Emergency medical services personnel awareness and training about personal protective equipment during the COVID-19 pandemic.
Conclusions: CDC guidance on COVID-19 for EMS may have increased N95 fit testing and training, but there remain substantial gaps in training on PPE use among EMS personnel. As the pandemic continues in our communities, EMS agencies should be supported in efforts to adequately prepare their staff. PMID: 33211613 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - November 21, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Point-of-care ultrasound diagnosis of community-acquired pneumonia in a high-altitude, resource-poor setting.
We present a case of severe respiratory disease in a young, otherwise healthy patient during a trek at high altitude in the Khumbu valley of Nepal. By using POCUS, we were able to exclude several important differential diagnoses and diagnose the patient with community-acquired pneumonia. Our findings allowed us to start early on-site treatment and positively influenced shared decision-making with the patient, which led to a helicopter evacuation. This case illustrates that POCUS can be a valuable tool in remote, high-altitude regions and could allow healthcare providers to diagnose and follow-up with patients exhibiting ac...
Source: Prehospital Emergency Care - November 21, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Association between Torso Gunshot Wound Volumes of Trauma Centers and Outcomes of Torso Gunshot Wound Patients. A Propensity-Matched Nationwide Cohort Study.
Authors: Fu CY, Bajani F, Bokhari M, Butler C, Starr F, Messer T, Kaminsky M, Dennis A, Schlanser V, Poulakidas S, Mis J, Bokhari F Abstract OBJECTIVE- The number and type of patients treated by trauma centers can vary widely because of a number of factors. There might be trauma centers with a high volume of torso GSWs that are not designated as high-level trauma centers. We proposed that, for torso gunshot wounds (GSWs), the treating hospital's trauma volume and not its trauma center level designation drives patient prognosis. METHODS- The National Trauma Data Bank was queried for torso GSWs. The characteristics o...
Source: Prehospital Emergency Care - November 21, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Design and derivation of the Austrian Prehospital Stroke Scale (APSS) to predict severe stroke with large vessel occlusion.
Conclusions: The easy assessable 5-item APSS score tended to outperform other LVO scores. Real-life prospective evaluation in prehospital setting is ongoing. PMID: 33201748 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - November 19, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Acute myocardial infarction identified by paramedics using the Smith-modified Sgarbossa criteria: a case report.
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. The patient was found with 95% stenosis of the left anterior descending artery and received stenting. PMID: 33151103 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - November 6, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Improved Out-of-Hospital Cardiac Arrest Survival with a Comprehensive Dispatcher-Assisted CPR Program in a Developing Emergency Care System.
This study evaluated the impact of a dispatcher-assisted CPR (DA-CPR) program on BCPR rate and outcomes of OHCA in a developing emergency medical services (EMS) system setting. Methods Data were extracted from the national cardiac arrest registry. A before-after analysis was performed between OHCA cases with cardiac etiology conveyed by EMS from April 2010-June 2012 (pre-intervention) and July 2012-December 2015 (post-intervention). Primary outcomes were survival-to-discharge/30th day post-arrest and favorable cerebral performance (Glasgow-Pittsburgh cerebral performance categories 1 and 2). Results 6365 OHCA cases were an...
Source: Prehospital Emergency Care - November 6, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Ambulance Calls for Substance-Related Issues Before and After COVID-19.
Authors: Weiner SG, Cash RE, Hendricks M, El Ibrahimi S, Baker O, Seethala RR, Peters G, Goldberg SA Abstract Background: The United States is currently facing two epidemics: sustained morbidity and mortality from substance use and the more recent COVID-19 pandemic. We tested the hypothesis that the pandemic has disproportionately affected individuals with substance use disorder by evaluating average daily 911 ambulance calls for substance use-related issues compared with all other calls. Methods: This was a retrospective cross-sectional analysis of 911 ambulance calls before and after the start of COVID-19 in Mass...
Source: Prehospital Emergency Care - November 5, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Abstracts for the 2021 NAEMSP Scientific Assembly.
