed epinephrine administration. Patient outcome data to assess appropriateness of EMS epinephrine administration are sparse.
Patterns of use of EMS transport Charles McConnel, Rosemary W. Wilson
DOI: http://dx.doi.org/10.1053/ajem.2001.16252
The American Journal of Emergency Medicine , Vol. 19 , Issue 1 ,
Published in issue: January 2001
x My colleague and I were pleased to review Dr Svenson's emergency medical service (EMS) transport study in this Journal 1 and hope that its publication is a sign of a heightened interest in population-based studies that focus on the socioeconomic and demographic factors underlying EMS use. It is a rich study with a variety of important findings that reinforce the view of previous research regarding the necessity for planning the public provision of emergency health resources as our society ages. Nonetheless, having pursued a similar research program over the past decade, we are compelled to quarrel with the investigator's assertion of priority in reporting EMS transport use rates across all age groups.
Emergency medical services: An annotated bibliography of the recent literature Jon R. Krohmer, Howard A. Werman, Members of the EMS Educators Committee, Stem
DOI: http://dx.doi.org/10.1016/0735-6757(89)90105-8
The American Journal of Emergency Medicine , Vol. 7 , Issue 1 ,
Published in issue: January 1989
The impact of emergency medical services on the ED care of severe sepsis Jonathan R. Studnek, Melanie R. Artho, Craymon L. Garner Jr, Alan E. Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: October 28 2010
x The identification and treatment of critical illness is often initiated by emergency medical services (EMS) providers. We hypothesized that emergency department (ED) patients with severe sepsis who received EMS care had more rapid recognition and treatment compared to non-EMS patients.
Outcomes of non–STEMI patients transported by emergency medical services vs private vehicle Mary Colleen Bhalla, Jennifer Frey, Sarah Dials, Kristin Baughman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.070
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 24 2015
x Non–ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS).
Type of arrhythmia at EMS arrival on scene in out-of-hospital cardiac arrest in relation to interval from collapse and whether a bystander initiated CPR Johan Herlitz, Lars Ekström, Bertil Wennerblom, Åsa Axelsson, Angela Bång, Stig Holmberg
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90116-3
The American Journal of Emergency Medicine , Vol. 14 , Issue 2 ,
Published in issue: March 1996
x Outcome after cardiac arrest is strongly related to whether the patient has ventricular fibrillation at the time the emergency medical service (EMS) arrives on the scene. The occurrence of various arrhythmias at the time of EMS arrival among patients with out-of-hospital cardiac arrest was studied in relation to the interval from collapse and whether cardiopulmonary resuscitation (CPR) was initiated by a bystander. The patients studied were all those with out-of-hospital cardiac arrest in Göteborg, Sweden, between 1980 and 1992 in whom CPR was attempted by the arriving EMS and for whom the interval between collapse and the arrival of EMS was known.
Cardiac arrests witnessed by EMS personnel in a multitiered system: Epidemiology and outcome Markku Kuisma, Teuvo Määttä, Jukka Repo
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90058-4
The American Journal of Emergency Medicine , Vol. 16 , Issue 1 ,
Published in issue: January 1998
x The purpose of the study was to determine the epidemiology and the etiology of cardiac arrests witnessed by emergency medical services (EMS) personnel and the survival from resuscitation according to the Utstein style. Consecutive prehospital cardiac arrests witnessed by EMS personnel in the Helsinki City EMS system between January 1, 1994 and December 31, 1995 were included in this prospective cohort study. A total of 809 cardiac arrests were registered during the study period, 108 (13.3%) of which were EMS-witnessed.
Characteristics of and outcome for patients with chest pain in relation to transport by the emergency medical services in a 20-year perspective Nguyen Dang Thang, Björn Wilgot Karlson, Bo Bergman, Marco Santos, Thomas Karlsson, Ann Bengtson, Per Johanson, Araz Rawshani, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x The aims of this study were to describe the characteristics of and outcome of patients with chest pain in relation to transport by the emergency medical services (EMS) and to describe possible changes in this relationship in a 20-year perspective.
Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool Carmen C. Polito, Alex Isakov, Arthur H. Yancey II, Duncan K. Wilson, Blake A. Anderson, Ingrid Bloom, Greg S. Martin, Jonathan E. Sevransky
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: April 22 2015
x To derive and validate a predictive model and novel emergency medical services (EMS) screening tool for severe sepsis (SS).
Case definition in survival studies of out-of-hospital cardiac arrest Sue A. Joslyn
DOI: http://dx.doi.org/10.1016/0735-6757(94)90143-0
The American Journal of Emergency Medicine , Vol. 12 , Issue 3 ,
Published in issue: May 1994
x The purpose of this investigation was to determine problems with case definition and selection biases in studies of survival from out-of-hospital cardiac arrest, by comparing characteristics of subjects with cardiac arrest who entered the emergency medical services (EMS) system and those who did not enter the system. Data for 143 prehospital cardiac arrest patients in Johnson County, Iowa, were obtained from death certificates and EMS reports. Approximately one half of cardiac arrest patients entered the EMS system.
Isolated trapezium subluxation in EMS provider with a novel reduction technique Christopher Gee
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: December 8 2011
x Hand injuries are a common complaint in the emergency department (ED). Oftentimes, these injuries occur in work settings. We report a case of a healthy EMS provider presenting to the ED with a left thumb injury that turned out to be an isolated trapezium subluxation. Using bedside fluoroscopy, the thumb carpometacarpal joint was isolated, injected, and subsequently reduced. The clinical course and management are discussed as well as a brief review of hand injuries.
Operation care: a pilot case management intervention for frequent emergency medical system users Michael L. Rinke, Elisabeth Dietrich, Traci Kodeck, Kathleen Westcoat
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 27 2011
x This study aims to determine if a prehospital case management intervention reduces transport and nontransport emergency medical system (EMS) responses to frequent EMS users.
The effect of bystander CPR and arrival time of EMS on successful out-of-hospital resuscitation : George Ritter, Sidney Goldstein, Richard Leighton, Richard Landis, Robert Wolfe, C. Mark Vasu, Allyn Acheson, Steven Kuritz. Henry Ford Hospital, Detroit, MI 48202
DOI: http://dx.doi.org/10.1016/0735-6757(84)90161-X
The American Journal of Emergency Medicine , Vol. 2 , Issue 4 ,
Published in issue: July 1984
Community surveillance of falls among the elderly using computerized EMS transport data James L. Wofford, Mark D. Heuser, William P. Moran, Earl Schwartz, Maurice B. Mittelmark
DOI: http://dx.doi.org/10.1016/0735-6757(94)90055-8
The American Journal of Emergency Medicine , Vol. 12 , Issue 4 ,
Published in issue: July 1994
x Because falls are common among the elderly and are associated with high morbidity and mortality, community surveillance has been recommended. The purpose of this study was to characterize the impact of falls among the elderly on emergency medical transport services (EMS) and to explore the potential for community surveillance of falls through the use of computerized EMS data. Computerized EMS data and United States census data for 1990 for persons aged ≥65 in Forsyth County, NC, were used to produce EMS transport rates for falls and to make comparisons by age, gender, race, and residence (nursing home vs community).
