scholarly journals The Relationship between Advanced Airway Management and Self-Efficacy by Level 1 Emergency Medical Technicians(EMT) in 119 Emergency Medical Service

2013 ◽  
Vol 14 (4) ◽  
pp. 1709-1717 ◽  
Author(s):  
Beom-Jun Jeong ◽  
Sung-Soo Choi ◽  
Seong-Woo Yun
Keyword(s):  
Airway Management ◽  
Emergency Medical Service ◽  
Self Efficacy ◽  
Medical Service ◽  
Emergency Medical Technicians ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Level 1 ◽  
The Relationship

Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study

2019 ◽  
Vol 36 (9) ◽  
pp. 541-547
Author(s):  
Jeong Ho Park ◽  
Kyoung Jun Song ◽  
Sang Do Shin ◽  
Young Sun Ro ◽  
Ki Jeong Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Cerebral Performance Category ◽  
Neurological Recovery ◽  
Multivariable Logistic Regression Analysis ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest

ObjectivesTo investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest.MethodsWe evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest (‘at scene’ or ‘in the ambulance’). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest.ResultsAmong 6620 cases, 1425 (21.5%) cases of arrest occurred ‘at the scene’, and 5195 (78.5%) cases of arrest occurred ‘in an ambulance’. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring ‘at the scene’ and 645 (12.4%) OHCAs occurring ‘in an ambulance’. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery.ConclusionOur data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.

scholarly journals Airway Management Difficulties in a Helicopter Emergency Medical Service (HEMS): A Retrospective Observational Study of 676 Out-of-Hospital Intubations

2021 ◽  
Author(s):  
Urs Pietsch ◽  
Raphael Müllner ◽  
Lorenz Theiler ◽  
Volker Wenzel ◽  
Lorenz Meuli ◽  
...  
Keyword(s):  
Airway Management ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Ventilatory Support ◽  
Helicopter Emergency Medical Service ◽  
Medical Services ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Number Of Patients

Abstract Background: Airway management is a key skill in any helicopter emergency medical service (HEMS). Successful intubation is less often than in the hospital, and alternative forms of airway management are needed more often. Methods: Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patients charts from all scene calls (n=9035) that took place between June 2016 and May 2017 (12 months) were analysed. The primary outcome parameter was intubation success rate. Secondary parameters included number of patients intubated by ground-based emergency medical services, alternative devices used, and comparison of patients with and without difficulties in airway management. Results: A total of 676 patients with invasive ventilatory support were identified. Difficulties in airway management were rare, occurring in 44 (6.5%) patients, and trauma was significantly more common (59.1% vs. 38.6%, p<0.001). In 335 (49.6%) patients, advanced airway management had already been initiated by Ground emergency medical services upon arrival of the HEMS. Paramedics had significantly more exposure to patients needing prehospital anaesthesia than the HEMS physicians; median 12 (IQR 9 to 17.5) versus 3 (IQR 2 to 6), p<0.001.Conclusion: Despite overall high success rates for endotracheal intubation in the physician-staffed service, each physician gets little real-life experience with advanced airway management in the field, highlighting the importance of a solid basic competence such as anaesthesiology and additional training. Direct laryngoscopy is still a valuable skill and an important Plan B in difficult airway situations in which factors such as fogging, blood, bright radiation on the video laryngoscopes screen, impaired the success of video laryngoscopes intubation.

Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Chisato Okamoto ◽  
Yoshio Tahara ◽  
Atsushi Hirayama ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Favorable Outcome ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

scholarly journals Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Hiroki Maeyama ◽  
Hiromichi Naito ◽  
Francis X. Guyette ◽  
Takashi Yorifuji ◽  
Yuki Banshotani ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical Service System ◽  
Success Rates ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Intubation Success Rate ◽  
Prehospital Time ◽  
Improve Patient

Abstract Introduction The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. Methods We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS. We divided the cohort in two groups, patients intubated during flight (flight group, FG) and patients intubated before takeoff (ground group, GG). The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications. Results We analyzed 376 patients transported during the study period, 192 patients in the FG and 184 patients in the GG. The intubation success rate did not differ between the two groups (FG 189/192 [98.4%] vs. GG 179/184 [97.3%], p = 0.50). There were also no differences in hypoxia (FG 4/117 [3.4%] vs. GG 4/95 [4.2%], p = 1.00) or hypotension (FG 6/117 [5.1%] vs. GG 5/95 [5.3%], p = 1.00) between the two groups. Scene time and total prehospital time were shorter in the FG (scene time 7 min vs. 14 min, p <  0.001; total prehospital time 33.5 min vs. 40.0 min, p <  0.001). Conclusions IFI was safely performed with high success rates, similar to intubation on the ground, without increasing the risk of hypoxia or hypotension. IFI by experienced providers shortened transportation time, which may improve patient outcomes.

Intubation Performance of Advanced Airway Devices in a Helicopter Emergency Medical Service Setting

2016 ◽  
Vol 35 (3) ◽  
pp. 132-137
Author(s):  
John W. Hafner ◽  
Blake W. Perkins ◽  
Joshua D. Korosac ◽  
Alayna K. Bucher ◽  
Jean C. Aldag ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical ◽  
Service Setting ◽  
Advanced Airway ◽  
Airway Devices

Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response

2021 ◽  
pp. 000313482098882
Author(s):  
Adel Elkbuli ◽  
Brianna Dowd ◽  
Carol Sanchez ◽  
Saamia Shaikh ◽  
Mason Sutherland ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Trauma Center ◽  
Medical Service ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Transport Time ◽  
Emergency Medical ◽  
Level 1 ◽  
Level 1 Trauma Center

Background The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. Methods A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. Results Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). Conclusions Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.

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