BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbid...BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease.METHODS: A prospective, multicenter, emergency medical service(EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality.RESULTS: A total of 961 patients were included, with a mortality rate of 17.5%(168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation(IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve(AUC) of 0.857(95% confidence interval [95% CI] 0.827–0.888).CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.展开更多
BACKGROUND:Oxygen supply is a common procedure performed by emergency medical services(EMS);however,whether prehospital oxygen or fraction of inspired oxygen(FiO2)therapy predict mortality has not been studied to date...BACKGROUND:Oxygen supply is a common procedure performed by emergency medical services(EMS);however,whether prehospital oxygen or fraction of inspired oxygen(FiO2)therapy predict mortality has not been studied to date.This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.METHODS:This was a prospective,observational,cohort,multicenter,EMS-delivery,ambulance-based study.Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces.Epidemiological variables,on-scene vital signs,and prehospital blood analysis data were collected.The primary outcome was short-(2-,7-,and 30-day),medium-(90-and 180-day),and long-term(365-day)all-cause cumulative mortality.The samples were a priori split according to thresholds of their received FiO2(FiO2=0.21,that is without oxygen therapy;FiO2 between 0.22 and 0.49;and FiO2≥0.5).The categorical variables FiO2,epidemiological variables,vital signs,prehospital point-of-care testing(POCT)and patient outcomes were fitted with a logistic regression model.Additionally,a propensity score matching and a survival analysis were used.RESULTS:The final sample included 7,494 patients,70.3%of whom did not receive oxygen therapy,15%with a FiO2 between 0.22 and 0.49,and 14.7%with a FiO2≥0.5.The 2-day mortality was 0.4%,5.3%,and 22.9%respectively(P<0.001).The 365-day mortality was 9.9%,33.1%,and 50.5%respectively(P<0.001).Finally,the FiO2 predictive capacities 2-,30-,and 365-day mortality were AUC=0.870(95%CI:0.840-0.899),0.810(95%CI:0.784-0.837),0.704(95%CI:0.679-0.728),respectively.CONCLUSION:Prehospital oxygen therapy by thresholds of FiO2 was linked to death and allowed mortality prediction.This finding could provide an aid for EMS providers,allowing to assess more individualized patient risk.展开更多
Objective: To understand the current situation of prehospital first aid knowledge, attitude and behavior of university students in Jingzhou City. Methods: A prehospital first aid knowledge questionnaire and the conven...Objective: To understand the current situation of prehospital first aid knowledge, attitude and behavior of university students in Jingzhou City. Methods: A prehospital first aid knowledge questionnaire and the convenience sampling method were used to survey 307 university students in Jingzhou City. Results: The mean score of prehospital first aid knowledge of university students in Jingzhou City was 12.85 ± 2.643, the mean score of attitude was 50.73 ± 4.114, and the mean score of behavior was 39.05 ± 8.898;There was a statistically significant difference in the scores of prehospital first aid knowledge, attitude, and behavior of university students depending on whether or not they had received prehospital first aid training (P P Conclusion: Jingzhou University students have a positive attitude toward pre-hospital first aid, but the knowledge level and behavior are low, which suggests that the government, society and the school should create good conditions to promote the improvement of pre-hospital first aid knowledge and ability.展开更多
Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department...Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.展开更多
BACKGROUND:Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well.We analyzed the database of the critical incident reporting system for prehosp...BACKGROUND:Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well.We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS:Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure,non-verbal communication failure and missing communication at all.RESULTS:Between 2005 and 2015,845 reports were analyzed,of which 247 reports were considered to be related to communication failure.An arbitrary classifi cation resulted in six different kinds:1)no acknowledgement of a suggestion;2)medication error;3)miscommunication with dispatcher;4)utterance heard/understood improperly;5)missing information transfer between two persons;and 6)other communication failure.CONCLUSION:Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.展开更多
To the Editor：Airway management is a crucial skill for emergency physician, who＇s often called to deal with difficult airways and requests for quick, simple and effective responses, as the many factors responsible f...To the Editor：Airway management is a crucial skill for emergency physician, who＇s often called to deal with difficult airways and requests for quick, simple and effective responses, as the many factors responsible for difficulties might be enhanced by emergency setting.[1] We now have many rescue devices as the LMA, I-gel, but they do not provide a definitive airway, and recent studies evaluating the use of the videolaryngoscopes in emergency show conflicting results.展开更多
Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the ...Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the prehospital first aid for 2 months to fully master the methods of improving prehospital hypotension and hypoxemia,then the prognosis of TBI patients pre-and post-training for 12 months was collected and recorded.The prognostic differences of different TBI subgroups were discussed through data analysis.Results:after the training,the proportion of prehospital hypotension and hypoxemia in TBI patients decreased by 77%(8.5%vs.1.9%)and 63%(9.9%vs.3.6%,P<0.05),respectively.However,only the prognosis of moderate and severe TBI patients was improved,the proportion of patients with"good prognosis^increased by 14%(61.4%vs.70.5%,respectively)and 62%(35.6%vs.58%),and no significant effect showed in mild and critical TBI patients.Conclusion:reducing the incidence of prehospital hypoxemia and hypotension can improve the prognosis of moderate and severe TBI patients,while no significant effect on mild and critical TBI patients.展开更多
Working in prehospital emergency medical services(EMS)can be unpredictable and emotionally demanding for ambulance clinicians(ACs).Burnout,stress,poor sleep quality,fatigue,and psychological health issues increase the...Working in prehospital emergency medical services(EMS)can be unpredictable and emotionally demanding for ambulance clinicians(ACs).Burnout,stress,poor sleep quality,fatigue,and psychological health issues increase the risk of accidents and adverse events re-lated to occupational and patient safety.This scoping review aimed to identify and map the existing literature on the current state of the effect of ACs’well-being on occupational or patient safety risks in prehospital emergency medical services settings.The methodologies of the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines were used.The databases searched included CINAHL Plus,PubMed,Scopus,Web of Science,and MedNar on March 8,2024.Peer-reviewed and nonpeer-reviewed scientific and nonscientific sources were searched.The reference lists of the selected sources were screened for further papers.Participants who were ACs working in prehospital EMS and reported their physical,psychological,and social well-being related to adverse events in occupational or patient safety were eligible for inclusion.Quantitative,qualitative,and mixed-method studies;reviews;text,opinion,and discussion papers;and gray literature were included.Two reviewers independently reviewed the titles,abstracts,and full texts and assessed the quality of the sources.Data were extracted from the 2 reviewers by using an extraction tool.Data were analyzed using numerical and thematic methods.In total,35 sources were included.Four themes were identified from the heterogeneous data:Deficiencies in psychological well-being,Deficiencies in physical well-being,Deficiencies in psychophysical well-being,and Deficiencies in social well-being.Fatigue and stress experienced by ACs are the most important factors that negatively affect patient and occupational safety.Deficiencies in psychophysical well-being have a clear effect on both patient and occupational safety.There is limited evidence on the effect of ACs’well-being on patient and occupational safety in prehospital EMS.展开更多
Purpose:Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous(PIV)access can be challenging during hemorrhagic shock due to periphe...Purpose:Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous(PIV)access can be challenging during hemorrhagic shock due to peripheral vessel collapse.Early intraosseous(IO)device use is suggested as an alternative.This study examines injury characteristics and factors linked to IO access requirements.Methods:A registry-based cohort study from the Israel Defense Forces Trauma Registry(2010-2023)included trauma casualties receiving PIV or IO access prehospital.Casualties who had at least one documented PIV or IO access attempt were included,while those without vascular access were excluded.Casualties requiring both PIV and IO were classified in the IO group.Univariable logistic regression assessed the factors associated with IO access.Results were reported as odds ratios(OR)with 95%confidence intervals(CI),and significant difference was set at p<0.05.Results:Of 3462 casualties(86.3%male,the median age:22 years),3287(94.9%)received PIV access and 175(5.1%)had IO access attempts.In the IO group,30.3%received freeze-dried plasma and 23.4%received low titer group O whole blood,significantly higher than that in the PIV group.Prehospital mortality was 35.0%in the IO group.Univariable analysis showed significant associations with IO access for increased PIV attempts(OR=1.69;95%CI:1.34-2.13)and signs of profound shock(OR=11.0;95%CI:5.5-23.3).Conclusion:Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion.IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality,indicating its use in emergent resuscitation situations.Early IO consideration is advised for trauma casualties with profound shock.展开更多
