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Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting.

https://arctichealth.org/en/permalink/ahliterature124570
Source
Scand J Trauma Resusc Emerg Med. 2012;20:34
Publication Type
Article
Date
2012
Author
Anne Møller Nielsen
Dan Lou Isbye
Freddy Knudsen Lippert
Lars Simon Rasmussen
Author Affiliation
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark. mnielsen.anne@gmail.com
Source
Scand J Trauma Resusc Emerg Med. 2012;20:34
Date
2012
Language
English
Publication Type
Article
Keywords
Algorithms
Defibrillators
Denmark
Emergency Medical Services - standards
Emergency Medical Technicians - standards
Female
Humans
Life Support Care - standards
Male
Manikins
Practice Guidelines as Topic
Professional Competence
Rural Population
Abstract
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.
Notes
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PubMed ID
22569089 View in PubMed
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Can a single primary care paramedic configuration safely transport low-acuity patients in air ambulances?

https://arctichealth.org/en/permalink/ahliterature303243
Source
CJEM. 2018 03; 20(2):247-255
Publication Type
Journal Article
Date
03-2018
Author
Homer Tien
Bruce Sawadsky
Michael Lewell
Sean Moore
Michael Peddle
Alun Ackery
Brodie Nolan
Russell D MacDonald
Author Affiliation
*Ornge,Mississauga,ON.
Source
CJEM. 2018 03; 20(2):247-255
Date
03-2018
Language
English
Publication Type
Journal Article
Keywords
Air Ambulances - standards
Emergencies
Emergency Medical Technicians - standards
Emergency Service, Hospital - statistics & numerical data
Female
Health Services Needs and Demand - organization & administration
Humans
Male
Middle Aged
Ontario
Retrospective Studies
Transportation of Patients - organization & administration
Abstract
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.
PubMed ID
28934993 View in PubMed
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[Danish Nursing Council believes: professionality and freedom of speech].

https://arctichealth.org/en/permalink/ahliterature206843
Source
Sygeplejersken. 1997 Nov 7;97(45):5
Publication Type
Article
Date
Nov-7-1997

Early identification of patients with an acute coronary syndrome as assessed by dispatchers and the ambulance crew.

https://arctichealth.org/en/permalink/ahliterature53744
Source
Am J Emerg Med. 2002 May;20(3):196-201
Publication Type
Article
Date
May-2002
Author
Johan Herlitz
Mia Starke
Elisabeth Hansson
Eva Ringvall
Björn W Karlson
Lisbeth Waagstein
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. johan.herlitz@hjl.gu.se
Source
Am J Emerg Med. 2002 May;20(3):196-201
Date
May-2002
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Ambulances
Angina Pectoris - diagnosis
Electrocardiography
Emergency Medical Technicians - standards
Female
Health Care Surveys
Humans
Logistic Models
Male
Myocardial Infarction - diagnosis
Outcome Assessment (Health Care)
Research Support, Non-U.S. Gov't
Risk factors
Statistics, nonparametric
Sweden
Triage
Abstract
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.
PubMed ID
11992339 View in PubMed
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[Emergency medicine--high need and low competence. Interview by Erik Dale].

https://arctichealth.org/en/permalink/ahliterature209026
Source
Tidsskr Sykepl. 1997 Mar 11;85(5):34-5
Publication Type
Article
Date
Mar-11-1997

[How is out-of-hospital cardiac arrest dispatched?]

https://arctichealth.org/en/permalink/ahliterature86904
Source
Ugeskr Laeger. 2008 Mar 31;170(14):1145-7
Publication Type
Article
Date
Mar-31-2008
Author
Mathiesen Ole Pagh
Nielsen Søren Loumann
Rasmussen Lars Simon
Author Affiliation
Rigshospitalet, HovedOrtoCentret, DK-2100 København Ø. ole_tanja@wanadoo.dk
Source
Ugeskr Laeger. 2008 Mar 31;170(14):1145-7
Date
Mar-31-2008
Language
Danish
Publication Type
Article
Keywords
Ambulances - standards
Denmark
Emergency Medical Service Communication Systems - standards
Emergency Medical Services - standards - statistics & numerical data
Emergency Medical Technicians - standards
Heart Arrest - diagnosis - therapy
Humans
Medical Records
Quality Assurance, Health Care
Unconsciousness - diagnosis
Abstract
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.
PubMed ID
18405478 View in PubMed
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Organization of regional and local stroke resources: methods to expedite acute management of stroke.