Does out-of-hospital EMS time affect trauma survival? Stan Feero, Jerris R Hedges, Erik Simmons, Lisa Irwin
DOI: http://dx.doi.org/10.1016/0735-6757(95)90078-0
The American Journal of Emergency Medicine , Vol. 13 , Issue 2 ,
Published in issue: March 1995
x To determine if out-of-hospital emergency medical services (EMS) time intervals are associated with unexpected survival and death in urban major trauma, a retrospective review was conducted of major trauma cases entered into an urban trauma system by an EMS system during a one-year period. Patients with unexpected death or unexpected survival were identified using TRISS methodology. The EMS response, on-scene time, transport time, and total EMS out-of-hospital time intervals were compared for the two groups using the unpaired t test (two-tailed analysis).
Description of procedures performed on patients by emergency medical services during mass casualty incidents in the United States Mazen El Sayed, Hani Tamim, N. Clay Mann
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 25 2015
x Emergency medical services (EMS) preparedness is essential to reduce morbidity and mortality from mass casualty incidents (MCIs).
Performance of a system to determine EMS dispatch priorities Liz Palumbo, John Kubincanek, Charles Emerman, Nick Jouriles, Rita Cydulka, Bruce Shade
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90056-X
The American Journal of Emergency Medicine , Vol. 14 , Issue 4 ,
Published in issue: July 1996
x Inappropriate use of emergency medical services (EMS) for nonemergencies strains EMS resources and limits efficiency. Protocol-driven dispatch systems attempt to correct the imbalance that exists between demand and available resources by prioritizing 911 calls. This study compared dispatch priority decisions with apparent patient need, based on emergency department (ED) presentation, by matching 320 ED charts with corresponding EMS dispatch and run information. The priorities assigned by the system based on dispatch information were compared with those assigned by a three-member panel of physicians based on ED presentation.
Characteristics and outcomes of injured patients presenting by private vehicle in a state trauma system Nicholas J. Johnson, Brendan G. Carr, Rama Salhi, Daniel N. Holena, Catherine Wolff, Roger A. Band
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 24 2012
x Previous studies have demonstrated lower mortality among patients transported to single urban trauma centers by private vehicle (PV) compared with Emergency Medical Services (EMS). We sought to describe the characteristics and outcomes of injured patients transported by PV in a state trauma system compared to patients transported by EMS.
Emergency medical services management of ST-segment elevation myocardial infarction in the United States—a report from the American Heart Association Mission: Lifeline Program Robert E. O'Connor, Graham Nichol, Louis Gonzales, Steven V. Manoukian, Peter H. Moyer, Ivan Rokos, Michael R. Sayre, Robert C. Solomon, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: April 21 2014
x ST-segment elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality in the United States. Emergency medical services (EMS) agencies play a critical role in its initial identification and treatment. We conducted this study to assess EMS management of STEMI care in the United States.
Factors associated with use of emergency medical services in patients with acute stroke Nai-Chuan Chen, Ming-Ju Hsieh, Sung-Chun Tang, Wen-Chu Chiang, Kuang-Yu Huang, Li-Kai Tsai, Patrick Chow-In Ko, Matthew Huei-Ming Ma, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 4 2013
x The aim of this study was to investigate the factors associated with use of emergency medical services (EMS) in patients with acute stroke.
The Three Rivers Regatta accident: An EMS perspective RAde B. Vukmir, Paul M. Paris
DOI: http://dx.doi.org/10.1016/0735-6757(91)90020-K
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
x The Three Rivers Regatta accident occurred on August 7, 1988 when a Formula I racing craft collided with shore, injuring 24 spectators. The authors retrospectively examined the prehospital-based response for this multiple-casualty incident that used emergency medical service (EMS) physicians and 32 paramedics stationed at water and land-based posts to triage and evacuate 24 patients in 32 minutes. Patients were transported to 5 hospitals including 4 Level I trauma centers; this was accomplished in 53 minutes.
Prehospital neurologic deterioration is independent predictor of outcome in traumatic brain injury: analysis from National Trauma Data Bank Shahram Majidi, Farhan Siddiq, Adnan I. Qureshi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 27 2013
x The prevalence and impact of prehospital neurologic deterioration (PhND) in patients with traumatic brain injury (TBI) have not been investigated. We aimed to determine the prevalence of PhND during emergency medical service (EMS) transportation among patients with TBI and its impact on patient's outcome.
EMS characteristics in an Asian metroplis Sheng-Chuan Hu, Jeffrey Tsai, Yun-Lin Lu, Chung-Fu Lan
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90022-4
The American Journal of Emergency Medicine , Vol. 14 , Issue 1 ,
Published in issue: January 1996
x A prospective citywide cohort study was conducted from August 1, 1993, through May 31, 1994 to analyze the epidemiological characteristics of emergency medical services (EMS) in an Asian city. Of 5,459 studied cases, the leading 3 causes were trauma (49.7%), alcohol intoxication (8.6%), and altered mental status (AMS) (6.9%). Half of the studied cases needed no prehospital care and 16.4% needed advanced life support (ALS) care. Traffic accidents accounted for 68% of trauma cases. Of 897 cases requiring ALS care, the two most common causes were AMS and dead on arrival (DOA) (32.1% and 21.2% in medical group, 10.1% and 4.5% in trauma group, respectively).
Anxiety levels in EMS providers: Effects of violence and shift schedules Elisabeth Fowlie Mock, Keith D Wrenn, Seth W Wright, T.Chadwick Eustis, Corey M Slovis
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90186-9
The American Journal of Emergency Medicine , Vol. 17 , Issue 6 ,
Published in issue: October 1999
x We tried to measure anxiety levels in emergency medical service (EMS) providers to determine the effects of (1) having had a violent encounter during a shift and (2) different shift schedules, conducting a prospective observational study over 3 months in an urban EMS system setting. A convenience sample of 23 EMTs and 40 EMT-Ps was observed. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory. A total of 99 inventories were completed by 63 EMS providers. The mean state (32.6 ± 8) and trait (31.7 ± 7.1) scores were less than normative scores (35.7 ± 10.4 and 34.9 ± 9.2 respectively) for working adult males (P = .004 and .007, respectively).
How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients? Stephanie J. Fessler, Harold K. Simon, Arthur H. Yancey II, Michael Colman, Daniel A. Hirsh
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 26 2013
x The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as “low-acuity” by initial EMS protocols.
