Transition From Military Prehospital Medicine to Civilian EMS.

Introduction: Currently, there is a disconnection between veteran military medics and the civilian Emergency Medical Services (EMS) workforce. This project aimed to characterize the rate of civilian certification among military medics, both active duty and retired, and identify perceived barriers to continuing a career in EMS after military separation.

Materials And Methods: The National Association of Emergency Medical Technicians (EMTs) administered a 21-question online survey to participants.

Prehospital blunt traumatic arrest resuscitation augmented by whole blood: a case report.

Background: Prehospital hemorrhagic shock accounts for approximately 25,000 civilian deaths annually in the United States. A balanced, blood-based resuscitation strategy is hypothesized to be the optimal treatment for these patients. Due to logistical constraints, delivering a balanced, blood-based resuscitation is difficult in the prehospital setting.

Use of intrathoracic pressure regulation therapy in breathing patients for the treatment of hypotension secondary to trauma.

Background: Intrathoracic pressure regulation (IPR) therapy has been shown to increase blood pressure in hypotensive patients. The potential value of this therapy in patients with hypotension secondary to trauma with bleeding is not well understood. We hypothesized that IPR would non-invasively and safely enhance blood pressure in spontaneously breathing patients with trauma-induced hypotension.

A randomized control hands-on defibrillation study-Barrier use evaluation.

Introduction: Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time results in a zero blood flow state.

Use of an impedance threshold device in spontaneously breathing patients with hypotension secondary to trauma: an observational cohort feasibility study.

Background: An impedance threshold device (ITD) intended for use in the spontaneously breathing patient has been shown to raise blood pressure in hypotensive patients. This device has not been evaluated in patients with hypotension secondary to trauma. This study focused on changes in key vital signs when the ITD was added to the paramedic treatment protocol for hypotensive patients with prehospital traumatic injury.

Promoting early diagnosis of hemodynamic instability during simulated hemorrhage with the use of a real-time decision-assist algorithm.

Background: This study aimed to test the hypothesis that the addition of a real-time decision-assist machine learning algorithm by emergency medical system personnel could shorten the time needed to identify an unstable patient during a hemorrhage profile as compared with vital sign information alone.

Methods: Fifty emergency medical team-paramedics from a large, urban fire department participated as subjects. Subjects viewed a monitor screen on two occasions as follows: (1) display of standard vital signs alone and (2) with the addition of an index (Compensatory Reserve Index) associated with estimated central blood volume status.

Capnography for the nonintubated patient in the emergency setting.

Background: Multiple studies illustrate the benefits of waveform capnography in the nonintubated patient. This type of monitoring is routinely used by anesthesia providers to recognize ventilation issues. Its role in the administration of deep sedation is well defined.

Cardiac arrest survival is rare without prehospital return of spontaneous circulation.

Background: Emergency medical services (EMS) are crucial in the management of out-of-hospital cardiac arrest (OHCA). Despite accepted termination-of-resuscitation criteria, many patients are transported to the hospital without achieving field return of spontaneous circulation (ROSC).

Objective: We examine field ROSC influence on OHCA survival to hospital discharge in two large urban EMS systems.

Paramedics successfully perform humeral EZ-IO intraosseous access in adult out-of-hospital cardiac arrest patients.

Objective: Studies on humeral placement of the EZ-IO (Vidacare, Shavano Park, TX, USA) have shown mixed results. We performed a study to determine the first-attempt success rate at humeral placement of the EZ-IO by paramedics among prehospital adult cardiac arrest patients.

Methods: A retrospective cohort analysis of data prospectively collected over a 9-month period.

No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose.

Introduction: Naloxone is widely used in the treatment and reversal of opioid overdose. Most emergency medical services (EMS) systems administer naloxone by standing order, and titrate only to reverse respiratory depression without fully reversing sedation. Some EMS systems routinely administer sufficient naloxone to fully reverse the effects of opioid overdose.

Needle thoracostomy: implications of computed tomography chest wall thickness.

Objectives: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax.

Methods: A convenience sample of 111 computed tomography (CT) scans of the chest in trauma and medical resuscitation patients at a military Level 1 trauma center in San Antonio, Texas, was pooled, and the chest wall thickness was measured at the second intercostal space, midclavicular line, to the nearest 0.1 cm.

A randomized, controlled trial comparing arteriovenous to venovenous rewarming of severe hypothermia in a porcine model.

Background: The purpose of this study was to evaluate active rewarming using continuous arteriovenous rewarming (CAVR) and continuous venovenous rewarming (CVVR) methods during severe hypothermia using an electromagnetic fluid warmer. Rapid rewarming using these techniques is superior to passive rewarming and is possible with commercially available equipment.

Methods: Eighteen swine (55-65 kg) were assigned to CAVR, CVVR, or control.

360-degree feedback: possibilities for assessment of the ACGME core competencies for emergency medicine residents.

The Accreditation Council for Graduate Medical Education (ACGME) has challenged residency programs to provide documentation via outcomes assessment that all residents have successfully mastered the six core competencies. A variety of assessment "tools" has been identified by the ACGME for outcomes assessment determination. Although rarely cited in the medical literature, 360-degree feedback is currently in widespread use in the business sector.