Motivating critical care clinicians of the future through the Advanced Life Support course

Resuscitation

10.1093/med/9780199683819.003.0006 ◽

2014 ◽

Author(s):

Tim Raine ◽

James Dawson ◽

Stephan Sanders ◽

Simon Eccles

Keyword(s):

Critical Care ◽

Early Warning ◽

Basic Life Support ◽

Life Support ◽

Advanced Life Support ◽

Advanced Trauma Life Support ◽

Improve Outcome ◽

Early Warning Scores

Early warning scoresPeri-arrestIn-hospital resuscitationAdvanced Life Support (ALS)Arrest equipment and testsAdvanced Trauma Life Support (ATLS)Paediatric Basic Life SupportNewborn Life Support (NLS)Obstetric arrestof the ‘unwell’ patient has repeatedly been shown to improve outcome. Identification of such patients allows suitable changes in management, including early involvement of critical care teams or transfer to critical care areas (HDU/ICU) where necessary....

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Abstract TMP63: Door-In-Door-Out Process Times at 5 Primary Stroke Centers in Chicago

Stroke ◽

10.1161/str.51.suppl_1.tmp63 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shyam Prabhakaran ◽

Rebeca Khorzad ◽

Zahra Parnianpour ◽

Christopher T Richards ◽

William Meurer ◽

...

Keyword(s):

Critical Care ◽

Quality Improvement ◽

Linear Regression ◽

Acute Stroke ◽

Life Support ◽

Advanced Life Support ◽

Ongoing Study ◽

Mode Of Transport

Introduction: Many patients with acute stroke require inter-facility transfer from primary stroke centers (PSC) to comprehensive stroke centers. Given the time-sensitive benefits of endovascular treatments, door-in-door-out (DIDO) time at the PSC is a target for quality improvement. Methods: As part of a funded ongoing study of redesigning the acute stroke DIDO process, we collected data on consecutive patients with acute stroke between February 2018 and February 2019 who required inter-facility transfer from 5 PSCs to one of 3 CSCs in the Chicago region. The stroke coordinators at each site abstracted data on mode of transport (critical care vs. advanced life support [ALS]), medical events and treatments (intubation, intravenous medications including tPA), times from arrival to: triage, telestroke activation and start, CT and CTA start, initial transfer center contact, ambulance request, and ambulance arrival and departure times. We evaluated predictors of DIDO time using linear regression. Results: Among 107 patients who met study criteria, 67.6% arrived by EMS, 83.2% had telestroke evaluation, 34.6% had tPA treatment, and 43.9% underwent CTA at the PSC. The median DIDO time was 146 (IQR 99-220) minutes. The largest contributors to DIDO time (Figure) were CT to CTA time (45 [18-86] minutes), ambulance scene time (26 [21-35] minutes), and telestroke to transfer center contact (median 23 [0-61] minutes). Independent predictors of DIDO time were obtaining CTA (+64.1 [29.4-98.5] minutes), use of ALS ambulance (+52.5 minutes [17.5-87.5] minutes), and use of intravenous medications besides tPA (+59.9 [15.7-104.1] minutes). Conclusions: We identified major opportunities for reducing DIDO times for inter-facility acute stroke transfers. Reducing the need for or time to CTA, earlier, streamlined transfer center contact, and using critical care ambulances are likely important strategies to decrease DIDO times.

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The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Southern African Journal of Critical Care ◽

10.7196/sajcc.2016.v32i2.275 ◽

2016 ◽

Vol 32 (2) ◽

pp. 58 ◽

Cited By ~ 1

Author(s):

Monique Venter ◽

Willem Stassen

Keyword(s):

Critical Care ◽

Delphi Study ◽

Life Support ◽

Advanced Life Support ◽

Scope Of Practice

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The Importance of Ground Critical Care Transport

Journal of Intensive Care Medicine ◽

10.1177/0885066616668484 ◽

2016 ◽

Vol 32 (2) ◽

pp. 163-169 ◽

Cited By ~ 6

Author(s):

Susan R. Wilcox ◽

Michael Ries ◽

Ted A. Bouthiller ◽

E. Dean Berry ◽

Travis L. Dowdy ◽

...

Keyword(s):

Critical Care ◽

Life Support ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Respiratory Acidosis ◽

Advanced Life Support ◽

Integrated Approach ◽

Tertiary Care Center ◽

Transport Services

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.

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Trends in trauma care before and after the introduction of ‘Mukhyamantri Santwana Harish Scheme’ in a tertiary care hospital at Kolar

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20181725 ◽

2018 ◽

Vol 5 (5) ◽

pp. 2072

Author(s):

Vikas Sankar Kottareddygari ◽

Vishwas S. ◽

Praveen G. P. ◽

Amal Abraham ◽

Sreeramulu P. N.

Keyword(s):

Critical Care ◽

Low Income ◽

Life Support ◽

Road Traffic ◽

Tertiary Care ◽

Advanced Life Support ◽

Low Income Countries ◽

Care Hospital ◽

Number Of Patients ◽

Before And After

Background: Road traffic injuries (RTI) are responsible for 1.2 million global deaths and rank 9th as cause of death in both the high and low income countries. Polytrauma cases make the bulk of emergencies in our centre and the victims were previously given only first aid and critical care before being referred to a government aided institute for further management due to monetary issues. After the introduction of Mukhyamantri Santwana - 'Harish' Scheme (MSHS), all the patients are entitled for cashless treatment for the first 48 hoursand this improved the quality of care they received.Methods: All the polytrauma cases brought to the emergency and critical care department for a period of 7months before the introduction of MSHS (October 2015- April 2016) and for a period of 7 months from the introduction of MSHS (May 2016- November 2016) were studied retrospectively. Data on the number of patients referred, admitted and underwent intervention during the time periods were collected and compared.Results: The number of cases that were admitted and given intervention in our centre increased considerably and number of cases referred to other centres decreased after the introduction of MSHS.Conclusions: Introduction of MSHS lead to patients receiving more advanced life support and interventions as necessary. However this cannot be generalised to all the centres as data is still lacking. Multicentric studies need to be done in this aspect.

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Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

BMJ Open ◽

10.1136/bmjopen-2018-028574 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028574

Author(s):

Johannes von Vopelius-Feldt ◽

Jane Powell ◽

Jonathan Richard Benger

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Cost Effectiveness ◽

Life Support ◽

Advanced Life Support ◽

Cost Effective ◽

Ambulance Service ◽

Sensitivity Analyses ◽

Decision Analysis Model ◽

Hospital Cardiac Arrest

ObjectivesThis research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective?SettingA single National Health Service ambulance service and a charity-funded prehospital critical care service in England.ParticipantsThe patient population is adult, non-traumatic OHCA.MethodsWe combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.ResultsCosts of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%.ConclusionThis is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive. Knowledge of the MEID for prehospital critical care can guide future research in this field.Trial registration numberISRCTN18375201

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