3 results
The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System
- Eric J. Cortez, Ashish R. Panchal, James E. Davis, David P. Keseg
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 18 January 2017, pp. 175-179
- Print publication:
- April 2017
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Introduction
The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model.
Hypothesis/ProblemThe objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).
MethodsThis was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (P<.05).
ResultsMedian on-scene times at Station A for the PP ambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates.
ConclusionIn the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in time to ALS interventions and protocol violation rates were not different. Hybrid ambulance teams may be an effective staffing alternative, but decisions to use this model must address clinical and operational concerns.
,Cortez EJ ,Panchal AR ,Davis JE .Keseg DP The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System . Prehosp Disaster Med.2017 ;32 (2 ):175 –179 .
Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia
- Eric Cortez, Ashish R. Panchal, James Davis, Paul Zeeb, David P. Keseg
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 5 / October 2015
- Published online by Cambridge University Press:
- 12 August 2015, pp. 452-456
- Print publication:
- October 2015
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Introduction
Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important.
Hypothesis/ProblemThis study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized.
MethodsThis evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger.
ResultsFifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge.
ConclusionRecent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.
,Cortez E ,Panchal AR ,Davis J ,Zeeb P .Keseg DP Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia . Prehosp Disaster Med2015 ;30 (5 ):452 –456 .
Retention of Basic Trauma Life Support Skills
- Howard A. Werman, David R. Keseg, Mayer Glimcher, Carol Schumacher, Steven Shaner, Charles G. Brown
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- Journal:
- Prehospital and Disaster Medicine / Volume 5 / Issue 2 / June 1990
- Published online by Cambridge University Press:
- 28 June 2012, pp. 137-144
- Print publication:
- June 1990
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The Basic Trauma Life Support (BTLS) course was developed to teach prehospital providers a rapid, prioritized approach to assess and manage the trauma victim. Little data currently are available relative to the retention of the cognitive and psychomotor skilk taught in the course. To examine this question, thirteen paramedics were retested on identically moulaged trauma scenarios and written examinations 14–16 months after initial training in BTLS. No advanced notification of the re-test was given. Written test scores decreased from an initial mean of 93.0±6.6 to a mean of 64.9±11.8 (p<0.001) 14–16 months later. Similarly, the trauma scenario test scores declined from 71.6±10.4 to 61.3±16.2 (p<0.05). The results suggest that there is significant loss of both didactic information and practical skills from the BTLS course 14–16 months after training. Frequent BTLS refresher training in the form of supplemental readings, lectures, and repeated exposures to trauma simulations is needed.