Authors: PMID: 33090927 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 23, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Fatal Sodium Nitrite Poisoning: Key Considerations for Prehospital Providers.
We report a case of an intentional fatal overdose of sodium nitrite. A 17-year-old female reportedly drank approximately one tablespoon of sodium nitrite in a self-harm attempt. The patient was hypotensive and cyanotic upon EMS arrival. The patient decompensated rapidly into a bradycardic arrest during transport despite intubation, push-dose epinephrine, and intravenous fluid resuscitation. In the Emergency Department (ED), she received methylene blue and packed red cells but could not be resuscitated despite a prolonged effort. EMS professionals should consider sodium nitrite toxicity in patients with a suspected overdose...
Source: Prehospital Emergency Care - October 22, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

COVID-19 Pandemic: The Role of EMS Physicians in a Community Response Effort.
Authors: Cabañas JG, Williams JG, Gallagher JM, Brice JH Abstract The COVID-19 Pandemic is a worldwide historical event that will continue to affect nearly every aspect of ordinary life, including affecting our economic, political, and healthcare eco-systems. An effective pandemic response demands a coordinated and integrated response across community healthcare stakeholders, including Public Health and Emergency Management Officials. EMS systems are in a unique position and perform an essential role on the frontlines of COVID-19, including facilitating coordination of response efforts to COVID-19 within the...
Source: Prehospital Emergency Care - October 22, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Description of Adverse Events in a Cohort of Dance Festival Attendees with Stimulant-Induced Severe Agitation Treated with Dissociative-Dose Ketamine.
ConclusionIn this cohort of festival attendees who developed stimulant-induced severe agitation and were treated with dissociative-dose ketamine, serious adverse events occurred in 5.9% of patients including one patient who was intubated. PMID: 33054495 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 20, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Child Abuse Recognition Training for Prehospital Providers using Deliberate Practice.
ConclusionAn online module utilizing deliberate practice led to measurable skill improvement among PHPs for differentiating abusive from non-abusive burn and bruise injuries. PMID: 33054522 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 20, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Refusals after prehospital administration of naloxone during the COVID-19 pandemic.
Conclusion: In this single EMS system, more than a two-fold increase in the rate of refusal after non-fatal opioid overdose was observed following the COVID-19 outbreak. PMID: 33054530 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 20, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Validation of the NUE rule to predict futile resuscitation of out-of-hospital cardiac arrest.
CONCLUSION: In external validation, the NUE rule (Non-shockable initial rhythm, Unwitnessed arrest, Eighty years or older) correctly identified 7.2% of OHCA patients unlikely to survive to hospital discharge. The NUE rule could be used in EMS protocols and policies to identify OHCA patients very unlikely to benefit from aggressive resuscitation. PMID: 33026273 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Reply to Dr. Dahdah's Letter to the Editor Re: "A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock".
Reply to Dr. Dahdah's Letter to the Editor Re: "A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock". Prehosp Emerg Care. 2020 Oct 07;:1-2 Authors: Donofrio-Ödmann JJ, Remoulet A, Burns J, Harvey H, Staats K PMID: 33026275 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Accuracy and Implications of Hemorrhagic Stroke Recognition by Emergency Medical Services.
The objectives of this study were to quantify EMS hemorrhagic stroke recognition, identify predictors of accurate EMS recognition, and examine associations between EMS recognition, quality of prehospital care, and patient outcomes. METHODS: Consecutive EMS-transported hemorrhagic strokes were identified from medical records at four primary stroke centers. Data regarding prehospital care were abstracted from EMS records and linked to in-hospital data. Clinical predictors of accurate EMS recognition were examined using logistic regression. EMS performance measure compliance and hospital outcomes were also compared among ...
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

The nipple as a landmark for needle decompression of tension pneumothorax in children - a CT-based evaluation and proposal of an alternative insertion site.
