Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?

Background: Despite negative troponins and nonischemic electrocardiograms (ECGs), patients at moderate risk for acute coronary syndrome (ACS) are frequently admitted. The objective of this study was to describe the major adverse cardiac event (MACE) rate in moderate-risk patients and how it differs based on history of coronary artery disease (CAD).

Methods: A secondary analysis of the HEART Pathway implementation study was conducted.

Prehospital time for patients with acute cardiac complaints: A rural health disparity.

Objective: Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints.

Methods: The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9-1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013-6/1/2018.

Prehospital Cross-Sectional Study of Drowning Patients Across the United States.

Introduction: Every year drowning is responsible for 7% of injury-related deaths worldwide, making it the third leading cause of unintentional injury-related death. However, in the United States, little is known regarding the prehospital presentation and management of these patients. The purpose of this study was to describe the drowning population in the United States, with a focus on prehospital time intervals, transport, and cardiac arrest frequency.

Barriers to Physical Activity Among Emergency Medical Services Professionals.

Background: Emergency medical services (EMS) professionals demonstrate low adherence to physical activity guidelines and experience a high prevalence of obesity and incidence of injury. The authors investigate the barriers to participating in physical activity among EMS professionals.

Methods: The EMS professionals employed by 15 North Carolina EMS agencies were surveyed with validated items.

One Notable Complication of Nasopharyngeal Airway: A Case Report.

Introduction: The nasopharyngeal airway (NPA) is used by emergency providers and first responders to assist with oxygenation in obtunded, critically ill patients. There are few recorded NPA complications.

Case Report: We describe a unique case in which a patient went multiple days with recurrent symptoms of upper airway obstruction secondary to retained NPA.

Prehospital Trauma Scene and Transport Times for Pediatric and Adult Patients.

Introduction: Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes.

One-Year Mortality and Associated Factors in Patients Receiving Out-of-Hospital Naloxone for Presumed Opioid Overdose.

Study Objective: Out-of-hospital naloxone has been championed as a lifesaving solution during the opioid epidemic. However, the long-term outcomes of out-of-hospital naloxone recipients are unknown. The objectives of this study are to describe the 1-year mortality of presumed opioid overdose victims identified by receiving out-of-hospital naloxone and to determine which patient factors are associated with subsequent mortality.

Medical Provider Ballistic Protection at Active Shooter Events.

There is some controversy about whether ballistic protective equipment (body armor) is required for medical responders who may be called to respond to active shooter mass casualty incidents. In this article, we describe the ongoing evolution of recommendations to optimize medical care to injured victims at such an incident. We propose that body armor is not mandatory for medical responders participating in a rapid-response capacity, in keeping with the Hartford Consensus and Arlington Rescue Task Force models.

Wilderness Emergency Medical Services Medical Director Course: core content developed with Delphi technique.

The National Association of Emergency Medical Services Physicians' (NAEMSP) position on the role of medical oversight within an operational Emergency Medical Service (EMS) program highlights the importance of integrating specially trained medical directors within the structure of these programs. In response, the NAEMSP Wilderness EMS (WEMS) Committee recognized the need for the development of an educational curriculum to provide physicians with the unique skills needed to be a medical director for a WEMS agency. This paper describes the Delphi process used to create the subject matter core content, as well as the actual core content developed.

Injuries in mountain bike racing: frequency of injuries in endurance versus cross country mountain bike races.

Objective: To determine the frequency of injuries requiring medical attention among mountain bike racers at endurance races (6 hours or greater in duration) versus traditional cross country races (less than 6 hours duration) and to determine the medical support available at races.

Methods: A survey was developed to determine participants' experience level, previous injuries, and demographic information. An additional survey was completed by injured riders to determine injuries and treatment received.

Advanced wilderness life support education using high-technology patient simulation.

Objective: (1) To determine if, after using the simulation mannequin SimMan in a wilderness "megacode" exercise, participants believe high-tech simulators are an effective tool for learning wilderness medicine skills. (2) To determine if participants believe high-tech simulation mannequins should be used with more or less frequency in future wilderness medicine exercises.

Methods: After completing a basic training session outlining the capabilities of SimMan and completing a wilderness megacode (defined as a series of progressive conditions that accumulate over time) using SimMan, participants were surveyed to ascertain whether they perceived SimMan to be an effective teaching tool for wilderness medical skills and to determine if they would like SimMan to be used with greater frequency at future wilderness medicine courses.

A skin abscess model for teaching incision and drainage procedures.

Background: Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure.

Methods: We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes.