scholarly journals Moving towards the next level...

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Chris O'Connor
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Support Service ◽  
Turn Of The Century ◽  
Prehospital Emergency Care ◽  
Bachelor Of Science ◽  
Body Of Knowledge ◽  
Science Degree ◽  
Prehospital Emergency ◽  
Bona Fide

<p>Since the turn of the century, significant progressive changes have taken place in the provision of prehospital emergency care in Ireland.  Few would have dared to imagine the scale of advancement both in terms of education and scope of practice that has taken place since the bells tolled to herald the arrival of the new millennium. Academically, paramedics in Ireland who for over 20 years have been qualified at diploma level now have the opportunity to qualify with an honours bachelor of science degree, and the possibility of progression to masters and doctoral degrees should they feel so inclined.  From a clinical perspective, the Advanced Life Support service that is available nationwide today has evolved from an emergency service provided by EMTs just a few short years ago.</p><p>In order to make the step up to the next level in our development as a bona fide recognised profession, it is essential that we embark on the journey of the development of our own body of knowledge in relation to our education, our practice and our profession as a whole. This editorial will explore some issues related to this.</p>

Vehicle Crash Rescue Skills and Residency Training in Emergency Medicine

1985 ◽  
Vol 1 (S1) ◽  
pp. 103-104
Author(s):  
Robert R. Harrison ◽  
Kimball I. Maull ◽  
C. Paul Boyan
Keyword(s):  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Hospital Environment ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Accident Victim ◽  
Prehospital Emergency ◽  
Time Required ◽  
Injured Patients

Recent advances in the resuscitation and stabilization skills of prehospital emergency care providers have done much to improve the quality of immediate care provided to suddenly ill or injured patients. Although much of the innovation and leadership in this area has been provided by emergency department physicians, most of them still lack an adequate appreciation of the circumstances under which these skills are executed. While many physicians participate in prehospital care teaching and evaluation of the system, most have not gained personal experience in those aspects of care foreign to hospital environment. They are particularly unacquainted with the intricacies of rescuing patients from automobile accidents and similar entrapments. It is not unusual, however, for an accident victim to spend half of the time required for the prehospital phase of emergency medical care undergoing extrication, and in many cases this must be done before full advanced life support measures may be initiated.

Improving the Appropriateness of Advanced Life Support Teams’ Dispatch: A Before-After Study

2021 ◽  
pp. 1-7
Author(s):  
Lorenzo Gamberini ◽  
Cosimo Picoco ◽  
Donatella Del Giudice ◽  
Corrado Zenesini ◽  
Marco Tartaglione ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Operation ◽  
Support Teams ◽  
Global Sensitivity ◽  
Emergency Logistics ◽  
Prehospital Emergency ◽  
Task Time ◽  
Algorithm Implementation

Abstract Background and Importance: The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched. Objectives: This study aimed to evaluate the effects on the appropriateness of ALS teams’ intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation. Design: This was a retrospective before-after observational study. Settings and Participants: Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018). Intervention: A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented. Outcomes: Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed. Results: The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced. Conclusion: The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.

scholarly journals Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Charles Payot ◽  
Christophe A Fehlmann ◽  
Laurent Suppan ◽  
Marc Niquille ◽  
Christelle Lardi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Multivariable Logistic Regression Model ◽  
Physician Decision Making ◽  
Factors Influencing ◽  
Cardio Pulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43&ndash;3.20) and bystander CPR (OR=4.10, 95%CI2.28&ndash;7.39). Traumatic aetiology (OR=0.04, 95%CI0.02&ndash;0.08), age &gt;80 years (OR=0.14, 95%CI0.09&ndash;0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06&ndash;0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP&rsquo;s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

scholarly journals A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa

2018 ◽  
Vol 33 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Annet Ngabirano Alenyo ◽  
Wayne P. Smith ◽  
Michael McCaul ◽  
Daniel J. Van Hoving
Keyword(s):  
South Africa ◽  
Emergency Care ◽  
Life Support ◽  
Major Incident ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Publication Type ◽  
Cross Sectional ◽  
Prehospital Emergency ◽  
Level Of Training

AbstractIntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.MethodsThis was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.ResultsA total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).ConclusionAccuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.

Current Controversies in Prehospital Resuscitation of the Terminally Ill Patient

1990 ◽  
Vol 5 (1) ◽  
pp. 49-57 ◽  
Author(s):  
R. Jack Ayres
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Care Provider ◽  
Life Support ◽  
Terminally Ill ◽  
Advanced Life Support ◽  
Care Providers ◽  
Emergency Health Care ◽  
Prehospital Emergency

Prehospital health-care providers regularly are called upon to assist terminally ill patients in residential or institutional, non-hospital settings such as nursing homes or hospices. Among the most crucial issues regarding such patients is whether they should be resuscitated. With alarming frequency, EMS providers are encountering vigorous and sometimes violent refusals of examination, treatment, and/or transportation from the terminally ill patient, members of the patient's family, or third persons ostensibly acting on the patient's behalf. Today, the prehospital emergency health-care provider repeatedly is faced with the legal and ethical questions that surround the issue of resuscitation and advanced life support.

Abstract 92: Evaluation Of Knowledge And Practice Of Cardiopulmonary Resuscitation Of Children And Infants By An Out-of-hospital Emergency Care Team

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nathalie S Goddet ◽  
François Dolveck ◽  
Alexis Descatha ◽  
Noella Lode ◽  
Jean-Louis Chabernaud ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Emergency Care ◽  
Life Support ◽  
Prehospital Emergency Care ◽  
Emergency Response System ◽  
First Aid Training ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Job Title ◽  
Knowledge And Practice

Introduction The French emergency response system in life threatening situations is the deployment of fully equipped ambulances with paramedic, nurse and emergency physician. The 2005 ILCOR and ERC guidelines concerning cardiopulmonary resuscitation (CPR) have led to significant changes, especially in terms of basic life support (BLS). We aimed to review fundamental knowledge and practice by our personnel concerning CPR in children and infants to determine current training needs for our teams. Materials and methods Paper questionnaires were filled out by our personnel and immediately collected. Inclusion criteria: physicians, nurses, and paramedics (refusals to fill out questionnaire were not included). We recorded: profile of personnel, knowledge of 2005 guidelines, basic CPR and advanced CPR parameters. Majors results were compared based on job title. Results Sixty-one questionnaires were filled out (25 paramedics, 13 nurses, and 23 physicians). Personnel was mostly aged under 40 (70,5%, n=43), with over 2 years experience in prehospital emergency care(75,4%, n=46); 47,5% (n=\29) had no training in pediatrics; 68,9% (n=42) had BLS certification and 31,1% (n=19) reported regular participation in first aid training programs. A minority of subjects declared knowing the 2005 Guidelines (11,5%, n=7), even among physician (17,4%, n=4). Table 1 shows major results about CPR parameters according to job title. Conclusion This study emphasizes the lack of knowledge and the repeated changes witch require more frequent and more extensive training for entire personnel on the team, focusing on basic CPR for physicians and advanced CPR for paramedics and nurses. Table 1: Answers according to job title AED : Automatic External Defibrillator

Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?

Resuscitation ◽  
2007 ◽  
Vol 74 (3) ◽  
pp. 461-469 ◽  
Author(s):  
Matthew Huei-Ming Ma ◽  
Wen-Chu Chiang ◽  
Patrick Chow-In Ko ◽  
Jimmy Ching-Chih Huang ◽  
Chi-Hao Lin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Support Service ◽  
Hospital Cardiac Arrest

Patient-Initiated Refusals of Prehospital Care: Ambulance Call Report Documentation, Patient Outcome, and On-line Medical Command

1995 ◽  
Vol 10 (1) ◽  
pp. 3-9 ◽  
Author(s):  
David C. Cone ◽  
David T. Kim ◽  
Steven J. Davidson
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Support Service ◽  
Exact Test ◽  
On Line ◽  
Potential Impact

AbstractIntroduction:There is a growing interest in cases in which emergency medical services (EMS) providers evaluate a patient, but do not transport the patient to a hospital. A subset of these cases, the patient-initiated refusal (PIR) in which the patient refused care and transport, was studied and evaluated. The objectives of the study were to examine the adequacy of ambulance call report documentation in PIR, to examine the clinical outcome of these patients in one hospital-based, suburban EMS system, and to assess the potential impact of on-line medical command (OLMC) on cases of PIR.Methods:The system studied is a hospital-based, transport-capable, advanced life support service in a suburban EMS system, with an annual call volume of 4,200 runs. During the 6-month study period, all ambulance call reports completed by the paramedics and medical command control forms completed by medical command physicians were examined, and cases of PIR collected. Each ambulance call report was examined for adequacy of documentation. Patient outcome was determined from emergency department records and telephone follow-up.Results:Eighty-five PIRs were documented during the study period. Four cases were excluded because of a missing ambulance call reports and/or medical command control forms, leaving 81 PIRs for analysis. Despite policy requiring OLMC in cases of PIR, OLMC was established in only 23 PIRs (28%). Of these, two (9%) had inadequate ambulance call report documentation. Of the 58 PIR in which OLMC was not established, 25 (43%) had inadequate ambulance call report documentation (p <0.001, Fisher's exact test). Follow-up was obtained for 54 (67%) PIR. Of these, 37 (68%) did not subsequently see a physician, and all needed no further medical care. Seven (13%) saw their own physicians within a few days of the initial refusal of prehospital care, and had no further problems. Ten patients were seen in an emergency department within a few days. Three (6%) were discharged, and did well. Seven (13%) were admitted to the hospital, with four (7%) admitted to monitored beds, and three (6%) to unmonitored beds. There were no deaths.Conclusions:Ambulance call report documentation is better with OLMC than without. Patients who initially refuse care may be ill, and some ultimately will be hospitalized. Further research may elucidate a role for OLMC in preventing refusals by incompetent patients, convincing patients who are competent but appear ill to accept transport, and assisting paramedics with other difficult or unusual circumstances.

scholarly journals Maximizing resource efficiency in rural prehospital emergency medical services through call frequency analysis

2013 ◽  
Vol 5 (2) ◽  
pp. 297-301
Author(s):  
Andrew Flynn
Keyword(s):  
Emergency Medical Services ◽  
Traffic Accident ◽  
Life Support ◽  
Advanced Life Support ◽  
Time Of Day ◽  
Medical Services ◽  
Red Cross ◽  
Emergency Medical ◽  
Accident Data ◽  
Prehospital Emergency

Rural prehospital emergency medical services are often lacking when compared with their urban counterparts in terms of resources and coordinated resource use: can only employ important resources, such as paramedics, during limited shifts. This project demonstrates a method for determining the most effective use of these limited resources in a rural Red Cross ambulance service in Guápiles, Costa Rica. In this community, paramedic services are only available six days a week for twelve hours. Emergency call frequency was mapped using 20 months of traffic accident data and after establishing that traffic accident frequency was statistically dependent on the time of day, polynomial models of the data were generated. The model functions were integrated and the results were tested for accuracy. Integrals were calculated, and the results were reported to the Guápiles Red Cross committee to achieve an improved service. Methods such as this can be applied to any emergency response service.KEY WORDSWorld Health Organization (WHO), Prehospital Emergency Medical Service(s) (PEMS), Traffic Accident (TA), Téchnico de Emergencias Medicas (Paramedic), Advanced Life Support (ALS)

scholarly journals Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

2021 ◽  
Vol 18 (16) ◽  
pp. 8323
Author(s):  
Charles Payot ◽  
Christophe A. Fehlmann ◽  
Laurent Suppan ◽  
Marc Niquille ◽  
Christelle Lardi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Multivariable Logistic Regression Model ◽  
Physician Decision Making ◽  
Factors Influencing ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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