Patterns of use of emergency medical transport: A population-based study James E Svenson
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90002-0
The American Journal of Emergency Medicine , Vol. 18 , Issue 2 ,
Published in issue: March 2000
x The objective of this study was to characterize population-based emergency medical service (EMS) use rates and examine some of the factors associated with usage of prehospital services. The design was a population-based observational study with multiple regression analysis. Transports reported by prehospital services to the Kentucky Emergency Medical Services Information System from Kentucky counties in which all EMS units submit computerized data was the data source. There were 102,321 emergent transports reported.
Emergency medical transport of the elderly: A population-based study James L Wofford, William P Moran, Mark D Heuser, Earl Schwartz, Ramon Velez, Maurice B Mittelmark
DOI: http://dx.doi.org/10.1016/0735-6757(95)90203-1
The American Journal of Emergency Medicine , Vol. 13 , Issue 3 ,
Published in issue: May 1995
x Patterns of utilization of emergency medical services transport (EMS) by the elderly are poorly understood. We determined population-based rates of EMS utilization by the elderly and characterized utilization patterns by age, gender, race, and reason for transport. This observational, population-based study was conducted in Forsyth County, NC, a semi-urban county served by one convalescent ambulance service and one EMS service. Using data on all 1990 EMS transports and the 1990 U.S. census data, age-, gender-, and race-specific transport rates for persons aged 60 or older were calculated.
Emergency medical services development in the Seychelles islands Eric Savitsky, Gwen Bourgeault Rehnborg, Kathryn Ibarra
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90131-1
The American Journal of Emergency Medicine , Vol. 18 , Issue 3 ,
Published in issue: May 2000
x The Republic of the Seychelles enjoys a sophisticated health care system by developing country standards. Basic food, water, sanitation, and preventative health care needs have been addressed and the Seychelles Ministry of Health has recently focused on the need to improve the country's emergency medical services (EMS). In response to this need, a joint international collaborative effort designed to improve the island's EMS was launched. This report profiles the current health care system in the Seychelles, with special emphasis on EMS.
Accuracy of weight estimates in pediatric patients by prehospital Emergency Medical Services personnel C. Anthoney E. Lim, Bradley J. Kaufman, John O’Connor Jr., Sandra J. Cunningham
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 23 2013
x Most medications administered to children are weight-based, and inaccurate weight estimation may contribute to medical errors. Previous studies have been limited to hypothetical patients and those in cardiopulmonary arrest. We aim to determine the accuracy of weight estimates by Emergency Medical Services (EMS) personnel of children receiving medications and to identify factors associated with accuracy.
Prehospital intervention probability score: a novel method for determining necessity of emergency medical service units Denise Livingston, Andreia Marques-Baptista, Richard Brown, Junfeng Liu, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.002
The American Journal of Emergency Medicine , Vol. 28 , Issue 5 ,
Published online: November 23 2009
x This article models use of emergency medical services (EMS) within a defined geographical area. Our goal was to develop an original quantitative method to delineate the need for EMS units within a geographical population.
The impact of a freestanding ED on a regional emergency medical services system Benjamin J. Lawner, Jon Mark Hirshon, Angela C. Comer, Jose V. Nable, Jeffrey Kelly, Richard L. Alcorta, Laura Pimentel, Christina L. Tupe, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.042
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: November 18 2015
x The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times.
Implementation of standing field treatment protocols in an urban EMS system Marc Eckstein
DOI: http://dx.doi.org/10.1053/ajem.2001.22666
The American Journal of Emergency Medicine , Vol. 19 , Issue 4 ,
Published in issue: July 2001
x The objective was to describe our experience with implementation of standing field treatment protocols (SFTP) in a large, urban EMS system. A prospective, consecutive observational study examining the first 21 days of implementation of SFTPs in the City of Los Angeles, California. SFTPs were developed for 7 medical chief complaints and all major trauma patients. There were 13,586 EMS incidents, of which 4,037 (30%) received ALS treatment. SFTPs were used on 2,177 of these incidents, representing 54% of all ALS runs and 16% of all EMS incidents.
Paramedic decisions with placement of out-of-hospital intravenous lines Steven A Pace, Frederick P Fuller, Timothy J Dahlgren
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90193-6
The American Journal of Emergency Medicine , Vol. 17 , Issue 6 ,
Published in issue: October 1999
x To determine the incidence of unused out-of-hospital intravenous line (IV) placements, we prospectively studied IV placement in emergency medical services (EMS) patients. Unused IV placement was defined as any patient having an EMS initiated IV that was not used for fluid bolus or medication administration in the field or in the emergency department (ED). Data were analyzed on placement and use of IV lines in the field and in the ED, transport time, years of paramedic practice, and paramedic student presence.
The impact of prehospital activation of the cardiac catheterization team on time to treatment for patients presenting with ST-segment-elevation myocardial infarction Teresa Camp-Rogers, Siddhartha Dante, Michael C. Kontos, Charlotte S. Roberts, Laura Kreisa, Michael Christopher Kurz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.005
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 28 2010
x We sought to evaluate the accuracy of emergency medical services (EMS) activation of the cardiac catheterization laboratory (CCL) for patients with ST-elevation myocardial infarction (STEMI) and its impact on treatment intervals from dispatch to reperfusion.
Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction Magali Fourny, Anne-Sophie Lucas, Loïc Belle, Guillaume Debaty, Pierre Casez, Hélène Bouvaist, Patrice François, Gérald Vanzetto, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.008
The American Journal of Emergency Medicine , Vol. 29 , Issue 1 ,
Published online: March 10 2010
x Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI.
Can prehospital personnel detect hypoxemia without the aid of pulse oximeters? Lawrence H Brown, Erik A Manring, Hervy B Kornegay, N.Heramba Prasad
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90012-1
The American Journal of Emergency Medicine , Vol. 14 , Issue 1 ,
Published in issue: January 1996
x Although pulse oximeters have been proven accurate in the prehospital environment, they have not been proven to be necessary. This study was undertaken to determine if emergency medical services (EMS) providers can identify hypoxemia without pulse oximetry. An oximeter was placed at the ambulance entrance to the emergency department (ED), and EMS personnel obtained saturation levels on all patients on arrival. Hypoxemia was defined as a saturation level of 95% or less. The hypoxemia was classified as “recognized” if the patient received aggressive intervention and “unrecognized” if the patient did not.
The use of TRISS methodology to validate prehospital intubation by urban EMS providers Heidi Frankel, Grace Rozycki, Howard Champion, J.Duncan Harviel, Robert Bass
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90174-1
The American Journal of Emergency Medicine , Vol. 15 , Issue 7 ,
Published in issue: November 1997
x The purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05).
