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.
