Paramedic intubation: patient position might matter.

Objective: Paramedics often intubate in challenging environments. We evaluated whether patient position might affect prehospital intubation success rates utilizing a cadaver model.

Methods: The study was conducted in two phases: a cross-sectional survey and an experimental model in which paramedics were asked to demonstrate intubation skills on cadavers in three positions.

Emergency mental health: lessons learned from flight 3407.

Emergency mental health (EMH), a field that is often not well represented when considering emergency preparedness, is nonetheless a vital component to any disaster response. Emergency mental health issues must be considered not only for victims of disasters and their families, friends, and coworkers but also for both on-scene and off-scene responders and members of the community who may have witnessed the disaster. This article describes the EMH preparation for and response to the crash of Continental Airlines flight 3407 in western New York on February 12, 2009, killing all 49 crew and passengers on board and 1 person on the ground.

Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions.

Objectives: To determine the proportion of out-of-hospital cardiac arrest (OOHCA) patients who received chest compressions, before EMS arrival, from bystanders who called the EMS emergency telephone number (9-1-1) at dispatch centers that provided telephone CPR instructions and to describe barriers to following instructions.

Methods: A retrospective case series was conducted in 2004 at three dispatch centers all of which provided sequential airway, breathing and chest compression pre-arrival instructions. All calls for which the call-taker established that the patient was in OOHCA were identified, and the recorded interaction was reviewed using a structured data collection tool.

Linkages of acute care and EMS to state and local public health programs: application to public health programs.

Response to terrorism and mass casualty incidents has become a focal point for many public service agencies. Public health agencies and the emergency response community must work together to effectively and efficiently respond to any future incidents. Historically, collaboration has been a challenge since these agencies have functioned independently from one another, maintaining separate infrastructures that are not adequately interoperable.

Electronic patient registration and tracking at mass vaccination clinics: a clinical study.

To protect the citizens of the United States from the use of dangerous biological agents, the Center for Disease Control and Prevention (CDC) has been actively preparing to deal with the consequences of such an attack. Their plans include the deployment of mass immunization clinics to handle postevent vaccinations. As part of the planning efforts by the Western New York Public Health Alliance, a Web-based electronic patient registration and tracking system was developed and tested at a recent trial smallpox vaccination clinic.

Regional emergency preparedness efforts by local health departments in Western New York.

Public health agencies at all levels are now under increasing pressure to prepare for and respond to emerging natural and manmade threats to the health and wellness of those they serve. In particular, local health departments must be prepared to provide front-line defense and first response as threats of terrorism have become increasingly real. Success in meeting this monumental task will be highly dependent on funding as well as the availability of other resources.

A comparison of first-responder automated external defibrillator (AED) application rates and characteristics of AED training.

Objective: To determine whether there were associations between the characteristics of first-responder automated external defibrillator (AED) training and AED application rates.

Methods: This multicenter retrospective cohort study analyzed data from ten emergency medical services systems where first responders were trained and equipped with AEDs. Data were provided for all out-of-hospital cardiac arrests (OHCAs) occurring over two years, including whether the first-responder AED was applied (pads attached to patient).

Is total out-of-hospital time a significant predictor of trauma patient mortality?

Objective: To determine if there is an association between total out-of-hospital time and trauma patient mortality.

Methods: A retrospective review was performed of a convenience sample of consecutive medical records for all admitted patients transported by helicopter or ambulance from the scene of injury to the regional trauma center. Descriptive and univariate analyses were conducted to determine which variables were associated with patient mortality and total out-of-hospital time.

The time first-response fire fighters have to initiate care in a midsize city.

The objective of this study was to determine whether simultaneously dispatched first-response firefighters (fire) arrive before transporting EMS providers (ambulance) and the amount of time fire has on scene to initiate care. Fire and ambulance dispatch records were obtained for all 9-1-1 responses from four 1-month intervals. Only incidents to which both agencies had been simultaneously dispatched were included.

Can paramedics safely treat and discharge hypoglycemic patients in the field?

To determine whether paramedics can safely treat and discharge insulin-dependent diabetic patients experiencing uncomplicated hypoglycemic events, we conducted a prospective, observational study with a convenience sample of diabetic patients whose hypoglycemia resolved after intravenous administration of dextrose and before they were transported by paramedics. On-line medical control was contacted to obtain approval and informed consent for participation from interested patients who met all eligibility criteria for the study. Participating patients were given instructions upon discharge from the study and were contacted by telephone 24 hours later to ascertain their medical outcomes and their opinions of the study protocol.

A survey of first-responder firefighters' attitudes, opinions, and concerns about their automated external defibrillator program.

Objective: To identify barriers to first-responder automated external defibrillator (AED) use by determining firefighter attitudes, opinions, and concerns about their AED program.

Methods: An anonymous survey was mailed to all firefighters in a municipal department that had had first-responder defibrillation for more than two years. A follow-up survey was mailed to all nonrespondents.

Assessment of emergency department health care professionals' behaviors regarding HIV testing and referral for patients with STDs.

