Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting.
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark. mnielsen.anne@gmail.com
Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island.
The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given.
On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40-50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01). During the rhythm analysis, 65% did not perform any visual or verbal safety check.
The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.
To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances.
We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario's Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls. Our primary outcome was clinical deterioration during transport. We then asked a panel to analyze each case of deterioration to determine if a dual-PCP configuration might have reasonably prevented the deterioration or have better treated the deterioration, compared to a single-PCP configuration.
In one year, contract carriers moved 3264 patients, who met inclusion criteria. 85% were from Northern Ontario. There were 21 cases of medical deterioration (0.6%±0.26%). Paper charts were found for 20 of these cases. Most were self-limited cases of pain or nausea. A small number of cases (n=5) were cardiorespiratory decompensation. There was 100% consensus amongst the panel that all cases of clinical deterioration were not related to team size. There was also 100% consensus that a dual-PCP team would not have been better able to deal with the deterioration, compared to a single-PCP crew.
We found that using a single-PCP configuration for transporting low acuity patients is safe. This finding is particularly important for rural areas where air ambulance is the only means for accessibility to care and where staffing issues are magnified.
This study was performed to evaluate the possibility of early identification of patients with an acute coronary syndrome who are transported by ambulance. All patients in the community of Göteborg who were transported by ambulance over a period of 3 months owing to symptoms raising any suspicion of an acute coronary syndrome were studied. In all 930 cases that were included in the survey, 130 (14%) had a final diagnosis of acute myocardial infarction (AMI) and 276 (30%) had a final diagnosis of an acute coronary syndrome. Independent risk indicators for development of AMI were: male sex (odds ratio 1.70; 95% confidence limits 1.02-2.84), cold and clammy on admission of the ambulance crew (odds ratio 2.07; 95% confidence limits 1.23-3.49) and showing electrocardiogram (ECG) signs of myocardial ischemia on admission to the emergency department (odds ratio 8.78; 95%confidence limits 5.28-14.61). Independent predictors for development of an acute coronary syndrome were: male sex (odds ratio 1.97; 95% confidence limits 1.30-2.99), a history of angina pectoris (odds ratio 3.41; 95% confidence limits 2.24-5.26), cold and clammy on admission of the ambulance crew (odds ratio 1.95; 95% confidence limits 1.21-3.15), and ECG signs of myocardial ischemia on admission to the emergency department (odds ratio 5.55; 95% confidence limits 3.63-8.58). Among patients seen by the ambulance crew with symptoms raising any suspicion of an acute coronary syndrome, predictors for that diagnosis included male sex, a history of angina pectoris, patients being cold and clammy on admission of the ambulance crew, and ECG signs of myocardial ischemia on admission to the emergency department.
INTRODUCTION: In Denmark any person needing urgent medical help can dial 112 and get in contact with an alarm centre where a non-health educated operator assesses what kind of help is needed. A specific dispatch report (DR) is used if an ambulance is dispatched. We assessed which DRs were used for the Copenhagen Mobile Emergency Care Unit (MECU) in the case of out-of-hospital cardiac arrest. MATERIALS AND METHOD: All DRs for the MECU during 2000 to 2006 were analyzed and compared with the diagnosis recorded by the dispatched specialist in anaesthesiology after every case. We divided the DRs into five categories: ''cardiac arrest'', ''possible death'', ''unconscious'', ''heart attack'', and ''miscellaneous'' (consisting of 40 different DR categories). RESULTS: We found 52088 DRs, 2902 of which were diagnosed as cardiac arrest. 32% of these cardiac arrests were dispatched in accordance with this, while the DRs were different from cardiac arrest in 68%. ''Unconscious'' accounted for 21%. 41% of the cases with DR cardiac arrest could not be verified upon the arrival of the dispatched medical doctor. CONCLUSION: Only 32% of the cases with cardiac arrest had a correct DR. We suspect that some of the patients had an unrecognized cardiac arrest at the time of contact to the alarm centre. The current alarm system can presumably be improved. The alarm centre has a central role in such a quality improvement.
Proving the efficacy of thrombolysis in improving outcome from stroke has put time to assessment of patients at the forefront for healthcare providers when organizing stroke care. The chain of recovery begins with the patient. Efforts are being made to improve the general public's understanding of stroke. However, it appears at the moment that a greater effect in reducing the delay to initial medical assessment and treatment decision is to be gained through streamlining care as soon as 911 has been called. Emergency medical services dispatchers and technicians play a key role in recognizing that a patient is having a stroke and prioritizing the transport of the patient to an appropriate facility. Emergency departments need to have clear protocols in place to ensure that physicians can make prompt treatment decisions after having fully assessed and investigated the patient. Only with all these pieces in place is the initial phase of the chain of recovery complete, with the end result that more patients have the chance to have an improved outcome from stroke.