Authors: Terboven T, Heblich LA, Weiß C, Viergutz T, Rudolph M, Waldeck S, Schönberg S, Overhoff D Abstract Objectives: Needle decompression of tension pneumothorax in children is a rarely encountered but potentially life-saving procedure, that is accompanied by a certain risk of injury. We evaluated the nipple as a landmark for an alternative anterior insertion site and as an aid in localizing lateral insertion sites, as well as its influence on the safety profile of the procedure. Methods: In thoracic computer tomography scans of children aged 0-10 years, the distance to the closest vital structure was...
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Paramedic Identification of Pediatric Seizures: A Prospective Cohort Study.
ConclusionParamedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation. PMID: 33026283 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

SARS-CoV-2 Infection Among Serially Tested Emergency Medical Services Workers.
Authors: Tarabichi Y, Watts B, Collins T, Margolius D, Avery A, Gunzler D, Perzynski A Abstract Emerging research has examined the prevalence of severe acute respiratory syndrome virus 2 (SARS-CoV-2) infections in numerous settings, but a critical gap in knowledge is an understanding of the rate of infection among first responders. We conducted a prospective serial serologic survey by recruiting public first responders from Cleveland area emergency medical services agencies and fire departments. Volunteers submitted a nasopharyngeal swab for SARS-CoV-2 PCR testing and serum samples to detect the presence of antibod...
Source: Prehospital Emergency Care - October 9, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines.
CONCLUSION: During simulated adult OHCA resuscitation attempts, ventilation practices rarely met guideline-based targets, despite being performed by well-trained EMS providers. Methods should be developed to monitor and ensure high-quality ventilation during actual OHCA resuscitation attempts. PMID: 33021857 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - October 7, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest.
Authors: Hubble MW, Van Vleet L, Taylor S, Bachman M, Williams JG, Vipperman R, Renkiewicz GK Abstract Introduction: The likelihood of survival from ventricular fibrillation (VF) declines 7%-10% per minute until successful defibrillation. When VF duration is prolonged, immediate defibrillation of the ischemic myocardium is less likely to result in ROSC, and repeated unsuccessful defibrillations are associated with post-resuscitation myocardial dysfunction. Thus, the timing of defibrillation should be based upon the probability of shock success-a function of VF duration. Unfortunately, VF duration is often unknown i...
Source: Prehospital Emergency Care - September 30, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Fatal myocardial ischemic shock after Kawasaki disease, the not to be missed differential diagnosis.
Authors: Dahdah N PMID: 32986492 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 30, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Epidemiology, Prehospital Characteristics and Outcomes of severe Traumatic Brain Injury in the Netherlands: The BRAIN-PROTECT study.
ConclusionThis article summarizes the prehospital epidemiology, characteristics and outcome of severe TBI in the Netherlands, and highlights areas in which primary prevention and prehospital care can be improved. PMID: 32960672 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 24, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

The Lombardy Emergency Medical System faced with COVID-19: the impact of out-of-hospital outbreak.
Authors: Fagoni N, Perone G, Villa GF, Celi S, Bera P, Sechi GM, Mare C, Zoli A, Botteri M Abstract Objective. The Lombardy region was among the areas most affected by COVID-19 infection worldwide; the Lombardy Emergency Medical System (EMS) responded immediately to this emergency. We analyzed several critical aspects to understand what occurred in that region.Methods. This retrospective study compares the events managed by the dispatch center and the characteristics of the patients transported to the hospital -age, sex, SpO2, deaths- managed by the EMS in Brescia and Bergamo provinces between March-April 2020 and ...
Source: Prehospital Emergency Care - September 19, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Modified Delphi Method Derivation of the FAMILY (Family Assessment of Medical Interventions & Liaisons with the Young) EMS Instrument.
Conclusion: A panel of EMS and family stakeholders successfully developed an instrument to assess family satisfaction with pediatric EMS care. Further validation is required in a large respondent population. Assessing family satisfaction with pediatric EMS encounters is an important step toward improving prehospital care. PMID: 32940539 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 19, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Impact of a Standardized EMS Handoff Tool on Inpatient Medical Record Documentation at a Level I Trauma Center.
