Predictors of intubation success and therapeutic value of paramedic airway management in a large, urban EMS system.

Background: Endotracheal intubation (ETI) is commonly used by paramedics for definitive airway management. The predictors of success and therapeutic value with regard to oxygenation are not well studied.

Objectives: 1) To explore the relationship between intubation success and perfusion status, Glasgow Coma Scale (GCS) score, and end-tidal carbon dioxide (EtCO2); 2) to describe the incidence of unrecognized esophageal intubations with use of continuous capnometry; and 3) to document the incremental benefit of invasive versus noninvasive airway management techniques in correcting hypoxemia.

The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation.

One of the purported benefits to invasive prehospital airway management is the prevention of aspiration; however, aspiration events may occur before the arrival of prehospital personnel. We explore the timing of aspiration in patients with severe traumatic brain injury (TBI) undergoing paramedic rapid sequence intubation (RSI). Severely head-injured (Glasgow Coma Scale [GCS] score 3-8) adults were prospectively enrolled into the San Diego Paramedic RSI Trial.

The association between field Glasgow Coma Scale score and outcome in patients undergoing paramedic rapid sequence intubation.

Early intubation is standard for treating severe traumatic brain injury (TBI). Aeromedical crews and select paramedic agencies use rapid sequence intubation (RSI) to facilitate intubation after TBI, with Glasgow Coma Scale (GCS) score commonly used as a screening tool. To explore the association between paramedic GCS and outcome in patients with TBI undergoing prehospital RSI, paramedics prospectively enrolled adult major trauma victims with GCS 3-8 and clinical suspicion for head trauma to undergo succinylcholine-assisted intubation as part of the San Diego Paramedic RSI Trial.

The association between operator confidence and accuracy of ultrasonography performed by novice emergency physicians.

The variable accuracy of emergency department (ED) ultrasound described in the literature has limited its utility as the sole imaging modality in critical decision making. Although ultrasound accuracy is highly dependent upon the technical abilities of the operator and conditions unique to each patient, no previous study of ED ultrasound has included estimates of operator confidence. This prospective observational study explores the association between operator confidence and the accuracy of ED ultrasound.

Ventilation patterns in patients with severe traumatic brain injury following paramedic rapid sequence intubation.

Introduction: Inadvertent hyperventilation has been documented during aeromedical transports but has not been studied following paramedic rapid sequence intubation (RSI). The San Diego Paramedic RSI Trial was designed to study the impact of paramedic RSI on outcome in patients with severe head injury. This analysis explores ventilation patterns in a cohort of trial patients undergoing end-tidal CO2 (ETCO2) monitoring.

The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel.

Background: Aeromedical crews routinely use needle thoracostomy (NT) and tube thoracostomy (TT) to treat major trauma victims (MTVs) with potential tension pneumothorax; however, the efficacy of prehospital NT and TT is unclear.

Objectives: To explore the efficacy of aeromedical NT and TT in MTVs.

Methods: A retrospective chart review was performed using prehospital medical records and the county trauma registry over a seven-year period.

Hospital bed surge capacity in the event of a mass-casualty incident.

Introduction: Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualty incident.

Objective: To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.

Methods: Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility.

The three-phase model of cardiac arrest as applied to ventricular fibrillation in a large, urban emergency medical services system.

Background: Cardiac arrest is responsible for significant morbidity and mortality, with consistently poor outcomes despite the rapid availability of prehospital personnel for defibrillation attempts in patients with ventricular fibrillation (VF). Recent evidence suggests a period of cardiopulmonary resuscitation (CPR) prior to defibrillation attempts may improve outcomes in patients with moderate time since collapse (4-10 min).

Objectives: To determine cardiac arrest outcomes in our community and explore the relationship between time since collapse, performance of bystander CPR, and survival.

The UCSD Research Associate Program: a recipe for successfully integrating undergraduates with emergency medicine research.

Previous reports have documented the successful integration of undergraduates into the Emergency Department (ED) to assist in data collection for various research projects, with resultant improvements in departmental academic productivity. These reports have not detailed the exact procedures required to institute such a program. Over 100 undergraduates from three institutions currently participate in the UCSD Research Associate Program.

The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients.

Background: An increase in mortality has been documented in association with paramedic rapid sequence intubation (RSI) of severely head-injured patients. This analysis explores the impact of hypoxia and hyperventilation on outcome.

Methods: Adult severely head-injured patients (Glasgow Coma Scale score of 3-8) unable to be intubated without neuromuscular blockade underwent paramedic RSI using midazolam and succinylcholine; rocuronium was administered after confirmation of tube position.

Air medical transport of severely head-injured patients undergoing paramedic rapid sequence intubation.

Introduction: The San Diego Paramedic Rapid Sequence Intubation (RSI) Trial documented an increase in mortality with paramedic RSI of patients with severe traumatic brain injury. This analysis explores the impact of air medical transport of trial patients on outcome.

Methods: Adult trauma victims with severe traumatic brain injury (Glasgow Coma Scale score of 3 to 8) were prospectively enrolled.