The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis.

Objectives: Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED.

Identification of high-risk communities for unattended out-of-hospital cardiac arrests using GIS.

Improving survival rates for out of hospital cardiac arrest (OHCA) at the neighborhood level is increasingly seen as priority in US cities. Since wide disparities exist in OHCA rates at the neighborhood level, it is necessary to locate neighborhoods where people are at elevated risk for cardiac arrest and target these for educational outreach and other mitigation strategies. This paper describes a GIS-based methodology that was used to identify communities with high risk for cardiac arrests in Franklin County, Ohio during the period 2004-2009.

Poisson cluster analysis of cardiac arrest incidence in Columbus, Ohio.

Background: Scarce resources in disease prevention and emergency medical services (EMS) need to be focused on high-risk areas of out-of-hospital cardiac arrest (OHCA).

Objective: Cluster analysis using geographic information systems (GISs) was used to find these high-risk areas and test potential predictive variables.

Methods: This was a retrospective cohort analysis of EMS-treated adults with OHCAs occurring in Columbus, Ohio, from April 1, 2004, through March 31, 2009.

Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology.

Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA).

Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09.

Identifying high-risk geographic areas for cardiac arrest using three methods for cluster analysis.

Objectives:   The objective was to identify high-risk census tracts, defined as those areas that have both a high incidence of out-of-hospital cardiac arrest (OHCA) and a low prevalence of bystander cardiopulmonary resuscitation (CPR), by using three spatial statistical methods.

Methods:   This was a secondary analysis of two prospectively collected registries in the city of Columbus, Ohio. Consecutive adult (≥18 years) OHCA patients, restricted to those of cardiac etiology and treated by emergency medical services (EMS) from April 1, 2004, to April 30, 2009, were studied.

Prehospital factors associated with mortality in injured air medical patients.

Background: Air medical transport provides rapid transport to definitive care. Overtriage and the expense and risk of transport may offset survival benefits.

Objective: We assessed the ability of prehospital factors to predict resource need for helicopter-transported patients.

Modification of Glasgow Coma Scale criteria for injured elders.

Objectives: An abnormal field Glasgow Coma Scale (GCS) score of ≤13 has been used in our emergency medical services (EMS) system to prompt transport to a trauma center. For elders, Ohio has recently adopted a GCS of ≤14 to prompt EMS transport to a trauma center, as older patients respond differently to trauma and may benefit from a different GCS threshold. This study sought to determine if a field GCS of 14 is an appropriate cutoff to initiate transport to a trauma center among injured elders.

Surrogate markers of transport distance for out-of-hospital cardiac arrest patients.

Background: Transport of out-of-hospital cardiac arrest (OHCA) patients expeditiously to appropriately equipped hospitals is of paramount importance.

Objective: We sought to test the correlation of the centroids of geographic units with the actual transport distance for OHCA patients in order to determine the most appropriate surrogate marker of location for future planning, protocol development, and research projects.

Methods: This was a prospective, observational analysis of OHCA events in Portland, Oregon.

Rocuronium versus succinylcholine in air medical rapid-sequence intubation.

Background: It is not known how rocuronium compares with succinylcholine in its effect on intubation success during air medical rapid-sequence intubation (RSI).

Objective: To examine the impact of succinylcholine use on the odds of successful prehospital intubation.

Methods: We performed a retrospective analysis of a critical care transport service administrative database containing patient encounters from 2004 to 2008.

Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF.

Are all trauma centers created equally? A statewide analysis.

Objectives: Prior work has shown differences in mortality at different levels of trauma centers (TCs). There are limited data comparing mortality of equivalently verified TCs. This study sought to assess the potential differences in mortality as well as discharge destination (discharge to home vs.

A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers.

Objectives: National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity.

Methods: Prospective, cohort study of OOHCA patients in 11 Resuscitation Outcomes Consortium (ROC) sites across North America.

Prehospital electrocardiograms (ECGs) do not improve the process of emergency department care in hospitals with higher usage of ECGs in non-ST-segment elevation myocardial infarction patients.

Background: This article will describe the impact of prehospital electrocardiogram (ECG) use on emergency department (ED) processes of care for non-ST-segment elevation myocardial infarction (NSTEMI) patients and assess the characteristics associated with prehospital ECG use.

Methods: This is a retrospective, multicenter, observational analysis of NSTEMI patients captured by the National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (NCDR ACTION-GWTG) in 2007. Patient and hospital data were stratified by documentation of a prehospital ECG (pECG).

Level I versus Level II trauma centers: an outcomes-based assessment.

Objective: Trauma centers improve outcomes compared with nontrauma centers, although the relative benefit of different levels of major trauma centers (Level I vs. Level II hospitals) remains unclear. We sought to determine whether there was a difference in the patient outcome in trauma victims taken to Level I versus Level II trauma centers.

Distance impacts mortality in trauma patients with an intubation attempt.

Objective: Out-of-hospital endotracheal intubation (OOH-ETI) has been associated with adverse outcomes; whether transport distance changes this relationship is unclear. We sought to determine whether patients injured farther from the hospital benefit more from OOH-ETI than those injured closer.

Methods: We performed a retrospective cohort analysis of trauma patients > 14 years old transported to two Level 1 trauma centers and surviving to admission from 2000 to 2003.

The impact of rapid sequence intubation on trauma patient mortality in attempted prehospital intubation.

Background: Rapid sequence intubation (RSI) has been instituted in some prehospital settings to improve the success of endotracheal intubation (ETI); whether RSI improves outcomes is unclear.

Objectives: We sought to determine if trauma patients intubated with RSI in the prehospital setting had better survival compared to those intubated without RSI.

Methods: Retrospective cohort analysis.

Endotracheal intubation increases out-of-hospital time in trauma patients.

Objectives: Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables.

Methods: Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003.

Adequacy of online medical command communication and emergency medical services documentation of informed refusals.

Background: In the out-of-hospital setting, when emergency medical services (EMS) providers respond to a 9-1-1 call and encounter a patient who wishes to refuse medical treatment and/or transport to the hospital, the EMS providers must ensure the patient possesses medical decision-making capacity and obtain an informed refusal. In the city of Cleveland, Ohio, Cleveland EMS completes a nontransport worksheet that prompts the paramedics to evaluate specific patient characteristics that can influence medical decision-making capacity and then discuss the risks of refusing with the patient. Cleveland EMS then contacts an online medical command (OLMC) physician to authorize the refusal.