Virtual Objective Structured Clinical Examination Experiences and Performance in Physical Medicine and Rehabilitation Residency.

Background: Virtual education has been described before and during the COVID-19 pandemic. Studies evaluating virtual objective structured clinical examinations with postgraduate learners are lacking. This study (1) evaluated the experiences of all participants in a virtual objective structured clinical examination and (2) assessed the validity and reliability of selected virtual objective structured clinical examination stations for skills in physical medicine and rehabilitation.

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial.

Objective: Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation.

Design: Multi-site, parallel, evaluator-masked randomized controlled trial.

Setting: Home-setting in three Canadian cities.

Walking while talking: validation in older adults with lower-limb amputation.

Background: Walking while talking (WWT) is a dual-task (cognitive and motor) performance test that has not yet been validated in older adults with lower-limb amputation (LLA). WWT is composed of two sections: WWT-simple (walking while reciting every letter of the alphabet) and WWT-complex (walking while reciting every other letter of the alphabet).

Objective: To determine the validity, and provide normative data and a new scoring system for the WWT test in older adults with LLA.

A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries.

Background: Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.

Objectives: The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.

Validity of measures for life space mobility and physical activity in older adults with lower-limb amputation.

Background: Older adults with lower-limb amputations (LLAs) often experience lack of confidence and poor balance, which limits their mobility. There are few validated measures for assessing these outcomes in the LLA population.

Objectives: To assess the validity of the Life Space Assessment (LSA) and the Physical Activity Scale for the Elderly (PASE) for older adults with LLA.

Changes in Field Termination of Resuscitation and Survival Rates After an Educational Intervention to Promote on Scene Resuscitation for Out-of-Hospital Cardiac Arrest.

Background: Emergency medical services (EMS) agencies with higher field termination-of-resuscitation (TOR) rates tend to have higher survival rates from out-of-hospital cardiac arrest (OHCA). Whether EMS agencies can improve survival rates through efforts to focus on resuscitation on scene and optimize TOR rates is unknown.

Objective: The goal of this study was to determine if an EMS agency's efforts to enhance on-scene resuscitation were associated with increased TOR and OHCA survival with favorable neurologic outcome.

Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation.

Background: While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement.

Objective: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation.

Study Design: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial.

Transport Home and Terminal Extubation by Emergency Medical Services: An Example of Innovation in End-of-Life Care.

For most terminally ill patients, the preferred place of death is home. Previous literature has demonstrated the feasibility of at-home terminal extubation performed by critical care and hospice physicians. This case report describes a terminal extubation performed by a paramedic under the direct supervision of an Emergency Medical Services physician in the patient's home.

Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study.

Objective: St. Paul's Early Discharge Rule was derived to determine which patients could be safely discharged from the emergency department after a 1-hour observation period following naloxone administration for opiate overdose. The rule suggested that patients could be safely discharged if they could mobilize as usual and had a normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score.

Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound.

Objectives: Rapid identification of esophageal intubations is critical to avoid patient morbidity and mortality. Continuous waveform capnography remains the gold standard for endotracheal tube (ETT) confirmation, but it has limitations. Point-of-care ultrasound (POCUS) may be a useful alternative for confirming ETT placement.

The usefulness of electrodiagnostic studies in the diagnosis and management of neuromuscular disorders.

Introduction: This study seeks to evaluate the usefulness of electrodiagnostic (EDX) studies in terms of the patient's diagnosis and subsequent management and to identify patient groups in which EDX is particularly useful.

Methods: The records of new patients referred to a single tertiary hospital EDX laboratory during 1 calendar year were reviewed to determine whether results of EDX studies led to a changed diagnosis and/or management plan. Logistic regression was used to determine whether any factors were associated with changed diagnosis or management.

Compulsory Use of the Backboard is Associated with Increased Frequency of Thoracolumbar Imaging.

Background: Backboards have been shown to cause pain in uninjured patients. This may alter physical exam findings, leading emergency department (ED) providers to suspect a spinal injury when none exists resulting in additional imaging of the thoracolumbar spine. New York had previously employed a "Spinal Immobilization" protocol that included compulsory backboard application for all patients with suspected spinal injuries.

Women in Emergency Medicine Residency Programs: An Analysis of Data From Accreditation Council for Graduate Medical Education-approved Residency Programs.

Objective: Understanding the factors associated with attracting women to a residency program would help residency program leadership build programs that are appealing to women candidates. The objective of this study was to identify factors associated with the percentage of women residents in emergency medicine (EM) residency programs.

Methods: A list of 161 Accreditation Council for Graduate Medical Education-approved EM residencies was compiled.

Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest.

Introduction: Guidelines endorse intravenous (IV) and intraosseous (IO) medication administration for cardiac arrest treatment. Limited clinical evidence supports this recommendation. A multiagency, retrospective study was performed to determine the association between parenteral access type and return of spontaneous circulation (ROSC) in out of hospital cardiac arrest.

Decisions by Default: Incomplete and Contradictory MOLST in Emergency Care.

Objectives: What patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms.

Procedures: MOLST forms that accompanied 100 patients who were transported to an ED were collected and their contents analyzed.

Patients Immobilized with a Long Spine Board Rarely Have Unstable Thoracolumbar Injuries.

Most Emergency Medical Services (EMS) protocols require spine immobilization with both a cervical collar and long spine board for patients with suspected spine injuries. The goal of this research was to determine the prevalence of unstable thoracolumbar spine injuries among patients receiving prehospital spine immobilization: a 4-year retrospective review of adult subjects who received prehospital spine immobilization and were transported to a trauma center. Prehospital and hospital records were linked.

Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study.

Background: Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.

Sufficient catheter length for pneumothorax needle decompression: a meta-analysis.

Introduction: Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.

"We Are Strangers Walking Into Their Life-Changing Event": How Prehospital Providers Manage Emergency Calls at the End of Life.

Context: Emergency 911 calls are often made when the end stage of an advanced illness is accompanied by alarming symptoms and substantial anxiety for family caregivers, particularly when an approaching death is not anticipated. How prehospital providers (paramedics and emergency medical technicians) manage emergency calls near death influences how and where people will die, if their end-of-life choices are upheld and how appropriately health care resources are used.

Objectives: The purpose of this study was to explore and describe how prehospital providers assess and manage end-of-life emergency calls.

Parenteral midazolam is superior to diazepam for treatment of prehospital seizures.

Introduction: Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures.

Methods: A retrospective chart review of a single, large, commercial agency during a 29-month period was performed.

Frequency of manuscript publication following presentation of EMS abstracts at national meetings.

Introduction: Specialized knowledge and a scientific body of literature are the foundation of the recognition of Emergency Medical Services (EMS) as a subspecialty within emergency medicine (EM). Emergency Medical Services research often is presented at national meetings and published in abstract form, but full publication occurs less frequently. Problem The primary goal of the study was to determine the rate at which EMS-related research presented at selected conferences went on to manuscript publication.

Preparation for frontline end-of-life care: exploring the perspectives of paramedics and emergency medical technicians.

Background: Prehospital emergency providers (emergency medical technicians [EMTs] and paramedics) who respond to emergency calls for patients near the end of life (EOL) make critical decisions in the field about initiating care and transport to an emergency department.

Objective: To identify how a sample of prehospital providers learned about EOL care, their perceived confidence with and perspectives on improved preparation for such calls.

Design: This descriptive study used a cross-sectional survey design with mixed methods.