We designed the Canadian C-Spine Rule for the clinical clearance of the cervical spine, without need for diagnostic imaging, in alert and stable trauma patients. Emergency physicians previously validated the Canadian C-Spine Rule in 8,283 patients. This study prospectively evaluates the performance characteristics, reliability, and clinical sensibility of the Canadian C-Spine Rule when used by paramedics in the out-of-hospital setting.
We conducted this prospective cohort study in 7 Canadian regions and involved alert (Glasgow Coma Scale score 15) and stable adult trauma patients at risk for neck injury. Advanced and basic care paramedics interpreted the Canadian C-Spine Rule status for all patients, who then underwent immobilization and assessment in the emergency department to determine the outcome, clinically important cervical spine injury.
The 1,949 patients enrolled had these characteristics: median age 39.0 years (interquartile range 26 to 52 years), female patients 50.8%, motor vehicle crash 62.5%, fall 19.9%, admitted to the hospital 10.8%, clinically important cervical spine injury 0.6%, unimportant injury 0.3%, and internal fixation 0.3%. The paramedics classified patients for 12 important injuries with sensitivity 100% (95% confidence interval [CI] 74% to 100%) and specificity 37.7% (95% CI 36% to 40%). The kappa value for paramedic interpretation of the Canadian C-Spine Rule (n=155) was 0.93 (95% CI 0.87 to 0.99). Paramedics conservatively misinterpreted the rule in 320 (16.4%) patients and were comfortable applying the rule in 1,594 (81.7%). Seven hundred thirty-one (37.7%) out-of-hospital immobilizations could have been avoided with the Canadian C-Spine Rule.
This study found that paramedics can apply the Canadian C-Spine Rule reliably, without missing any important cervical spine injuries. The adoption of the Canadian C-Spine Rule by paramedics could significantly reduce the number of out-of-hospital cervical spine immobilizations.
Notes
Comment In: Ann Emerg Med. 2010 Apr;55(4):380-920346840
Comment In: Ann Emerg Med. 2009 Nov;54(5):672-319853780
The Swedish healthcare system aims to provide the best care possible, thus fulfilling legal and program requirements despite the need for reducing costs. This study's aim has been to acquire deeper understanding of the factors underlying patients' experience of inappropriate treatment and care or personnel's problematical attitudes during their contact with the Emergency Medical Services (EMS) (Ambulance Services).
This study used a care science perspective. It applied qualitative content analysis, analyzing data for meaning. Data comprised 32 deviation reports or complaints from patients in Stockholm, Sweden in 2014.
Patients at the limits of their self-help experienced acute need for speedy transfer to hospital. Lack of recognition for their suffering caused them to feel badly treated by ambulance personnel.
Patients in this study felt objectified and not treated as individual human beings, i.e. they "suffered from care". Ambulance personnel should avoid patient objectification by establishing an engaged relationship with attentiveness and committal, thus supporting patients' health processes. The aim of this study has been to draw attention to patients' experiences of the healthcare they received, in order to be able to improve and maintain healthcare standards, thus guaranteeing continued quality of care. This may be achieved by increasing the awareness of personnel concerning how their attitudes and treatment can influence patient well-being. Information, education and follow-up lead to increased awareness in personnel. The intended result of personnel's increased awareness is greater well-being and feelings of security for patients.
To examine the ability of a unified metropolitan paramedic system to provide IV access in children when indicated.
Retrospective, descriptive clinical study.
A large metropolitan area in Canada.
Five hundred thirteen children from birth through 18 years of age who were transported by paramedics.
Indications for IV access, rates of successful placement, and time to achieve access were determined. Criteria for IV line placement were developed and applied retrospectively.
Intravenous line attempts were made in 300 children (58%). Intravenous line placement was obtained in 253 (84% of the patients attempted). One hundred fifty-nine children met criteria for IV placement in the field. Six of these children were clinically dead and received no on-scene resuscitative efforts and were excluded from data analysis. Of the remaining 153 children who met criteria, 122 (80%) had IV attempts made, and 104 (68%) had an IV line placed successfully. For children who met the criteria for IV placement, a significantly smaller proportion of children younger than 6 years had an IV line placed successfully (49%) compared with children 6 years or older (75%) (P
