Circulating Folate and Folic Acid Concentrations: Associations With Colorectal Cancer Recurrence and Survival.

Background: Folates, including folic acid, may play a dual role in colorectal cancer development. Folate is suggested to be protective in early carcinogenesis but could accelerate growth of premalignant lesions or micrometastases. Whether circulating concentrations of folate and folic acid, measured around time of diagnosis, are associated with recurrence and survival in colorectal cancer patients is largely unknown.

Paramedic specialization: a strategy for better out-of-hospital care.

Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs.

Helicopter emergency medical services utilization for winter resort injuries.

Introduction: Helicopter and ground emergency medical services (EMS) units are frequently called to transport patients from winter resorts to area trauma centers.

Objective: The purpose of this study was to examine helicopter EMS (HEMS) utilization for such patients, and to investigate out-of-hospital clinical variables that might help providers determine the most appropriate utilization of HEMS.

Methods: The study included patients aged ≥ 12 years who were transported by ground EMS (GEMS) or HEMS to a regional trauma center with an acute injury sustained at a winter resort.

Air medical transport of prisoners.

Introduction: The medical problems of the incarcerated population often require emergent transport to medical facilities via air or ground. The transport of this population, however, can be logistically challenging because of the potentially dangerous nature of the patients and requirements for accompanying security personnel.

Methods: A retrospective chart review was conducted of prisoners transported by our air medical service from January 1, 2000 to December 31, 2008.

Air ambulance transport times and advanced cardiac life support interventions during the interfacility transfer of patients with acute ST-segment elevation myocardial infarction.

Objectives: To characterize transport times for the interfacility air ambulance transport of patients with acute ST-segment elevation myocardial infarction (STEMI), to estimate the proportion of patients at risk of in-transport clinical decompensation, and to explore associated risk factors for such.

Methods: The electronic medical records of 35 air ambulance programs in the United States from December 2003 through December 2008 were reviewed. We defined clinical decompensation during transport as the combined outcome of either cardiopulmonary arrest or the receipt of any of a prespecified set of advanced life support (ALS) interventions.

Location of airway management in air medical transport.

Background: Prehospital providers are constantly challenged with the task of managing airways in unpredictable and often inhospitable environments. Air medical transport (AMT) crews must be prepared to work in restrictive spaces with limited resources while in the aircraft. This study examines flight crew success rate and circumstances surrounding airway management in different locations.

Cricothyrotomy in air medical transport.

Background: Airway management is an essential skill for air medical transport (AMT) providers. The endpoint of airway maneuvers is a cricothyrotomy which may be live-saving if other measures fail. We reviewed cricothyrotomy cases in our AMT program to evaluate the success rate and the circumstances surrounding the procedure.

Outcomes of pediatric trauma patients transported from rural and urban scenes.

Objectives: Mortality differences exist between victims of urban and rural trauma. It is unknown if these differences persist in those patients who survive to HEMS transport. This study examined the in-hospital mortality, hospital LOS, and discharge status of pediatric blunt trauma victims transported by HEMS from rural and urban scenes.

Outcomes of blunt trauma victims transported by HEMS from rural and urban scenes.

Objective: Mortality differences exist between victims of urban and rural trauma; however, it is unknown if these differences persist in those patients who survive to HEMS transport. This study examined the in-hospital mortality, length of hospital stay, and discharge status of adult blunt trauma victims transported by HEMS from rural and urban scenes to regional trauma centers.

Methods: Retrospective review of all adult (age >/= 15) HEMS transports in 2001; 271 urban and 141 rural blunt trauma patients were identified from HEMS transport records and the trauma registries at three level one trauma centers.

Use of a triage pain protocol in the ED.

Purposes: This study was designed to evaluate the ability of a triage pain protocol to improve frequency and time to delivery of analgesia for musculoskeletal injuries in the emergency department (ED).

Basic Procedures: Frequency and time to analgesic administration were measured before and after use of a triage pain protocol. The protocol allowed analgesic medications to be given at the time of triage.

Pelvic antishock sheeting.

The authors present a brief technique guide for the application of pelvic antishock sheeting. In the hypotensive blunt trauma patient with discernible pelvic instability, this field-acceptable measure may help to attain some degree of retroperitoneal hemostasis via indirect tamponade. The technique is explained and existing literature reviewed.

Scene transport of pediatric patients injured at winter resorts.

Objective: To examine the characteristics of pediatric patients (age =16 years) injured at winter resort scenes and transported by helicopter emergency medical services (HEMS) or ground EMS (GEMS) ambulance services to regional trauma centers.