Background This study analyses the determinants of prehospital(index event to admission)and in-hospital delay(admission to carotid endarterectomy(CEA)).In addition,the analysis addresses the association between prehos...Background This study analyses the determinants of prehospital(index event to admission)and in-hospital delay(admission to carotid endarterectomy(CEA)).In addition,the analysis addresses the association between prehospital or in-hospital delay and outcomes after CEA for symptomatic patients in German hospitals.Materials and methods This retrospective analysis is based on the nationwide German statutory quality assurance database.55437 patients were included in the analysis.Prehospital delay was grouped as follows:180-15,14-8,7-3,2-0 days or‘in-hospital index event’.In-hospital delay was divided into:0-1,2-3 and>3 days.The primary outcome event(POE)was in-hospital stroke or death.Univariate and multivariable regression analyses were performed for statistical analysis.The slope of the linear regression line is given as theβ-value,and the rate parameter of the logistic regression is given as the adjusted OR(aOR).Results Prehospital delay was 0-2 days in 34.9%,3-14 days in 29.5%and>14 days in 18.6%.Higher age(β=−1.08,p<0.001)and a more severe index event(transitory ischaemic attack:β=−4.41,p<0.001;stroke:β=−6.05,p<0.001,Ref:amaurosis fugax)were determinants of shorter prehospital delay.Higher age(β=0.28,p<0.001)and female sex(β=0.09,p=0.014)were associated with a longer in-hospital delay.Index event after admission(aOR 1.23,95%CI:1.04 to 1.47)and an intermediate in-hospital delay of 2-3 days(aOR 1.15,95%CI:1.00 to 1.33)were associated with an increased POE risk.Conclusions This study revealed that older age,higher American Society of Anesthesiology(ASA)stage,increasing severity of symptoms and ipsilateral moderate stenosis were associated with shorter prehospital delay.Non-specific symptoms were associated with a longer prehospital delay.Regarding in-hospital delay,older age,higher ASA stage,contralateral occlusion,preprocedural examination by a neurologist and admission on Fridays or Saturdays were associated with lagged treatment.A very short(<2 days)prehospital and intermediate in-hospital delay(2-3 days)were associated with increased risk of perioperative stroke or death.展开更多
BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleedi...BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.展开更多
For the German speaking countries, Tscherne＇s definition of ＂polytrauma＂ which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequ...For the German speaking countries, Tscherne＇s definition of ＂polytrauma＂ which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The ＂Primary Survey＂ is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support （PHTLS）-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis （＂treat-first-what-kills-first＂）. If no immediate treatment is necessary, a ＂Secondary Sur- vey＂ follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay （＂work and go＂） to TR-DGU certified trauma centers of the local trauma networks. Due to the difficult prehospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline ＂Polytrauma/Schwerstverletzten Behandlung＂, the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.展开更多
Background： Differentiating intracerebral hemorrhage （ICH） from cerebral infarction as early as possible is vital tbr the timely initiation of different treatments. This study developed an applicable model for the ...Background： Differentiating intracerebral hemorrhage （ICH） from cerebral infarction as early as possible is vital tbr the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes. Methods： From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography （CT） or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes＇ discriminant model was applied to discriminate stroke subtypes. Results： Among the 1989 patients, 797,689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure _〉180 mmHg, and age 〈65 years were more typical of ICH. For noncomatose stroke patients, Bayes＇ discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%. Conclusions： The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.展开更多
Purpose： To evaluate the performance of a prehospital trauma diversion system in Hong Kong, China. Methods： A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hon...Purpose： To evaluate the performance of a prehospital trauma diversion system in Hong Kong, China. Methods： A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hong Kong from I January 2009 to 31 December 2013 was done. All adult patients aged 18 years or above, either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol, were recruited. Need for trauma center level of care was based on a consensus-based criterion standard published in 2014. Performance of the protocol in terms of over-diversion and under-diversion was determined. Results： A total of 209 patients were included for analysis. About 30% of the patients required trauma center level of care. The most common reason was the need for vascular, neurologic, abdominal, thoracic, pelvic, spine or limb-conserving surgery within 24 h of presentation. The over-diversion rate and under-diversion rate were 69.6% and 19.7% respectively. Conclusion： The trauma patient diversion protocol currently in use in Hong Kong is not accurate enough. Further revision and refinement is needed.展开更多
BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019(COVID-19)patients.There is conflicting evidence on the effects of chronic anticoagulation on mortality an...BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019(COVID-19)patients.There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.AIM To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.METHODS A Literature search was performed on LitCovid PubMed,WHO,and Scopus databases from inception(December 2019)till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19.The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants.Secondary outcomes included COVID-19 disease severity,in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection,and mortality.The random effects models were used to calculate crude and adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs).RESULTS Forty-six observational studies met our inclusion criteria.The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk[n=43851,9 studies,odds ratio(OR)=0.67(0.22,2.07);P=0.49;I2=95%].The association between prior anticoagulation and disease severity was non-significant[n=186782;22 studies,OR=1.08(0.78,1.49);P=0.64;I2=89%].However,pre-hospital anticoagulation significantly increased all-cause mortality risk[n=207292;35 studies,OR=1.72(1.37,2.17);P<0.00001;I2=93%].Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk[aOR=0.87(0.42,1.80);P=0.71],mortality[aOR=0.94(0.84,1.05);P=0.31],and disease severity[aOR=0.96(0.72,1.26);P=0.76].CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events,improved survival,and lower disease severity in COVID-19 patients.展开更多
BACKGROUND: Point-of-care ultrasound(US) is a proven diagnostic imaging tool in the emergency department(ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in auster...BACKGROUND: Point-of-care ultrasound(US) is a proven diagnostic imaging tool in the emergency department(ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the fi eld and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients.METHODS: We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest.RESULTS: Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making(89%, 95%CI 67%–99%). Paramedics accurately recorded 17 cases of cardiac activity(100%, 95%CI 84%–100%) and 2 cases of cardiac standstill(100%, 95%CI 22%–100%).CONCLUSION: Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.展开更多
BACKGROUND： Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and in...BACKGROUND： Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance. METHODS： The EMBASE and MEDLINE （through the Pubmed interface） databases, and the Cochrane library were searched with the key words ＂epinephrine＂, ＂cardiac arrest＂ and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review. RESULTS： The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome. CONCLUSIONS： The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.展开更多
BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab co...BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab countries,as there are no current studies to support this.Therefore,this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIM To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODS A cross-sectional study of five different groups of participants including radiation technologists,emergency physicians,paramedics,Red Crescent managers and the public.Email and social media were used to deliver a questionnaire to these groups.The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTS Each group had some knowledge on ultrasound and its benefits.More than 50%in each study group supported the availability of ultrasound in ambulances.Additionally,60%of emergency physicians reported that they had difficulties in venous access,checking the presence of internal bleeding,recognizing pregnancy in trauma cases,and inserting endotracheal tubes,and the majority of them confirmed the effective role of ultrasound in achieving such tasks.Almost all paramedics(93.33%),physicians(98.89%),and Saudi Red Crescent managers(96.3%)emphasized the importance of communication between ambulance staff and emergency departments.Moreover,most physicians(77.78%),and technologists(82.73%)supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSION Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.展开更多
Helicopter Emergency Medical Services (HEMS) use in civilian medical transport has its roots in the use of rotor-wing trauma transport in the military setting. Much of the literature and evidence based?on the use of H...Helicopter Emergency Medical Services (HEMS) use in civilian medical transport has its roots in the use of rotor-wing trauma transport in the military setting. Much of the literature and evidence based?on the use of HEMS is therefore related to scene and interfacility transport of injured patients. Regionalization of care and increased understanding of time-criticality of various non-trauma conditions has contributed to growing utilization of HEMS for non-trauma conditions over recent decades. It is common for HEMS to be utilized for a variety of non-trauma situations ranging from neonatal and obstetrics transports to cardiac and stroke transports. The purpose of this review is to overview the use of HEMS for non-trauma, focusing on situations in which there is evidence addressing possible HEMS utility.展开更多
Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chr...Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.展开更多
基金supported by the Institute of Health Carlos Ⅲ (Spain)co-financed by the European Union (DTS23/00010) for FMR。
文摘BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease.METHODS: A prospective, multicenter, emergency medical service(EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality.RESULTS: A total of 961 patients were included, with a mortality rate of 17.5%(168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation(IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve(AUC) of 0.857(95% confidence interval [95% CI] 0.827–0.888).CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.