Conclusions: The use of the standardized MIST tool for EMS to hospital patient handoff was associated with a mixed value on inpatient documentation of prehospital events. After MIST implementation, agreement was higher for mechanism and location of injury and lower for vital signs and treatments. Further research can advance the prehospital to treatment facility handoff process. PMID: 32940577 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 19, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Ketamine for prehospital pain management does not prolong emergency department length of stay.
This study compared ED LOS among EMS patients who received prehospital ketamine, fentanyl or morphine specifically for pain control. We hypothesized ED LOS would not differ between patients receiving the three medications.Methods: This retrospective observational study utilized the 2018 ESO Research Database, which includes more than 7.5 million EMS events attended by more than 1,200 agencies. Inclusion criteria were: a 9-1-1 scene response; age ≥18 years; a recorded pain score greater than 4; an initial complaint or use of a treatment protocol indicating a painful condition; prehospital administration of ketamine, fent...
Source: Prehospital Emergency Care - September 6, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Transport of a nonintubated prone patient with severe hypoxemic respiratory failure due to COVID-19.
Authors: Boomhower J, Noland HE, Frakes MA, Seethala RR, Cohen JE, Wilcox SR Abstract With the COVID-19 pandemic, healthcare systems have been facing an unprecedented, large-scale respiratory disaster. Prone positioning improves mortality in severe hypoxemic respiratory failure, including COVID-19. While this is effective for intubated patients with moderate-to-severe ARDS, it has also been shown to be beneficial for non-intubated patients. Critical care transport (CCT) has become an essential component of combating COVID-19, frequently transporting patients to receive advanced respiratory therapies and distribute ...
Source: Prehospital Emergency Care - September 6, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Prehospital management of traumatic brain injury across Europe: a CENTER-TBI study.
Authors: Gravesteijn B, Sewalt CA, Stocchetti N, Citerio G, Ercole A, Lingsma HF, von Steinbüchel N, Steyerberg EW, Wilson L, Maas AIR, Menon DK, Lecky FE, CENTER-TBI collaborators Abstract Prehospital care for traumatic brain injury (TBI) is important to prevent secondary brain injury. We aim to compare prehospital care systems within Europe and investigate the association of system characteristics with the stability of patients at hospital arrival. We studied TBI patients who were transported to CENTER-TBI centers, a pan-European, prospective TBI cohort study, by emergency medical services between 2014 and 2...
Source: Prehospital Emergency Care - September 4, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Association of Interfacility Helicopter versus Ground Ambulance Transport and In-Hospital Mortality Among Trauma Patients.
Authors: Stewart K, Garwe T, Oluborode B, Sarwar Z, Albrecht RM Abstract Background: Relatively few studies have compared outcomes between helicopter transport (HT) and ground transport (GT) for the inter-facility transfer of trauma patients to tertiary trauma centers (TTC). Mixed results have been reported from these studies ranging from a slight increase in odds of survival for the severely injured to no evident benefit for HT patients. We hypothesized there was no adjusted difference in mortality between patients transported interfacility by HT or GT taking into account distance from TTC.Methods: Data from an in...
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Identification of generalized convulsive status epilepticus from emergency medical service records: a validation study of diagnostic coding.
Conclusions: EMS diagnostic impressions have reasonable PPV and specificity but low sensitivity for GCSE. Improved coding algorithms and training will allow for improved benchmarking, quality improvement, and research about this neurologic emergency. PMID: 32870726 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

An analysis of prehospital administration of blood products to pediatric casualties in Iraq and Afghanistan.
Conclusions: Prehospital administration of blood products occurred infrequently within this pediatric dataset, but those that received blood were critically injured with most receiving a massive transfusion. Given the frequency with which medical personnel are carrying blood products in the prehospital, combat setting, guidelines specific to pediatric administration would be beneficial. PMID: 32870733 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Documentation of Child Maltreatment by Emergency Medical Services in a National Database.
