Prehospital Surgical Airway Management Skills in a Rural Emergency Medical Service System.

Background: The objective of this study is to describe the education, training, and use of prehospital surgical airways in a rural Emergency Medical Service (EMS) system.

Materials And Methods: We conducted an internet-based survey instrument of all advanced life support (ALS) EMS agencies in a seven-county rural EMS system in Pennsylvania. ALS agencies were queried regarding basic demographic information as well as the number of surgical airways performed in the previous 10 years as well as the education and training of EMS providers in surgical airways.

An unusual presentation of spontaneous spinal epidural hematoma.

We report a rare case of spontaneous spinal epidural hematoma. Various presentations may occur, most commonly including neck pain, interscapular pain, radicular pain, and paralysis. This condition is frequently associated with paralysis and long-term disability.

A rare case of sphenoid sinus lymphoma.

Malignancy of the sphenoid sinus is rare. Tumors may extend to adjacent anatomic structures before detection and may be easily missed. Outcomes are typically poor and vary by tumor type.

An itchy rash and muscle weakness.

Dermatomyositis is a rare disease affecting primarily skin and muscles and is associated with malignancies, especially in at-risk patients. Clinical presentations vary widely but proximal muscle weakness and typical skin findings should prompt consideration of the diagnosis. Immunosuppressive therapy is required, as is continued screening for malignant disease during follow-up.

The effectiveness of a formal curriculum in teaching mass casualty management.

Objective: To improve knowledge, skills, and confidence in mass casualty management through design and im-plementation of a formal educational curriculum.

Design: Observational study using a mixed-methods formal educational training curriculum.

Setting: Rural Emergency Medical Services (EMS) system in Pennsylvania.

Sydenham's Chorea.

Background: Sydenham's chorea is the most common acquired movement disorder of adolescence. This clinical manifestation of acute rheumatic fever has a clear and documented relationship with Group A streptococcal infections. The symptoms are involuntary choreiform movements that can affect the face and all extremities.

Type I AV fistula of the thoracic spinal cord.

Type I AV fistulas of the spinal cord are exceedingly rare. The average age at diagnosis is 50. Clinical presentation is often very non-specific, and sensory deficits and sphincter dysfunction may also occur.

A pilot, prospective, randomized trial of video versus direct laryngoscopy for paramedic endotracheal intubation.

Background: Prehospital intubation poses several unique challenges. Video assisted laryngoscopy has been shown to help increase intubation success in the hospital setting; however, little prospective data have examined video assisted laryngoscopy in traditional ground ambulance agencies.

Methods: We performed a randomized, cross-over, non-blinded trial in ground ambulances comparing first attempt success and overall intubation success between video assisted laryngoscopy using the King Video Laryngoscope (KVL) and direct laryngoscopy (DL).

Reduction in unavailable-for-response episodes in a private emergency medical services agency.

Objective: Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/benefit analysis.

Design: The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes.

Prevalence of Risk Factors for Coronary Artery Disease in Pennsylvania (USA) Firefighters.

Introduction: Firefighting is a physically demanding profession. Heart disease remains the number one killer of firefighters. Many firefighters have multiple risk factors, putting them at risk for sudden cardiac events.

Portable suction unit failure in a rural EMS system.

Introduction: Portable suction units used by EMS personnel are utilized infrequently and often are powered by batteries. Lack of use and inspection often results in failure of the device when it is needed. The purpose of this study was to examine the incidence of portable suction unit failure in a rural EMS system and to identify the reasons for failures.

Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain?

Introduction: The aim of this study was to assess the effectiveness of written and moulage scenarios using video instruction for mass-casualty triage by evaluating skill retention at six months post intervention.

Methods: Prehospital personnel were instructed in the START method of mass-casualty triage using a video. Moulage and written testing were completed by each participant immediately after instruction and at six months post instruction.

Analysis of complaints in a rural emergency medical service system.

Introduction: The health care industry is increasingly focused on customer service, one aspect of which is dealing with customer complaints. The purpose of this study was to assess the prevalence and nature of complaints against prehospital providers in a rural Emergency Medical Services (EMS) system.

Methods: This retrospective study of logged complaints utilized data from May 28, 1999 through September 26, 2008.

A novel method for continuous environmental surveillance for carbon monoxide exposure to protect emergency medical service providers and patients.

Background: Carbon monoxide exposure is an important, but frequently undiagnosed, cause for Emergency Medical Services (EMS) response. Its elusive characteristics and non-specific symptoms make detection difficult without monitoring devices. Consequently, both patients and EMS providers are at increased risk of harm from such exposures.

A two-hour intervention using START improves prehospital triage of mass casualty incidents.

Objective: There are few data concerning the ability of prehospital providers to triage patients in a mass casualty incident (MCI). The authors evaluated the effectiveness of a brief educational intervention on MCI triage with a written scenario and test. The START method (simple triage and rapid treatment) was used.