基金supported by the Institute of Health Carlos III(Spain)and co-financed by the European Union[grant numbers DTS23/00010]for FM-R。
文摘BACKGROUND:Oxygen supply is a common procedure performed by emergency medical services(EMS);however,whether prehospital oxygen or fraction of inspired oxygen(FiO2)therapy predict mortality has not been studied to date.This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.METHODS:This was a prospective,observational,cohort,multicenter,EMS-delivery,ambulance-based study.Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces.Epidemiological variables,on-scene vital signs,and prehospital blood analysis data were collected.The primary outcome was short-(2-,7-,and 30-day),medium-(90-and 180-day),and long-term(365-day)all-cause cumulative mortality.The samples were a priori split according to thresholds of their received FiO2(FiO2=0.21,that is without oxygen therapy;FiO2 between 0.22 and 0.49;and FiO2≥0.5).The categorical variables FiO2,epidemiological variables,vital signs,prehospital point-of-care testing(POCT)and patient outcomes were fitted with a logistic regression model.Additionally,a propensity score matching and a survival analysis were used.RESULTS:The final sample included 7,494 patients,70.3%of whom did not receive oxygen therapy,15%with a FiO2 between 0.22 and 0.49,and 14.7%with a FiO2≥0.5.The 2-day mortality was 0.4%,5.3%,and 22.9%respectively(P<0.001).The 365-day mortality was 9.9%,33.1%,and 50.5%respectively(P<0.001).Finally,the FiO2 predictive capacities 2-,30-,and 365-day mortality were AUC=0.870(95%CI:0.840-0.899),0.810(95%CI:0.784-0.837),0.704(95%CI:0.679-0.728),respectively.CONCLUSION:Prehospital oxygen therapy by thresholds of FiO2 was linked to death and allowed mortality prediction.This finding could provide an aid for EMS providers,allowing to assess more individualized patient risk.
文摘Objective: To understand the current situation of prehospital first aid knowledge, attitude and behavior of university students in Jingzhou City. Methods: A prehospital first aid knowledge questionnaire and the convenience sampling method were used to survey 307 university students in Jingzhou City. Results: The mean score of prehospital first aid knowledge of university students in Jingzhou City was 12.85 ± 2.643, the mean score of attitude was 50.73 ± 4.114, and the mean score of behavior was 39.05 ± 8.898;There was a statistically significant difference in the scores of prehospital first aid knowledge, attitude, and behavior of university students depending on whether or not they had received prehospital first aid training (P P Conclusion: Jingzhou University students have a positive attitude toward pre-hospital first aid, but the knowledge level and behavior are low, which suggests that the government, society and the school should create good conditions to promote the improvement of pre-hospital first aid knowledge and ability.
文摘Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.