Methods: Between 1997 and 2001, a total of 119 patients (GEMS = 69; HEMS = 50) were identified from trauma registries and HEMS transport records. Demographic data, initial vital signs, hospital interventions, and discharge status of the two groups were examined.

Transport of winter resort injuries to regional trauma centers.

Introduction: This study examined the epidemiology of winter resort injuries presenting to regional trauma centers by helicopter (HEMS) or ground (GEMS) ambulance.

Methods: Five hundred seventy-five patients (GEMS 289; HEMS 286) were identified from trauma registries and HEMS transport records. Demographic data, hospital interventions, and discharge status were examined.

Changing attitudes about pain and pain control in emergency medicine.

Oligoanalgesia continues to be a large problem in the ED. An attitude of suspicion, a culture of ignoring the problem, and an environment that is not conducive to change in practice combine to present formidable obstacles for effective pain management in the emergency setting. Overcoming these obstacles for effective analgesia in the ED is not beyond the capabilities of the individual ED, the emergency physician, or the specialty of emergency medicine.

Correlation of change in visual analog scale with pain relief in the ED.

Objectives: To evaluate the validity of change in visual analog Scale (VAS) as a measure of pain relief using a verbal descriptor Scale (VDS) of change in pain.

Methods: A prospective observational study of emergency department patients measured pain with VAS and recorded verbal report of change in pain.

Results: One thousand four hundred ninety patients yielded 1999 comparisons between change in VAS and VDS.

Air medical rapid sequence intubation: How can we achieve success?

Airway management is an essential component of the air medical transport of critically ill or injured patients. Many controversies surround the use of rapid sequence intubation (RSI) in the prehospital setting. The challenges of establishing an airway in this environment may exceed those in the hospital.

Comparison of etomidate and midazolam for prehospital rapid-sequence intubation.

Objective: This study compares etomidate with midazolam for prehospital rapid-sequence intubation (RSI).

Methods: The authors conducted a retrospective review of consecutive intubations at a university-based air medical program from January 1995 to December 2000. Exclusion criteria were patients not undergoing RSI, age <15 years, and incomplete chart data.

Patient expectations for pain relief in the ED.

The objective of the study was to assess patient expectations for pain relief in the ED. A convenience sample of 522 patients with pain and 144 patients without pain were enrolled in a prospective observational study at a university ED. Patients reported a mean expectation for pain relief of 72 % (95% CI 70-74).

The 2003 Air Medical Leadership Congress: findings and recommendations.

To address important concerns facing the air medical community, 149 air medical transport leaders, providers, consultants, and experts met September 4-6, 2003, in Salt Lake City, Utah, for a 3-day summit-the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community. Using data from a Web-based survey, top air medical transport issues were identified in four core areas: safety, medical care, cost/benefit, and regulatory/compliance. This report reviews the findings of previous congresses and summarizes the discussions, findings, recommendations, and proposed industry actions to address these issues as set forth by the 2003 congress participants.

Comparison of the intubating laryngeal mask airway versus laryngoscopy in the Bell 206-L3 EMS helicopter.

Introduction: The purpose of this study is to compare intubation success rate and time to intubation for the intubating laryngeal mask airway (I-LMA) versus direct laryngoscopy (DL) using a manikin model during a simulated in-flight scenario.

Setting: The setting for the study was a University hospital-based air medical program.

Methods: This was a prospective, randomized, crossover trial.

Patient preference for route of pain medication delivery.

We sought to determine Emergency Department (ED) patient preference for oral (p.o.), intramuscular (i.

Pain medication use before ED arrival.

The objective of this study was to determine the frequency and types of pain medications taken before ED arrival based on pain intensity, duration of pain, chief complaint, gender, age, and race. A convenience sample of patients in pain was enrolled in this university hospital-based prospective, observational study. A total of 1233 patients were enrolled.

EMS provider level does not impact use of air medical transport.

Introduction: The local emergency medical services (EMS) provider level within a nearby EMS system changed from EMT-I to paramedic. This increase in level of care was expected to decrease utilization of air medical transport and increase acuity of patients flown.

Setting: Semirural, mountainous area with an annual volume of 2800 transports.

Effect of an airway education program on prehospital intubation.

Introduction: The purpose of this study was to determine the impact of an airway education program (AEP) on prehospital intubation.

Setting: University-based air medical program

Methods: Retrospective review of 372 consecutive intubations for 3 years before and 3 years after the institution of an AEP. Descriptive statistics were used and comparisons were made using chi-square analysis.