Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

AbstractIntroductionDuring disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.ObjectivesThe objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).MethodsEighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.ResultsIn all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).ConclusionsThe use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.Soremekun OA, Shear ML, Connolly J, Stewart CE, Thomas SH. Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access. Prehosp Disaster Med. 2012;27(3):1-6.

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The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16001539 ◽

2017 ◽

Vol 32 (2) ◽

pp. 175-179 ◽

Cited By ~ 4

Author(s):

Eric J. Cortez ◽

Ashish R. Panchal ◽

James E. Davis ◽

David P. Keseg

Keyword(s):

Success Rate ◽

Life Support ◽

Advanced Life Support ◽

Emergency Medical Technician ◽

Publication Type ◽

Protocol Violation ◽

Difficult Decision ◽

Emergency Medical ◽

Different Levels ◽

Medical Technician

AbstractIntroductionThe 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.CortezEJ, PanchalAR, DavisJE, KesegDP. The effect of ambulance staffing models in a metropolitan, fire-based EMS system. Prehosp Disaster Med. 2017;32(2):175–179.

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Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061930 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1930

Author(s):

Pin-Hui Fang ◽

Yu-Yuan Lin ◽

Chien-Hsin Lu ◽

Ching-Chi Lee ◽

Chih-Hao Lin

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Emergency Medical Technician ◽

Population Database ◽

Emergency Medical ◽

The Impact ◽

Hospital Cardiac Arrest ◽

Medical Technician

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

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Reasons Prehospital Personnel Do Not Administer Aspirin to All Patients Complaining of Chest Pain

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00003435 ◽

2006 ◽

Vol 21 (2) ◽

pp. 101-103 ◽

Cited By ~ 5

Author(s):

Edmond A. Hooker ◽

Taylor Benoit ◽

Timothy G. Price

Keyword(s):

Chest Pain ◽

Chief Complaint ◽

Emergency Medical Technician ◽

Common Reason ◽

Medical Provider ◽

Convenience Sample ◽

Emergency Medical ◽

Coronary Syndromes ◽

Basic Level ◽

Medical Technician

AbstractIntroduction:Aspirin is administered to patients with acute coronary syndromes (ACSs), but prehospital providers do not administer aspirin to all patients with chest pain that could be secondary to an ACS.Objective:To identify reasons prehospital providers fail to administer aspirin to all patients complaining of chest pain.Methods:A convenience sample of prehospital providers was surveyed as they transported patients with a chief complaint of chest pain to the emergency department. The providers were asked if they had given aspirin, nitroglycerin, or oxygen, or if they utilized a monitor. If the medications had not been administered, the paramedic was asked about the reason. The patient's age and previous cardiac history also was recorded.Results:A total of 52 patients with chest pain who were transported were identified over eight weeks, and all of the providers agreed to participate in the study. Only 13 of the patients (25%) received aspirin. Reasons given for not administering aspirin to the other 39 patients included: (1) chest pain was not felt to be cardiac in 13 patients (33%); (2) 10 patients already had taken aspirin that day (26%); (3) the medical provider was a basic-level emergency medical technician (EMT)-Basic and could not administer aspirin to six patients (15%); (4) pain subsided prior to arrival of emergency medical services (EMS) in these three patients; and (5) other reasons were provided for the remaining seven patients.Conclusions:The most common reason that paramedics did not administer aspirin was the paramedic's belief that the chest pain was not of a cardiac nature. Another common reason for not giving aspirin was the inability of EMT-Basic providers to administer aspirin.

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Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100606 ◽

2014 ◽

Vol 21 (6) ◽

pp. 373-381 ◽

Cited By ~ 1

Author(s):

Sc Hung ◽

Yh Li ◽

Mc Chen ◽

Sw Lai ◽

Fc Sung ◽

...

Keyword(s):

Response Time ◽

Emergency Medical Service ◽

Medical Service ◽

Life Support ◽

Advanced Life Support ◽

Patient Characteristics ◽

Emergency Medical Technician ◽

Mountain Areas ◽

Emergency Medical ◽

The Mean

Background This study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas. Methods This was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements. Results From January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan. Conclusions The rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)

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A Survey of Advanced Life Support Practices in the United States

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00039388 ◽

1992 ◽

Vol 7 (2) ◽

pp. 144-150 ◽

Cited By ~ 13

Author(s):

Robert F. Lavery ◽

James Doran ◽

Bartholomew J. Tortella ◽

Ronald P. Cody

Keyword(s):

United States ◽

Local Governments ◽

Life Support ◽

Mail Survey ◽

Advanced Life Support ◽

Advanced Cardiac Life Support ◽

The United States ◽

Emergency Medical Technician ◽

Study Objective ◽

Emergency Medical

AbstractStudy Objective:A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.Methods:A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.Results:One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.Conclusion:The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.

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