GPS computer navigators to shorten EMS response and transport times Floyd S. Ota, Russ S. Muramatsu, Blake H. Yoshida, Loren G. Yamamoto
DOI: http://dx.doi.org/10.1053/ajem.2001.22662
The American Journal of Emergency Medicine , Vol. 19 , Issue 3 ,
Published in issue: May 2001
x GPS (global positioning satellite system to determine one's position on earth) units have become inexpensive and compact. The purpose of this study is to assess the effectiveness of a GPS enhanced computer street map navigator to improve the ability of EMS drivers in an urban setting to locate their destination and shorten response times. For part I, residential addresses in the city were randomly selected from a telephone directory. Two driver/navigator teams were assigned to drive to the address adhering to speed limits.
Language disparities in patients transported by emergency medical services N.R. Weiss, S.J. Weiss, R. Tate, S. Oglesbee, A.A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 6 2015
x The population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital.
The prehospital and hospital costs of emergency care for frequent ED patients Robert G. Solberg, Brandy L. Edwards, Jeffrey P. Chidester, Debra G. Perina, William J. Brady, Michael D. Williams
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.066
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care.
Factors associated with the safety of EMS helicopters Ronald B. Low, Mary Jo Dunne, Ira J. Blumen, Gail Tagney
DOI: http://dx.doi.org/10.1016/0735-6757(91)90167-I
The American Journal of Emergency Medicine , Vol. 9 , Issue 2 ,
Published in issue: March 1991
x The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions.
Wilderness emergency medical services: The experiences at Sequoia and Kings Canyon National Parks Jeffrey Johnson, Mark Maertins, Marc Shalit, Tucker J. Bierbaum, Douglas E. Goldman, Robert A. Lowe
DOI: http://dx.doi.org/10.1016/0735-6757(91)90078-X
The American Journal of Emergency Medicine , Vol. 9 , Issue 3 ,
Published in issue: May 1991
x This article describes the National Park Service wilderness emergency medical services (EMS) system, as implemented at Sequola-Kings Canyon National Park. EMS records on all 434 patients in the period from August 1, 1986, to July 31, 1987, were reviewed. Most patients had minor problems. Overall, 77% of patients contacting the EMS system were released at the scene, and base hospital contact was made in only 28% of cases. However, there were three deaths, 44 (10%) patients who received advanced life support, and 292 (67%) patients who received basic life support.
Staffing and equipping emergency medical services systems: Rapid identification and treatment of acute myocardial infarction National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee
DOI: http://dx.doi.org/10.1016/0735-6757(95)90245-7
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x Each year, about 1,250,000 people in the United States experience an acute myocardial infarction (AMI). Emergency medical services (EMS) systems play a key part in the prehospital care and transportation of AMI patients. Rapid, state-of-the-art treatment by EMS personnel is essential for improving AMI survival and outcomes, as dramatized by the patient who is the victim of out-of-hospital cardiac arrest. In order to improve the prehospital care provided to AMI patients, this article by the Access to Care Subcommittee of the National Heart Attack Alert Program Coordinating Committee makes a number of recommendations regarding the staffing and equipping of EMS systems.
A geographic information system simulation model of EMS: reducing ambulance response time Kobi Peleg, Joseph S. Pliskin
DOI: http://dx.doi.org/10.1016/j.ajem.2004.02.003
The American Journal of Emergency Medicine , Vol. 22 , Issue 3 ,
Published in issue: May 2004
x Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. All calls that were pinpointed geographically by the GIS were included, and their data were stratified by weekday and by daily shifts.
Improving emergency medical services for children with special health care needs: Does training make a difference? Daniel W. Spaite, Carol Conroy, Katherine J. Karriker, Marsha Seng, Norma Battaglia
DOI: http://dx.doi.org/10.1053/ajem.2001.27146
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses.
Emergency medical services' use of poison control centers for unintentional drug ingestions Scott A. Bier, Douglas J. Borys
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.015
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: March 10 2010
x Every year, emergency medical services (EMS) providers respond to thousands of calls for toxic ingestions. Many systems have begun using poison control centers (PCCs) when unsure of disposition. We sought to determine the type of exposures EMS personnel were using the PCCs for and treatments suggested. Secondary end points included transport rate after consulting the PCC and amount of money saved by avoiding unnecessary transports.
Out-of-hospital resuscitation in Tartu: Effect of reorganization of Estonian EMS system Aleksander Sipria, Raul Talvik, Ago Kõrgvee, Silver Sarapuu, Aare Ööpik
DOI: http://dx.doi.org/10.1053/ajem.2000.7350
The American Journal of Emergency Medicine , Vol. 18 , Issue 4 ,
Published in issue: July 2000
x The objective of this study was to evaluate the effect of reorganization of Estonian emergency medical services (EMS) system. The outcomes of out-of-hospital resuscitation in the Tartu urban area were investigated during the 6-year study period. The main aim of reorganization was to provide rapid access to early defibrillation with simultaneous advanced cardiac life support (ACLS) procedures on the scene. The changes were implemented since summer 1994 in Tartu at first. Quick availability of a mobile intensive care unit for high-risk calls; implementation of standards for resuscitation, and routine systematic, realistic, compulsory ACLS training for all ambulance staff were established.
The role of paramedics in resuscitation of patients with prehospital cardiac arrest from coronary artery disease Richard P. Lewis, John M. Stang, James V. Warren
DOI: http://dx.doi.org/10.1016/0735-6757(84)90003-2
The American Journal of Emergency Medicine , Vol. 2 , Issue 3 ,
Published in issue: May 1984
x Columbus, Ohio added prehospital coronary care to its Emergency Medical Services System (EMS) in 1969. The EMS System, which is citizen activated and tax supported ($5 per citizen per year), currently sees 32,000 patients a year in a city with a population of 650,000. Ninety-six per cent of the population is aware of the system. Over two thirds of patients with ischemic sudden death or myocardial infarction are seen by advanced life support paramedic (EMT-P) units. The EMT-Ps operate by protocol without telemetry and carry all standard resuscitative drugs and devices.
Effect of a social services intervention among 911 repeat users Steven J. Weiss, Amy A. Ernst, Margaret Ong, Ray Jones, Debra Morrow, Rosemary Milch, Katie O'Neil, Jay Glass, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.003
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x To determine whether emergency medical services (EMS) 911 frequent users would benefit from social services intervention.
Patients who initially refuse prehospital evaluation and/or therapy Geraldine Stark, Jerris R. Hedges, Keith Neely, Robert Norton
DOI: http://dx.doi.org/10.1016/0735-6757(90)90152-P
The American Journal of Emergency Medicine , Vol. 8 , Issue 6 ,
Published in issue: November 1990
x The authors performed a retrospective descriptive and analytical cohort study of prehospital patient initial refusal of care (PIRC) cases to characterize the types of patients encountered and to assess factors associated with their dispositions. During a 6-month period, 169 of 1715 (9.9%) base station calls in an urban emergency medical service (EMS) system were for physician involvement in a PIRC. Patients' dispositions were as follows: left at scene against medical advice (53%); taken by ambulance to the hospital (28%); left with friend (13%); other disposition (5%).
