Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System.

Introduction: Prehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure.

City-Specific Air Quality Warnings for Improved Asthma Self-Management.

Introduction: This study presents a framework for identifying "high-risk" days for asthma attacks associated with elevated concentrations of criteria pollutants using local information to warn citizens on days when the concentrations differ from Environmental Protection Agency Air Quality Index (AQI) warnings. Studies that consider the unique mixture of pollutants and the health data specific to a city provide additional information for asthma self-management. This framework is applied to air pollution and asthma data to identify supplemental warning days in Houston, Texas.

A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston.

Background: Despite evidence to suggest significant spatial variation in out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (BCPR) rates, geographic information systems (GIS) and spatial analysis have not been widely used to understand the reasons behind this variation. This study employs spatial statistics to identify the location and extent of clusters of bystander CPR in Houston and Travis County, TX.

Methods: Data were extracted from the Cardiac Arrest Registry to Enhance Survival for two U.

Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction.

Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions.

The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients.

Objectives: The purpose of this study was to assess the attitude of paramedics to on-scene termination of cardiopulmonary resuscitation (T-CPR) efforts in children prior to developing a pediatric T-CPR policy.

Methods: A 26-item anonymous survey was conducted of all of the active paramedics in a large urban EMS system where T-CPR had been practiced routinely for adults. Questions addressed paramedic demographics, training level, experience with adult and pediatric advanced cardiac life support (ACLS), experience with T-CPR in adults, T-CPR case scenarios, and T-CPR in children.

Customer satisfaction in a large urban fire department emergency medical services system.

Objectives: The purpose of this study was to determine if emergency medical services (EMS) customer satisfaction could be assessed using telephone-survey methods. The process by which customer satisfaction with the EMS service in a large, fire department-based EMS system is reported, and five month results are presented.

Methods: Ten percent of all patients transported during the period of October 15, 2001, through March 15, 2002, were selected for study.

Cardiac arrest survival as a function of ambulance deployment strategy in a large urban emergency medical services system.

Introduction: This study examines the effect of paramedic deployment strategy on witnessed ventricular fibrillation (VF) cardiac arrest outcomes. Our null hypothesis was that there is no difference in survival between an EMS system using targeted response (TR) and one using a uniform or all advanced life support (ALS) response (UR) model. We define targeted response as a system where paramedics are sent to critical incidents while ambulances staffed with basic EMTs are sent to less critical incidents.

Can first responders be sent to selected 9-1-1 emergency medical services calls without an ambulance?

Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs).

The effect of a quality improvement feedback loop on paramedic-initiated nontransport of elderly patients.

Objective: To examine the effect of a paramedic educational program and quality improvement feedback loop on paramedic-initiated nontransport of patients 65 years of age and older.

Methods: Prospective observational study. Patients 65 years of age and older who were evaluated but not transported by paramedics were contacted by telephone within two weeks of emergency medical services (EMS) contact and asked: 1) whether the patient sought medical help within 24 hours after contact; 2) whether the patient was admitted to a hospital and, if so, what was the diagnosis; 3) who was responsible for the nontransport decision (patient, paramedic, or mutual); and 4) how satisfied the patient was with the EMS service.

Managing the post-resuscitation patient in the field.

The principal goal after successful resuscitation of a cardiac arrest patient is to maintain the patient's pulse and avoid a pulseless state. Of equal importance in the post-resuscitation patient are efforts to prevent myocardial dysfunction and increase the likelihood of a good neurologic outcome. To optimize cardiac and hemodynamic resuscitation, paramedics should obtain good background information, which could provide clues to factors contributing to the cardiac arrest, such as the use of certain drugs or being overdue for dialysis, and could aid in customizing therapy for rhythm disturbances and hemodynamic aberrations.