The objective of this study was to evaluate human immunodeficiency virus (HIV) counseling, testing, and referral practices of emergency department health care professionals (i.e., medical doctors [MD], physician assistants [PA], nurse practitioners [NP], and registered nurses [RN]) for patients presenting with other sexually transmitted diseases (STD).

Out-of-hospital do-not-resuscitate orders by primary care physicians.

The objective of this study was to determine the knowledge, utilization, and experience of primary care physicians (PCPs) with nonhospital do-not-resuscitate (NH-DNR) orders. An anonymous survey was sent to all PCPs in a single northeastern county. Up to two surveys were mailed to each PCP.

Automated external defibrillator (AED) utilization rates and reasons fire and police first responders did not apply AEDs.

Objectives: To determine the rate at which fire and police first responders (FRs) apply automated external defibrillators (AEDs) and to ascertain reasons for not applying them.

Methods: Twenty-one emergency medical services (EMS) systems whose FRs had been supplied with AEDs by a philanthropic foundation provided data for all out-of-hospital cardiac arrest (OHCA) patients. Data including the incidence of AED application and explanations for not applying AEDs were analyzed using descriptive statistics.

The influence of demographic factors on seatbelt use by adults injured in motor vehicle crashes.

This study determined demographic factors associated with reported seatbelt use among injured adults admitted to a trauma center. A retrospective chart review was conducted including all patients admitted to a trauma center for injuries from motor vehicle crashes (MVC). E-codes (i.

Delay in ED arrival resulting from a remote helipad at a trauma center.

Introduction: Ground transport from a remote helipad at a trauma center may delay patient arrival in the ED and affect patient morbidity and mortality. Prehospital care providers must be aware of the magnitude of any delay when selecting the most expedient means of transport for trauma patients. This study quantifies the time required for a 0.

The lay public's expectations of prearrival instructions when dialing 9-1-1.

Objective: To determine whether the lay public expects public safety answering points (PSAPs) to provide prearrival instructions.

Methods: Two thousand telephone numbers were randomly generated from all listed residential numbers in a county containing urban, suburban, and rural communities served by 26 enhanced 9-1-1 PSAPs. Only a minority of the PSAPs provided prearrival instructions.

Endotracheal tube introducer for failed intubations: a variant of the gum elastic bougie.

There is no universally accepted nonsurgical adjunct for management of the difficult airway in the emergency department. The gum elastic bougie is widely accepted in the British anesthesia literature. One model of endotracheal tube introducer, the Flex-Guide ET Tube Introducer (GreenField Medical Sourcing, Inc, Northborough, MA), is a less expensive plastic version of the gum elastic bougie with the same properties, available in the United States.

Ambulance, fire, and police dispatch times compared with the atomic clock.

Objectives: To quantify any differences between the times used by public safety answering points (PSAPs) in a multijurisdictional county compared with the atomic clock and to determine whether there was consistency in any time differences.

Methods: All 25 ambulance, fire, and police PSAPs were contacted by telephone. The current time in hours, minutes, and seconds on the dispatch center's timepiece was requested.

Use of a geographic information system to determine appropriate means of trauma patient transport.

Objective: To determine whether a geographic information system (GIS) and historical transport data can be used to create a map that identifies locations (zones) from which either ambulance or helicopter transport will result in shorter out-of-hospital times.

Methods: A retrospective, cross-sectional review of a trauma registry was conducted in a two-county region served by a single trauma center. Data were gathered for all patients transported directly to the trauma center between 1993 and 1996.

Blood loss estimation by out-of-hospital emergency care providers.

Objectives: To evaluate emergency medical technicians' (EMTs') ability to estimate spilled blood volume and to determine whether limited training improves estimate accuracy and whether there is a difference in improvement comparing two different training methods.

Methods: The study design was a single-blinded, clinical model, utilizing EMTs (basic, intermediate, and advanced) from a local commercial ambulance service. Participants estimated the volume of randomly selected volumes of packed red blood cells reconstituted to a normal hematocrit and poured onto three absorbent (carpet) and three nonabsorbent (vinyl) surfaces.

Triage, transportation, and destination decisions by out-of-hospital emergency care providers.

Introduction: The effectiveness of a tiered emergency medical services system often hinges upon the ability of initial care providers with little or no formal training to identify emergent patient needs and determine the best means to meet those needs.

Objectives: To determine if out-of-hospital emergency care providers consistently make appropriate triage, transportation, and destination decisions; and to determine if experience and training have an effect on these decisions.

Methods: A survey consisting of 14 patient-care scenarios was administered to certified and non-certified out-of-hospital emergency-care providers (n = 311) from 20 randomly selected EMS agencies.

The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects.

Objectives: To compare the incidences and severities of pain experienced by healthy volunteers undergoing spinal immobilization in the neutral position with and without occipital padding. To compare the incidence of pain when immobilized in the neutral position with the incidence in a nonneutral position.

Methods: Thirty-nine healthy volunteers over the age of 18 years who had no acute pain or illness, were not pregnant, and had no history of back problems or surgery voluntarily participated in a prospective, randomized, crossover study conducted in a clinical laboratory setting.