The relationship between paramedics' level of education and degree of commitment Melissa Alexander, Steven Weiss, Darren Braude, Amy A. Ernst, Lynne Fullerton-Gleason
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.039
The American Journal of Emergency Medicine , Vol. 27 , Issue 7 ,
Published in issue: September 2009
x Emergency medical services (EMS) personnel attrition is a serious concern. Two fundamental psychological constructs linked to attrition are organizational and occupational commitment.
The 911 emergency telephone number: Impact on emergency medical systems access in a metropolitan area Ray Mayron, Robert S. Long, Ernest Ruiz
DOI: http://dx.doi.org/10.1016/0735-6757(84)90070-6
The American Journal of Emergency Medicine , Vol. 2 , Issue 6 ,
Published in issue: November 1984
x The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. Paul provides a unique opportunity to examine this assumption. Prior to the introduction of the 911 emergency telephone number on December 1, 1982, the area was serviced by over 100 different seven-digit emergency telephone numbers.
Resource reallocation in an emergency medical service system using computer simulation Syi Su, Chung-Liang Shih
DOI: http://dx.doi.org/10.1053/ajem.2002.35453
The American Journal of Emergency Medicine , Vol. 20 , Issue 7 ,
Published in issue: November 2002
x Emergency medical service (EMS) policy makers must seek to achieve maximum effectiveness with finite resources. This research establishes an EMS computer simulation model using eM-Plant software. The simulation model is based on Taipei city's EMS system with input data from prehospital care records from December 2000; it manipulates resource allocation levels and rates of idle errands. Presently, EMS ambulance utilization is about 8.78%. On average, 20.89 minutes are required to transport a patient to the hospital.
Pattern of basic life support ambulance use in an urban pediatric population William J Brady Jr, Halim Hennes, Ann Wolf, Kent N Hall, Marsha Davis
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90168-0
The American Journal of Emergency Medicine , Vol. 14 , Issue 3 ,
Published in issue: May 1996
x To evaluate the pattern of use of basic life support (BLS) ambulances in a pediatric population, emergency medical service (EMS) and pediatric emergency department (PED) records from an urban hospital PED for all children transported to PED by ambulance during a 1-month study period were retrospectively reviewed. Excluded were: (1) advanced life support transport, (2) transport from other medical facility, (3) patients with chronic medical disability without acute decompensation, and (4) patients in police custody.
Circadian, day-of-week, and age patterns of the occurrence of acute coronary syndrome in Beijing's emergency medical services system Yi Li, Tiekuan Du, Matthew R. Lewin, Houli Wang, Xu Ji, Yanping Zhang, Tengda Xu, Lingjie Xu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.033
The American Journal of Emergency Medicine , Vol. 28 , Issue 6 ,
Published online: March 26 2010
x Previous in-hospital studies suggest that there are significant circadian rhythms associated with the incidence of acute coronary syndromes (ACSs). No study to date has examined the presentation of ACS in the prehospital setting. Our goal was to examine circadian, day-of-week, and age patterns of occurrence in ACS in a large, urban emergency medical services (EMS) system.
International EMS: Lessons learned in Costa Rica Connie Mitchell
DOI: http://dx.doi.org/10.1016/0735-6757(91)90062-O
The American Journal of Emergency Medicine , Vol. 9 , Issue 4 ,
Published in issue: July 1991
x Health care planners in Costa Rica, seeking to upgrade their emergency medical services, contracted with United States agencies for additional funding and established a national program for the development of an emergency medical service system. Three years later some of the problems and accomplishments of both the planning and early implementation phases have been identified and include the importance of a detailed assessment of current system components, resources, and priorities; the early implementation of an accurate data collection system; early planning for system self-sufficiency; the vital role of the lead agency with formal lines of authority; the careful development of local expertise and leadership.
Emergency medical dispatching: Rapid identification and treatment of acute myocardial infarction National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee
DOI: http://dx.doi.org/10.1016/0735-6757(95)90246-5
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x Emergency medical telephone calls (ie, those made to 9-1-1 or 7-digit emergency numbers) are directed to emergency medical dispatchers (EMDs) who are responsible for quickly obtaining critical pieces of information from the caller, then activating an appropriate level of emergency medical services (EMS) response and providing the caller with patient care instructions until medical help arrives. The impact of well-trained, medically managed EMDs on the early care of potential acute myocardial infarction (AMI) patients is believed to be beneficial.
Prehospital gastrointestinal decontamination of toxic ingestions: A missed opportunity Paul M Wax, Daniel J Cobaugh
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90024-9
The American Journal of Emergency Medicine , Vol. 16 , Issue 2 ,
Published in issue: March 1998
x The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac.
A method to reduce response times in prehospital care: The motorcycle experience Chaou-Shune Lin, Hang Chang, Kou-Gi Shyu, Cheng-Yan Liu, Chang-Chung Lin, Chi-Ren Hung, Pao-Huei Chen
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90185-1
The American Journal of Emergency Medicine , Vol. 16 , Issue 7 ,
Published in issue: November 1998
x This study compared the response times of a motorcycle and a standard ambulance in a congested urban emergency medical services (EMS) setting. The study was performed in Taipei, Taiwan, a densely populated urban area. A basic life support (BLS) motorcycle (without defibrillation capability) and an advanced life support (ALS) ambulance were based at three study hospitals and simultaneously dispatched when there was a perceived need for ALS ambulance transport. Over a 3-month period, prehospital personnel evaluated 307 medical and trauma emergencies.
Community hospital management of pediatric emergencies: Implications for pediatric emergency medical services Alfred Sacchetti, Carol Carraccio, Todd Warden, Steven Gazak
DOI: http://dx.doi.org/10.1016/0735-6757(86)90241-X
The American Journal of Emergency Medicine , Vol. 4 , Issue 1 ,
Published in issue: January 1986
x The ability of emergency physicians in a general community hospital to manage pediatric patients was evaluated. Essential diagnostic and therapeutic procedures performed in the emergency department on pediatric patients transferred for admission to a tertiary care center were compared with those initially performed on the same patients by the pediatricians and residents of the tertiary care center. The overall care rendered by the emergency physicians correlated well with that of the referral center.
Treatment and career attitudes of prehospital care providers associated with potential exposure to HIV/AIDS James N. Eastham Jr, Michael E. Thompson, Patricia A. Ryan
DOI: http://dx.doi.org/10.1016/0735-6757(91)90171-F
The American Journal of Emergency Medicine , Vol. 9 , Issue 2 ,
Published in issue: March 1991
x Career and treatment attitudes related to potential human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) exposure are reported based on a survey of 1,228 Maryland career and volunteer prehospital care providers trained to provide basic (BLS) and advanced (ALS) life support. Sixty-five percent stated potential exposure to HIV/AIDS was a major occupational stressor. Ninety-two percent stated they would treat HIV/AIDS patients if protected. Given a choice, 38% would avoid providing treatment to HIV/AIDS patients.
Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Yuichi Ono, Mineji Hayakawa, Kunihiko Maekawa, Asumi Mizugaki, Kenichi Katabami, Takeshi Wada, Atsushi Sawamura, Satoshi Gando
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x Few studies have compared airway management via laryngeal masks (LM) or laryngeal tubes (LT) in patients with out-of-hospital cardiac arrest (OHCA). This study evaluated whether LT insertion by emergency medical service (EMS) personnel affected ventilation and outcomes in OHCA patients (vs. the standard LM treatment).
A retrospective review of the prehospital use of activated charcoal Joseph Villarreal, Christopher A. Kahn, James V. Dunford, Ekta Patel, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 21 2014
x We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated.
Retrograde intubation training using a mannequin Daved W Van Stralen, Mark Rogers, Ronald M Perkin, Steve Fea
DOI: http://dx.doi.org/10.1016/0735-6757(95)90242-2
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x The purpose of this study was to determine the efficacy of a mannequin for training emergency caregivers in the technique of retrograde intubation. This was a descriptive study using duration of time needed for completion of intubation as a measure of success. A cohort of 88 Emergency Medical Service (EMS) personnel included prehospital caregivers, registered nurses, and respiratory care practitioners. Participants were trained in retrograde intubation by modeling. Students practiced before they were tested.
Use of a limited lights and siren protocol in the prehospital setting vs standard usage Mark A. Merlin, Kimberly T. Baldino, David P. Lehrfeld, Matt Linger, Eliyahu Lustiger, Anthony Cascio, Pamela Ohman-Strickland, Frank DosSantos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: May 13 2011
x Our objective was to determine if implementing a standard lights and sirens (L&S) protocol would reduce their use and if this had any effect on patient disposition.
The prehospital 12-lead electrocardiogram: Impact on management of the out-of-hospital acute coronary syndrome patient Jeffrey D. Ferguson, William J. Brady, Andrew D. Perron, Nicole D. Kielar, John P. Benner, Scott B. Currance, Sabina Braithwaite, Tom P. Aufderheide
DOI: http://dx.doi.org/10.1053/ajem.2003.50011
The American Journal of Emergency Medicine , Vol. 21 , Issue 2 ,
Published in issue: March 2003
x The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. The prehospital ECG may also detect an ischemic change that has resolved with treatment delivered by emergency medical services (EMS) prior to the patient's arrival in the emergency department (ED).
A novel diversion protocol dramatically reduces diversion hours Osei Kwame Asamoah, Steven J. Weiss, Amy A. Ernst, Michael Richards, David P. Sklar
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.020
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
x Ambulance diversion is a problem in many communities. When patients are diverted prompt and appropriate medical care may be delayed.
Can stock rotation effectively mitigate EMS medication exposure to excessive heat and cold? Lawrence H. Brown, Susan M. Wojcik, Leonard C. Bailey, Calvin D. Tran
DOI: http://dx.doi.org/10.1016/j.ajem.2005.05.013
The American Journal of Emergency Medicine , Vol. 24 , Issue 1 ,
Published in issue: January 2006
x The United States Pharmacopeia recently published a general chapter specifically addressing on-ambulance storage of medications, including a suggestion for stock rotation. This study describes the effectiveness of a simple stock rotation strategy in mitigating EMS medication exposure to excessive heat and cold. Previously collected on-ambulance temperature data from 5 US cities were randomly resampled to generate model exposures of 2 days to 6 months duration. The temperature measurements for every other 24-hour period were then set at 20°C to model the rotation of medications into a controlled environment.
9-1-1: Rapid identification and treatment of acute myocardial infarction National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee
DOI: http://dx.doi.org/10.1016/0735-6757(95)90092-6
The American Journal of Emergency Medicine , Vol. 13 , Issue 2 ,
Published in issue: March 1995
x The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards.
Evaluation of the injury profile of personnel in a busy urban EMS system Paul T. Hogya, Lloyd Ellis
DOI: http://dx.doi.org/10.1016/0735-6757(90)90081-A
The American Journal of Emergency Medicine , Vol. 8 , Issue 4 ,
Published in issue: July 1990
x The occupational injury profile of emergency medical technicians (EMTs) and paramedics is not well described. We retrospectively studied 254 injuries over a 3.5-year period in a busy urban EMS system. Low back strain was the most common injury (, 36%), with EMTs suffering a significantly higher injury rate than paramedics (0.33 v 0.17 injuries/person-years at risk, P = .03). Liffting caused (62.4%) of back injuries, and most occurred at the scene to which personnel were dispatched (, 62.4%). The back injuries were recurrent in 31% of personnel.
Acute cognitive impairment in elderly ED patients: Etiologies and outcomes James L Wofford, Laura R Loehr, Earl Schwartz
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90080-7
The American Journal of Emergency Medicine , Vol. 14 , Issue 7 ,
Published in issue: November 1996
x Despite the common occurrence of acute cognitive impairment in elderly emergency department (ED) patients, there is much uncertainty regarding the evaluation and management of this syndrome. We performed a retrospective cohort study of all patients 60 years of age and older transported by emergency medical services (EMS) to hospital EDs in Forsyth County, North Carolina, during 1990 specifically for evaluation of acute cognitive impairment. Five percent (227 of 4,688) of EMS transports during this time period were for the purpose of evaluation of acute cognitive impairment.
Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness Jennifer Brokaw, Lenora Olson, Lynne Fullerton, Dan Tandberg, David Sklar
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90031-6
The American Journal of Emergency Medicine , Vol. 16 , Issue 2 ,
Published in issue: March 1998
x Three chronic conditions were examined—acute alcohol intoxication, seizure disorder, and respiratory illness—to quantify the extent of repetitive emergency medical services (EMS) use in a defined population. Urban EMS system ambulance data from 1992 to 1994 were analyzed for the three designated conditions with respect to transports by condition and individual patient. Analysis by χ 2 was used for comparing proportions. Analysis of variance after square root transformation was used to evaluate differences among means.
Out-of-hospital cardiac arrests: An 8-year New York city experience Richard E Westfal, Stephan Reissman, Garrett Doering
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90050-9
The American Journal of Emergency Medicine , Vol. 14 , Issue 4 ,
Published in issue: July 1996
x A retrospective study was conducted to determine the outcome of out-of-hospital cardiac arrests by one prehospital system in New York City from January, 1986, through December, 1993. The results were recorded consistent with the Utstein Style. Of 481 attempted patient resuscitations 406 were of cardiac etiology, with 382 patients having arrested prior to EMS arrival; their overall survival rate was 2.1% (8/382). Cardiac arrests were witnessed in 246 patients. Of the witnessed arrest patients found in ventricular fibrillation (96/246), the overall survival rate was 7.3% (7/96).