https://arctichealth.org/en/permalink/ahliterature182311
Source
Curr Neurol Neurosci Rep. 2004 Jan;4(1):13-8
Publication Type
Article
Date
Jan-2004
Author
James Kennedy
Christina Ma
Alastair M Buchan
Author Affiliation
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Room 1162, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
Source
Curr Neurol Neurosci Rep. 2004 Jan;4(1):13-8
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Canada
Clinical Protocols - standards
Disease Management
Emergency Medical Services - organization & administration - standards - trends
Emergency Medical Technicians - standards
Emergency Service, Hospital - organization & administration - standards
Health Education - standards
Health Planning Guidelines
Humans
Regional Medical Programs - organization & administration
Stroke - diagnosis - nursing - therapy
Thrombolytic Therapy - standards - trends
Time Factors
Abstract
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.
PubMed ID
14683622 View in PubMed
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The out-of-hospital validation of the Canadian C-Spine Rule by paramedics.

https://arctichealth.org/en/permalink/ahliterature151332
Source
Ann Emerg Med. 2009 Nov;54(5):663-671.e1
Publication Type
Article
Date
Nov-2009
Author
Christian Vaillancourt
Ian G Stiell
Tammy Beaudoin
Justin Maloney
Andrew R Anton
Paul Bradford
Ed Cain
Andrew Travers
Matt Stempien
Martin Lees
Doug Munkley
Erica Battram
Jane Banek
George A Wells
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Source
Ann Emerg Med. 2009 Nov;54(5):663-671.e1
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cervical Vertebrae - injuries
Clinical Competence
Cohort Studies
Confidence Intervals
Decision Support Techniques
Emergency Medical Services - methods - standards
Emergency Medical Technicians - standards
Female
Humans
Immobilization - methods
Male
Middle Aged
Neck Injuries - diagnosis - therapy
Outcome Assessment (Health Care)
Practice Guidelines as Topic
Prospective Studies
Reproducibility of Results
Risk assessment
Sensitivity and specificity
Spinal Injuries - diagnosis - therapy
Unnecessary Procedures - statistics & numerical data
Wounds, Nonpenetrating - diagnosis - therapy
Abstract
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
Erratum In: Ann Emerg Med. 2010 Jan;55(1):22
PubMed ID
19394111 View in PubMed
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Patients' experience of being badly treated in the ambulance service: A qualitative study of deviation reports in Sweden.

https://arctichealth.org/en/permalink/ahliterature285870
Source
Int Emerg Nurs. 2017 Jan;30:25-30
Publication Type
Article
Date
Jan-2017
Author
Marie Ahlenius
Veronica Lindström
Veronica Vicente
Source
Int Emerg Nurs. 2017 Jan;30:25-30
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Ambulances - standards
Emergency Medical Services - manpower - standards
Emergency Medical Technicians - standards
Female
Humans
Male
Patient satisfaction
Perception
Qualitative Research
Quality of Health Care - standards
Surveys and Questionnaires
Sweden
Abstract
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.
PubMed ID
27567212 View in PubMed
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Prehospital intravenous access in children.

https://arctichealth.org/en/permalink/ahliterature222676
Source
Ann Emerg Med. 1992 Dec;21(12):1430-4
Publication Type
Article
Date
Dec-1992
Author
K A Lillis
D M Jaffe
Author Affiliation
Department of Pediatrics, Children's Hospital of Buffalo, NY.
Source
Ann Emerg Med. 1992 Dec;21(12):1430-4
Date
Dec-1992
Language
English
Publication Type
Article
Keywords
Adolescent
Ambulances
Canada
Child
Child, Preschool
Clinical Competence
Emergency medical services
Emergency Medical Technicians - standards
Female
Humans
Infant
Infant, Newborn
Infusions, Intravenous
Male
Retrospective Studies
Sex Factors
Time Factors
Transportation of Patients
Abstract
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
PubMed ID
1443836 View in PubMed
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13 records – page 1 of 2.