文摘BACKGROUND:Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well.We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS:Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure,non-verbal communication failure and missing communication at all.RESULTS:Between 2005 and 2015,845 reports were analyzed,of which 247 reports were considered to be related to communication failure.An arbitrary classifi cation resulted in six different kinds:1)no acknowledgement of a suggestion;2)medication error;3)miscommunication with dispatcher;4)utterance heard/understood improperly;5)missing information transfer between two persons;and 6)other communication failure.CONCLUSION:Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.
文摘To the Editor：Airway management is a crucial skill for emergency physician, who＇s often called to deal with difficult airways and requests for quick, simple and effective responses, as the many factors responsible for difficulties might be enhanced by emergency setting.[1] We now have many rescue devices as the LMA, I-gel, but they do not provide a definitive airway, and recent studies evaluating the use of the videolaryngoscopes in emergency show conflicting results.
文摘Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the prehospital first aid for 2 months to fully master the methods of improving prehospital hypotension and hypoxemia,then the prognosis of TBI patients pre-and post-training for 12 months was collected and recorded.The prognostic differences of different TBI subgroups were discussed through data analysis.Results:after the training,the proportion of prehospital hypotension and hypoxemia in TBI patients decreased by 77%(8.5%vs.1.9%)and 63%(9.9%vs.3.6%,P<0.05),respectively.However,only the prognosis of moderate and severe TBI patients was improved,the proportion of patients with"good prognosis^increased by 14%(61.4%vs.70.5%,respectively)and 62%(35.6%vs.58%),and no significant effect showed in mild and critical TBI patients.Conclusion:reducing the incidence of prehospital hypoxemia and hypotension can improve the prognosis of moderate and severe TBI patients,while no significant effect on mild and critical TBI patients.
文摘Working in prehospital emergency medical services(EMS)can be unpredictable and emotionally demanding for ambulance clinicians(ACs).Burnout,stress,poor sleep quality,fatigue,and psychological health issues increase the risk of accidents and adverse events re-lated to occupational and patient safety.This scoping review aimed to identify and map the existing literature on the current state of the effect of ACs’well-being on occupational or patient safety risks in prehospital emergency medical services settings.The methodologies of the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines were used.The databases searched included CINAHL Plus,PubMed,Scopus,Web of Science,and MedNar on March 8,2024.Peer-reviewed and nonpeer-reviewed scientific and nonscientific sources were searched.The reference lists of the selected sources were screened for further papers.Participants who were ACs working in prehospital EMS and reported their physical,psychological,and social well-being related to adverse events in occupational or patient safety were eligible for inclusion.Quantitative,qualitative,and mixed-method studies;reviews;text,opinion,and discussion papers;and gray literature were included.Two reviewers independently reviewed the titles,abstracts,and full texts and assessed the quality of the sources.Data were extracted from the 2 reviewers by using an extraction tool.Data were analyzed using numerical and thematic methods.In total,35 sources were included.Four themes were identified from the heterogeneous data:Deficiencies in psychological well-being,Deficiencies in physical well-being,Deficiencies in psychophysical well-being,and Deficiencies in social well-being.Fatigue and stress experienced by ACs are the most important factors that negatively affect patient and occupational safety.Deficiencies in psychophysical well-being have a clear effect on both patient and occupational safety.There is limited evidence on the effect of ACs’well-being on patient and occupational safety in prehospital EMS.
文摘Purpose:Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous(PIV)access can be challenging during hemorrhagic shock due to peripheral vessel collapse.Early intraosseous(IO)device use is suggested as an alternative.This study examines injury characteristics and factors linked to IO access requirements.Methods:A registry-based cohort study from the Israel Defense Forces Trauma Registry(2010-2023)included trauma casualties receiving PIV or IO access prehospital.Casualties who had at least one documented PIV or IO access attempt were included,while those without vascular access were excluded.Casualties requiring both PIV and IO were classified in the IO group.Univariable logistic regression assessed the factors associated with IO access.Results were reported as odds ratios(OR)with 95%confidence intervals(CI),and significant difference was set at p<0.05.Results:Of 3462 casualties(86.3%male,the median age:22 years),3287(94.9%)received PIV access and 175(5.1%)had IO access attempts.In the IO group,30.3%received freeze-dried plasma and 23.4%received low titer group O whole blood,significantly higher than that in the PIV group.Prehospital mortality was 35.0%in the IO group.Univariable analysis showed significant associations with IO access for increased PIV attempts(OR=1.69;95%CI:1.34-2.13)and signs of profound shock(OR=11.0;95%CI:5.5-23.3).Conclusion:Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion.IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality,indicating its use in emergent resuscitation situations.Early IO consideration is advised for trauma casualties with profound shock.