Safety and compliance with an emergency medical service direct psychiatric center transport protocol Paul Cheney, Tiffany Haddock, Leslie Sanchez, Amy Ernst, Steven Weiss
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.019
The American Journal of Emergency Medicine , Vol. 26 , Issue 7 ,
Published in issue: September 2008
x To evaluate compliance and safety of an emergency medical service (EMS) triage protocol that allows paramedics to transport patients directly to psychiatric emergency services.
Lack of t-PA use for acute ischemic stroke in a community hospital: High incidence of exclusion criteria Elly Engelstein, Jeffrey Margulies, Joseph S Jeret
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90116-5
The American Journal of Emergency Medicine , Vol. 18 , Issue 3 ,
Published in issue: May 2000
x Thrombolytic therapy with t-PA for acute ischemic stroke may provide benefit in long-term outcome. This retrospective study was undertaken to evaluate appropriateness of the National Institute of Neurological Disorders and Stroke (NINDS) protocol in the emergency department (ED). All patients with appropriate International Classification of Diseases, 9th revision (ICD-9) codes indicating stroke who presented to our 387-bed trauma-l community hospital during 1997 were included in the study. Of the nearly 35,000 patients screened, 201 patients satisfied our inclusion criteria.
Prehospital midthigh trauma and traction splint use: Recommendations for treatment protocols Neal Robert Abarbanell
DOI: http://dx.doi.org/10.1053/ajem.2001.21302
The American Journal of Emergency Medicine , Vol. 19 , Issue 2 ,
Published in issue: March 2001
x The present study was completed to establish an epidemiologic database defining the prehospital occurrence of midthigh trauma/suspected femoral shaft fractures, and the use of/need for traction splints (TS) in hope of developing recommendations for further treatment protocols. On review of 4,513 paramedic run reports for the 12-month period from January 1999 through December 1999, from a low-volume urban emergency medical services (EMS) system, 16 persons (0.35% total patients) presented with midthigh injuries.
Photograph documentation of motor vehicle damage by EMTs at the scene: A prospective multicenter study in the United States Richard C Hunt, Theodore W Whitley, E.Jackson Allison Jr, Richard V Aghababian, Jon R Krohmer, Fred Landes, John B McCabe, N.Heramba Prasad, and others
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90003-6
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x The purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes.
An algorithm for identification of ST-elevation myocardial infarction patients by emergency medicine services Ryan E. Wilson, Herman S. Kado, Robert F. Percy, Ryan C. Butterfield, Joseph Sabato Jr, Joel A. Strom, Lyndon C. Box
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 24 2013
x ST-elevation myocardial infarction (STEMI) identification by emergency medicine services (EMS) leading to pre-hospital catheterization laboratory (CL) activation shortens ischemic time and improves outcomes. We examined the incremental value of addition of a screening clinical tool (CT), containing clinical information and a Zoll electrocardiogram (ECG)-resident STEMI identification program (ZI) to ZI alone.
Emergency medical systems in Czechoslovakia Kenneth Elam, Richard A. Harvey
DOI: http://dx.doi.org/10.1016/0735-6757(92)90192-Z
The American Journal of Emergency Medicine , Vol. 10 , Issue 6 ,
Published in issue: November 1992
x The year 1987 witnessed the “velvet revolution” of Vaclav Havel and the beginning of democratic reform in Czechoslovakia. As the country struggles to build a market-based economy, it maintains a well-developed socialist system of health care that is patterned after the former Soviet system and is free to all (Am J Emerg Med 1984;2:455–456). Formal private medical practice does not exist. Non-emergency care is provided by multispecialty, primary-care oriented clinics (polyklinka) where afterhours visits are possible due to the presence of on-call physicians.
The influence of urban, suburban, or rural locale on survival from refractory prehospital cardiac arrest Rade B Vukmir, The Sodium Bicarbonate Study Group
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.008
The American Journal of Emergency Medicine , Vol. 22 , Issue 2 ,
Published in issue: March 2004
x There are many variables that can have an effect on survival in cardiopulmonary arrest. This study examined the effect of urban, suburban, or rural location on the outcome of prehospital cardiac arrest as a secondary end point in a study evaluating the effect of bicarbonate on survival. The proportion of survivors within a type of EMS provider system as well as response times were compared. This prospective, randomized, double-blind clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered by prehospital urban, suburban, and rural regional EMS area.
Outcome of patients who refused out-of-hospital medical assistance Jonathan L Burstein, Mark C Henry, Jeanne Alicandro, David Gentile, EMT-D, Henry C Thode Jr, Judd E Hollander
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90007-8
The American Journal of Emergency Medicine , Vol. 14 , Issue 1 ,
Published in issue: January 1996
x Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient.
The effect of interhospital transfers, emergency medical services, and distance on ischemic time in a rural ST-elevation myocardial infarction system of care James R. Langabeer II, Sapna Prasad, Munseok Seo, Derek T. Smith, Wendy Segrest, Theophilus Owan, Daniela Gerard, Michael D. Eisenhauer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 9 2015
x Regional myocardial infarction systems of care have been shown to improve timely access to primary percutaneous coronary intervention (PCI). However, there is a relatively sparse research on rural “frontier” regions. Arrival mode, high rates of interhospital transfers, long transport times, low population density, and mostly volunteer emergency medical services (EMS) distinguish this region from metropolitan systems of care. We sought to assess the effect of interhospital transfers, distance, and arrival mode on total ischemic times for patients with ST-elevation myocardial infarctions undergoing primary PCI.
Trauma care systems Leo Uzych
DOI: http://dx.doi.org/10.1016/0735-6757(90)90300-O
The American Journal of Emergency Medicine , Vol. 8 , Issue 1 ,
Published in issue: January 1990
x Injury is a major cause of disability and death in the United States. The effective development and implementation of trauma care systems has the potential to reduce substantially the level of morbidity and mortality otherwise suffered by trauma and injury victims. However, extant trauma care systems have been strongly affected by disruptive forces, particularly uncompensated care of the indigent. The passage of proposed federal legislation (S 15 and HR 1602) may serve to relieve some of the more financially stressed trauma centers and construct a framework for trauma care systems having a viable future.
Emergency medicine in Ukraine: Challenges in the post-Soviet era Seth W. Wright, Lawrence B. Stack, Brian R. McMurray, Sergei Bolyukh
DOI: http://dx.doi.org/10.1053/ajem.2000.18110
The American Journal of Emergency Medicine , Vol. 18 , Issue 7 ,
Published in issue: November 2000
x The practice of emergency medicine in Ukraine is markedly different from the practice in North America. The emergency physician counterpart in Ukraine attends 6 years of medical school then 18 months of prehospital physician training at an EMS base station. Once trained, prehospital physicians work 160 hours/month in 24-hour shifts at the base station as part of a physician-nurse team which answers ambulance requests. Most patients are seen and treated on site of the ambulance call. Patients are transported to the hospital only 20% of the time.
