Prehospital care - scoop and run or stay and play?

Improved training and expertise has enabled emergency medical personnel to provide advanced levels of care at the scene of trauma. While this could be expected to improve the outcome from major injury, current data does not support this. Indeed, prehospital interventions beyond the BLS level have not been shown to be effective and in many cases have proven to be detrimental to patient outcome.

Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization.

Objectives: To identify predictors of positive computed tomographic (CT) yield and to measure the impact of CT yield on the disposition of patients referred for computed tomography after presenting to an emergency department with nontraumatic abdominal pain.

Materials And Methods: Computed tomographic reports, laboratory data, and emergency department and hospital records were retrospectively analyzed in 604 consecutive patients undergoing CT examinations. Computed tomographic yield was correlated to age, gender, leukocyte count, specified precomputed-tomography clinical diagnosis, and patient disposition.

Falls from height: spine, spine, spine!

Background: Falls from a height are a major cause of morbidity and hospital cost. Spinal injury is frequently associated with falls from height, but reliable predictive factors have not been identified. Diagnostic evaluation of the spine is complex and debated.

Routine repeat head CT for minimal head injury is unnecessary.

Background: Patients with MHI and a positive head computed tomography (CT) scan frequently have a routine repeat head CT (RRHCT) to identify possible evolution of the head injury requiring intervention. RRHCT is ordered based on the premise that significant injury progression may take place in the absence of clinical deterioration.

Methods: In a Level I urban trauma center with a policy of RRHCT, we reviewed the records of 692 consecutive trauma patients with Glasgow Coma Scale scores of 13-15 and a head CT (October 2004 through October 2005).

Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice.

Background: This study assessed patients with traumatic brain injury (TBI) to determine whether prehospital and community hospital providers employed hyperventilation therapy inconsistent with consensus recommendation against its routine use.

Methods: This prospective analysis of 37 intubated TBI patients without herniation, undergoing helicopter transport to an urban Level I center, entailed flight crews' noting of assisted ventilation rate (AVR) and end-tidal carbon dioxide (ETCO2) upon their arrival at trauma scenes or community hospitals. A priori-set levels of AVR and ETCO2 were used to assess frequency of guideline-inconsistent hyperventilation, and Fisher's exact and Kruskal-Wallis tests assessed association between guideline-inconsistent hyperventilation and manual vs.

EMS Agenda for the Future: Where We Are … Where We Want to Be.

During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the "EMS Agenda for the Future.