基金a preplanned substudy of the ISAR-IQ project(Integration and Spatial Analysis of Regional,Site-specific and patient-level factors for Improving Quality of treatment for carotid artery stenosis)that was funded by the Germany’s Federal Joint Committee Innovation Fund(G-BA Innovationsfonds,01VSF19016 ISAR-IQ).
文摘Background This study analyses the determinants of prehospital(index event to admission)and in-hospital delay(admission to carotid endarterectomy(CEA)).In addition,the analysis addresses the association between prehospital or in-hospital delay and outcomes after CEA for symptomatic patients in German hospitals.Materials and methods This retrospective analysis is based on the nationwide German statutory quality assurance database.55437 patients were included in the analysis.Prehospital delay was grouped as follows:180-15,14-8,7-3,2-0 days or‘in-hospital index event’.In-hospital delay was divided into:0-1,2-3 and>3 days.The primary outcome event(POE)was in-hospital stroke or death.Univariate and multivariable regression analyses were performed for statistical analysis.The slope of the linear regression line is given as theβ-value,and the rate parameter of the logistic regression is given as the adjusted OR(aOR).Results Prehospital delay was 0-2 days in 34.9%,3-14 days in 29.5%and>14 days in 18.6%.Higher age(β=−1.08,p<0.001)and a more severe index event(transitory ischaemic attack:β=−4.41,p<0.001;stroke:β=−6.05,p<0.001,Ref:amaurosis fugax)were determinants of shorter prehospital delay.Higher age(β=0.28,p<0.001)and female sex(β=0.09,p=0.014)were associated with a longer in-hospital delay.Index event after admission(aOR 1.23,95%CI:1.04 to 1.47)and an intermediate in-hospital delay of 2-3 days(aOR 1.15,95%CI:1.00 to 1.33)were associated with an increased POE risk.Conclusions This study revealed that older age,higher American Society of Anesthesiology(ASA)stage,increasing severity of symptoms and ipsilateral moderate stenosis were associated with shorter prehospital delay.Non-specific symptoms were associated with a longer prehospital delay.Regarding in-hospital delay,older age,higher ASA stage,contralateral occlusion,preprocedural examination by a neurologist and admission on Fridays or Saturdays were associated with lagged treatment.A very short(<2 days)prehospital and intermediate in-hospital delay(2-3 days)were associated with increased risk of perioperative stroke or death.
文摘BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.
文摘For the German speaking countries, Tscherne＇s definition of ＂polytrauma＂ which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The ＂Primary Survey＂ is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support （PHTLS）-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis （＂treat-first-what-kills-first＂）. If no immediate treatment is necessary, a ＂Secondary Sur- vey＂ follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay （＂work and go＂） to TR-DGU certified trauma centers of the local trauma networks. Due to the difficult prehospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline ＂Polytrauma/Schwerstverletzten Behandlung＂, the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.
文摘Background： Differentiating intracerebral hemorrhage （ICH） from cerebral infarction as early as possible is vital tbr the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes. Methods： From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography （CT） or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes＇ discriminant model was applied to discriminate stroke subtypes. Results： Among the 1989 patients, 797,689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure _〉180 mmHg, and age 〈65 years were more typical of ICH. For noncomatose stroke patients, Bayes＇ discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%. Conclusions： The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.