Emergent cricothyroidotomies for trauma: training considerations David R. King, Michael P. Ogilvie, George Velmahos, Hasan B. Alam, Marc A. deMoya, Susan R. Wilcox, Ali Y. Mejaddam, Gwendolyn M. Van Der Wilden, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: December 28 2011
x Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons.
Is 15 minutes an appropriate resuscitation duration before termination of a traumatic cardiac arrest? A case-control study Cheng-Yu Chien, Yi-Chia Su, Chi-Chun Lin, Chan-Wei Kuo, Shen-Che Lin, Yi-Ming Weng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.004
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 11 2015
x Previous guidelines suggest up to 15 minutes of cardiopulmonary resuscitation (CPR) accompanied by other resuscitative interventions before terminating resuscitation of a traumatic cardiac arrest. The current study evaluated the duration of CPR according to outcome using the model of a county-based emergency medical services (EMS) system in Taiwan.
The effect of Combitube use on paramedic experience in endotracheal intubation Charles E. Cady, Ronald G. Pirrallo
DOI: http://dx.doi.org/10.1016/j.ajem.2005.07.013
The American Journal of Emergency Medicine , Vol. 23 , Issue 7 ,
Published in issue: November 2005
x To determine the change in number of endotracheal intubations per paramedic after the implementation of Combitube use and to explore consequences.
Outcomes in severely ill patients transported without prehospital ALS Sheng-Chuan Hu, Wei-Fong Kao
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90023-6
The American Journal of Emergency Medicine , Vol. 14 , Issue 1 ,
Published in issue: January 1996
x Because of the debate regarding the impact of advanced life support (ALS) care on the outcome of prehospital patients, we monitored the influence of lack of sophisticated prehospital treatment in cases of severe illness arriving by ambulance to the emergency department (ED). A prospective cohort study to examine and compare the outcome of trauma- and nontrauma-induced “ALS-eligible” cases in the setting of no prehospital care was carried out from August 1, 1993 through May 31, 1994. On arriving at the ED, patients meeting the criteria for ALS cases and sent by EMS public prehospital personnel were assessed for subjective and objective status and change in severity by triage nurses as well as being followed up for neurological status until discharged from the hospital.
Prehospital management of rapid atrial fibrillation: Recommendations for treatment protocols Neal Robert Abarbanell, Mary Ann Marcotte, Beata A. Schaible, Glenn E. Aldinger
DOI: http://dx.doi.org/10.1053/ajem.2001.18124
The American Journal of Emergency Medicine , Vol. 19 , Issue 1 ,
Published in issue: January 2001
x The present study was completed to establish an epidemiological database defining prehospital rapid atrial fibrillation (RAF) and interventions given such patients in the hope of developing recommendations for further treatment protocols. On review of 4,749 paramedic run reports from a low-volume urban emergency medical services (EMS) system, 33 persons (0.69%) presented with RAF. Data collected included vital signs/ventricular rate, patient age, ambulance field times, patient chief complaint, prehospital interventions, efficacy of interventions, additional cardiac rhythms, iatrogenic complications, and patient past medical history.
Efficiency and cost-effectiveness of advanced EMS in West Germany G. Riediger, Thomas Fleischmann-Sperber
DOI: http://dx.doi.org/10.1016/0735-6757(90)90301-F
The American Journal of Emergency Medicine , Vol. 8 , Issue 1 ,
Published in issue: January 1990
x A model study was performed by an economist in Lower Frankonia (a mostly rural area of West Germany with several urban centers) to examine the efficiency and cost-effectiveness of the emergency medical service that included prehospital physician presence.‡ To perform this examination about $3.5 million were spent to improve organization and communication within the local emergency medical service, to purchase additional equipment and further emergency vehicles, and to install pre-hospital emergency physician service.
Seroprevalence of hepatitis B and hepatitis C among rural emergency medical care personnel Howard A Werman, Robert Gwinn
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90006-1
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x To identify the prevalence of serologic markers of hepatitis B and hepatitis C among rural prehospital providers, a prospective descriptive study was conducted of a rural county emergency medical services (EMS) system. Participants included 107 prehospital care providers: 102 EMT-Bs, 1 paramedic, and 4 law enforcement first responders. Blood samples taken from prehospital care providers were tested for hepatitis B surface antigen (HBsAg), antibody to HBsAg (HBsAb), antibody to hepatitis B core antigen (HBcAb), and antibody to hepatitis C (anti-HC).
Factors contributing to paramedic onscene time during evaluation and management of blunt trauma Jerris R. Hedges, Stan Feero, Brian Moore, Bette Shultz, Dennis W. Haver
DOI: http://dx.doi.org/10.1016/0735-6757(88)90242-2
The American Journal of Emergency Medicine , Vol. 6 , Issue 5 ,
Published in issue: September 1988
x Prehospital patient management decisions are complex because the traumatized patient population is heterogeneous with respect to demographics, mechanism of injury, physiological response to injury, and time from injury to medical care. One hundred and nine blunt trauma patient evaluations by paramedics in a county-wide semirural emergency medical services (EMS) system were analyzed to determine paramedic time on the scene and the factors that might influence onscene time. Onscene time linearly correlated with a prolonged transport time.
Factors associated with sudden death of individuals requiring restraint for excited delirium Samuel J. Stratton, Christopher Rogers, Karen Brickett, Ginger Gruzinski
DOI: http://dx.doi.org/10.1053/ajem.2001.22665
The American Journal of Emergency Medicine , Vol. 19 , Issue 3 ,
Published in issue: May 2001
x The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eighteen cases of such deaths witnessed by emergency medical service (EMS) personnel are reported. The 18 cases reported were restrained with the wrists and ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% of the sudden death cases.
Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or non–heart-beating organ procurement Jean Marc Agostinucci, Mirko Ruscev, Michel Galinski, Serge Gravelo, Tomislav Petrovic, Cyril Carmeaux, Hakim Haouache, France Roussin, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.029
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 18 2010
x The aim of the study was to assess the ease-of-use, safety, and usefulness of an automated external chest compression device for cardiopulmonary resuscitation.
Response times and outcomes for cardiac arrests in las vegas casinos Steven B Karch, Jon Graff, Sandra Young, Chih-Hsiang Ho
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90094-8
The American Journal of Emergency Medicine , Vol. 16 , Issue 3 ,
Published in issue: May 1998
x This study was conducted to measure emergency medical services (EMS) response times in sudden out-of-hospital cardiac arrests and relate those times to probability of survival in cardiac arrest victims in Las Vegas casino-hotels from January 1993 to June 1996. Times from 911 activation to casino arrival and casino arrival to arrival at patient's side (time to first defibrillatory shock), as well as survival to hospital discharge, were studied with regression analysis. Sixty patients survived (29.3%).