We examined patient demographics including race, gender, Emergency Medical Services (EMS) primary and secondary impression, associated symptoms, anatomic location of chief complaint, and cause of injury. Our primary outcome is the percentage of CAN reported as an EMS primary or secondary impression; secondary outcomes include proportion of children with each subtype of abuse, the description of patients by demographic information, anatomic location of injury, and associated symptoms.Results: There were 498,555 for children ≤3 years old, of which 522 had an impression of CAN (0.10%). Within our cohort, 43% were
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Multimedia Evaluation of EMT-Paramedic Assessment and Management of Pediatric Respiratory Distress.
Authors: Schroter S, Thomas D, Nimmer M, Visotcky A, Fraser R, Colella MR, Browne LR Abstract Background: The prehospital care of asthma, bronchiolitis and croup is directed by evidence-based Emergency Medical Services (EMS) protocols. Determining the appropriate intervention for these conditions requires Emergency Medical Technicians-Paramedics (EMT-Ps) to correctly differentiate asthma/bronchospasm, bronchiolitis, and croup. The diagnostic accuracy of EMT-Ps for these pediatric respiratory distress conditions is unknown.Objective: We hypothesized increasing provider age, years of provider experience, higher volum...
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Strategies to handle increased demand in the COVID-19 crisis: A coronavirus EMS support track and a web-based self-triage system.
Authors: Jensen T, Holgersen MG, Jespersen MS, Blomberg SN, Folke F, Lippert F, Christensen HC Abstract BackgroundIn emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two...
Source: Prehospital Emergency Care - September 3, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review.
Conclusion: Ultrasound use in the prehospital setting for trauma is feasible and demonstrates potential. However, the evidence in the medical literature mainly consists of prospective observational studies of physicians utilizing ultrasound for trauma in a HEMS setting. Further scientific research must be undertaken to firmly establish the role of prehospital ultrasound in trauma management by all types of EMS providers. PMID: 32815755 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 22, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

The value of prehospital early warning scores to predict in - hospital clinical deterioration: a multicenter, observational base-ambulance study.
CONCLUSIONS: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services. PMID: 32820947 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 22, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

The Role of Emergency Medical Services in the Opioid Epidemic.
Authors: Joiner A, Kumar L, Barhorst B, Braithwaite S, Public Health Committee on behalf of the NAEMSP Board of Directors PMID: 32795103 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 18, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Code of Ethics for EMS Physician Medical Directors.
Authors: Berry BC, Williams KA, Yee A, Wesley AK, Sirmons K, Lawner BJ Abstract EMS Medical Directors are physicians who have a responsibility to the public, EMS practitioners, and to health care systems. However, there is currently no accepted Code of Ethics for EMS Medical Directors, and existing Codes of Ethics for physicians do not address the unique responsibilities of EMS Medical Directors. Therefore, the following document was crafted by a working group representing the National Association of State EMS Officials, the National EMS Physician Association, and the Air Medical Physician Association, and approved...
Source: Prehospital Emergency Care - August 14, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Survival in patients with paramedic-identified ST-segment elevation myocardial infarction.
Conclusions. Mortality in STEMI patients identified and treated by paramedics was low, and the prehospital fibrinolysis treatment pathway was effective with a mortality rate comparable to that of patients undergoing primary PCI. PMID: 32790490 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 14, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Food and Drug Administration and Institutional Review Board Approval of a Novel Prehospital Informed Consent Process for Emergency Research.
We describe how these challenges were addressed during Institutional Review Board review and approval of an FDA-regulated randomized placebo-controlled trial of intranasal ketamine (vs. placebo) in acutely injured patients receiving standard of care fentanyl for prehospital pain management (NCT02866071). To our knowledge, this trial is the first instance in the United States of paramedics screening, consenting, enrolling, and administering study medications to patients without direct, real-time support from a dedicated clinical research team. PMID: 32790539 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 14, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Intranasal Ketamine as an Adjunct to Fentanyl for the Prehospital Treatment of Acute Traumatic Pain: Design and Rationale of a Randomized Controlled Trial.