文摘Purpose： To evaluate the performance of a prehospital trauma diversion system in Hong Kong, China. Methods： A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hong Kong from I January 2009 to 31 December 2013 was done. All adult patients aged 18 years or above, either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol, were recruited. Need for trauma center level of care was based on a consensus-based criterion standard published in 2014. Performance of the protocol in terms of over-diversion and under-diversion was determined. Results： A total of 209 patients were included for analysis. About 30% of the patients required trauma center level of care. The most common reason was the need for vascular, neurologic, abdominal, thoracic, pelvic, spine or limb-conserving surgery within 24 h of presentation. The over-diversion rate and under-diversion rate were 69.6% and 19.7% respectively. Conclusion： The trauma patient diversion protocol currently in use in Hong Kong is not accurate enough. Further revision and refinement is needed.
文摘BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019(COVID-19)patients.There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.AIM To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.METHODS A Literature search was performed on LitCovid PubMed,WHO,and Scopus databases from inception(December 2019)till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19.The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants.Secondary outcomes included COVID-19 disease severity,in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection,and mortality.The random effects models were used to calculate crude and adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs).RESULTS Forty-six observational studies met our inclusion criteria.The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk[n=43851,9 studies,odds ratio(OR)=0.67(0.22,2.07);P=0.49;I2=95%].The association between prior anticoagulation and disease severity was non-significant[n=186782;22 studies,OR=1.08(0.78,1.49);P=0.64;I2=89%].However,pre-hospital anticoagulation significantly increased all-cause mortality risk[n=207292;35 studies,OR=1.72(1.37,2.17);P<0.00001;I2=93%].Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk[aOR=0.87(0.42,1.80);P=0.71],mortality[aOR=0.94(0.84,1.05);P=0.31],and disease severity[aOR=0.96(0.72,1.26);P=0.76].CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events,improved survival,and lower disease severity in COVID-19 patients.
文摘BACKGROUND: Point-of-care ultrasound(US) is a proven diagnostic imaging tool in the emergency department(ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the fi eld and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients.METHODS: We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest.RESULTS: Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making(89%, 95%CI 67%–99%). Paramedics accurately recorded 17 cases of cardiac activity(100%, 95%CI 84%–100%) and 2 cases of cardiac standstill(100%, 95%CI 22%–100%).CONCLUSION: Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.
文摘BACKGROUND： Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance. METHODS： The EMBASE and MEDLINE （through the Pubmed interface） databases, and the Cochrane library were searched with the key words ＂epinephrine＂, ＂cardiac arrest＂ and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review. RESULTS： The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome. CONCLUSIONS： The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.
文摘BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab countries,as there are no current studies to support this.Therefore,this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIM To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODS A cross-sectional study of five different groups of participants including radiation technologists,emergency physicians,paramedics,Red Crescent managers and the public.Email and social media were used to deliver a questionnaire to these groups.The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTS Each group had some knowledge on ultrasound and its benefits.More than 50%in each study group supported the availability of ultrasound in ambulances.Additionally,60%of emergency physicians reported that they had difficulties in venous access,checking the presence of internal bleeding,recognizing pregnancy in trauma cases,and inserting endotracheal tubes,and the majority of them confirmed the effective role of ultrasound in achieving such tasks.Almost all paramedics(93.33%),physicians(98.89%),and Saudi Red Crescent managers(96.3%)emphasized the importance of communication between ambulance staff and emergency departments.Moreover,most physicians(77.78%),and technologists(82.73%)supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSION Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.
文摘Helicopter Emergency Medical Services (HEMS) use in civilian medical transport has its roots in the use of rotor-wing trauma transport in the military setting. Much of the literature and evidence based?on the use of HEMS is therefore related to scene and interfacility transport of injured patients. Regionalization of care and increased understanding of time-criticality of various non-trauma conditions has contributed to growing utilization of HEMS for non-trauma conditions over recent decades. It is common for HEMS to be utilized for a variety of non-trauma situations ranging from neonatal and obstetrics transports to cardiac and stroke transports. The purpose of this review is to overview the use of HEMS for non-trauma, focusing on situations in which there is evidence addressing possible HEMS utility.
文摘Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.