CONCLUSION: These studies will test the hypotheses that ketamine plus fentanyl, when compared to fentanyl alone, effectively manages pain, decreases opiate requirements, and decreases PTSD at 90 days. PMID: 32772873 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - August 13, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Impact of a standardized patient hand-off tool on communication between Emergency Medical Services personnel and Emergency Department staff.
Authors: Maddry LCJK, Simon MEM, Reeves LK, Mora AG, Clemons MA, Shults NM, Savell S, Blessing A, Walrath CBD Abstract Handoff communication between Emergency Medical Services (EMS) and Emergency Department (ED) staff is critical to ensure quality patient care. In January 2016, the Southwest Texas Regional Advisory Council (STRAC) implemented MIST (Mechanism, Injuries, vital Signs, Treatments), a standardized EMS to ED handoff tool. The En route Care Research Center conducted a pre-MIST implementation survey of ED staff in December 2015 and a post-MIST follow-up survey in July 2017 to determine the impact of the MI...
Source: Prehospital Emergency Care - August 13, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement.
Authors: Morgan MM, Perina DG, Acquisto NM, Fallat ME, Gallagher JM, Brown KM, Ho J, Burnett A, Lairet J, Rowe D, Gestring ML Abstract The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated...
Source: Prehospital Emergency Care - August 13, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Simplified Prehospital Prediction Rule to Estimate the Likelihood of 4 Types of Stroke: The 7-Item Japan Urgent Stroke Triage (JUST-7) Score.
Conclusions: The simplified 7-item JUST (JUST-7) score had good predictive ability and can help healthcare providers to estimate the likelihood of different types of stroke and decide the referral hospital. PMID: 32701385 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - July 25, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Utility of Shock Index for suspected rupture of abdominal aortic aneurysms.
Authors: Dirks NPM, Mestrom M, van der Lugt M, van Osch F, Peters NALR, Elshof JM, Barten DG Abstract Background: A ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, with high mortality rates. The Shock Index (SI) is an easy tool and a useful predictor of hemodynamic instability in trauma patients. We aimed to assess the predictive and prognostic value of the SI for patients with a suspected rAAA in the prehospital and hospital setting.Methods: This was a retrospective, observational, single-center study. Patients>18 years old who visited the emergency department with a suspected rAAA be...
Source: Prehospital Emergency Care - July 18, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

COVID-19 Preliminary Case Series: Characteristics of EMS Encounters with Linked Hospital Diagnoses.
Conclusion: In this large sample of prehospital encounters, EMS COVID-19 suspicion demonstrated sensitivity of 78% and positive predictive value of 20% compared with hospital ICD-10 codes. These data indicate that EMS suspicion alone is insufficient to determine appropriate utilization of PPE. PMID: 32677858 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - July 18, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Using Red Lights and Sirens for Emergency Ambulance Response: How Often are Potentially Life-Saving Interventions Performed?
ConclusionIn this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies. PMID: 32678993 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - July 18, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

NEMSMA Position Statement and White Paper: Process and Outcomes Data Sharing Between EMS and Receiving Hospitals.
Authors: Gunderson MR, Florin A, Price M, Reed J Abstract Emergency Medical Services provider agencies and programs for systems of care for time-sensitive conditions in many communities and regions struggle with hospitals to obtain feedback data regarding patient outcomes and hospital processes relevant to EMS quality programs. EMS provider agencies also have issues in providing information to hospitals at the time of patient transfer to support continuity of care. The paper presents a position statement and supporting rationale from the National EMS Management Association on the bi-lateral exchange of data between...
Source: Prehospital Emergency Care - July 15, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Development of a Binary End-of-Event Outcome Indicator for the NEMSIS Public Release Research Dataset.
CONCLUSION: A binary end-of-event outcome indicator can be determined for 98.6% of 9-1-1 initiated ground EMS scene responses and 89.1% of cardiac arrests included in the NEMSIS dataset. The events with a determinable outcome appear representative of the larger dataset and the end-of-event indicators are generally consistent with reported emergency department outcomes. PMID: 32658624 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - July 15, 2020 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research