Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort.

Study Objective: The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality.

Methods: This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged > or =15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007.

Assessment of risk tolerance for adverse events in emergency department chest pain patients: a pilot study.

Background: Emergency physicians commonly encounter low-probability/high-morbidity decisions, and chest pain is a prime example. Negative outcomes are improbable but feared, resulting in substantially more patients admitted for chest pain than have important disease. The literature gives little guidance on patient preferences for decision-making when the negative outcomes are unlikely but potentially severe.

Expert verification of the knowledge base of FEED--a feedback expert system for EMS documentation.

Feedback Expert System for Emergency Medical Services (EMS) Documentation (FEED) has a rule-based knowledge base (KB) that was verified against specifications in a focus group consisting of six experts. The focus group suggested changes in almost all rules discussed, indicating that the KB did not meet specifications at that stage of development. However, enough information was gathered to address these issues in the next iteration of development.

Information needs of pre-hospital care providers - a requirements analysis.

To assess information needs of Emergency Medical Services (EMS) personnel and the potential of electronic decision support tools, we surveyed 39 paramedic students and practicing EMS personnel. We found frequent use of paper-based tools, with imperfect accessibility and ease of use. Potential electronic decision support tools were rated as helpful, but some alerts were rated low.

Expert validation of the knowledge base for E-CAD - a pre-hospital dispatch triage decision support system.

The knowledge base (KB) for E-CAD (Enhanced Computer-Aided Dispatch), a triage decision support system for Emergency Medical Dispatch (EMD) of medical resources in trauma cases, is being evaluated. We aim to achieve expert consensus for validation and refinement of the E-CAD KB using the modified Delphi technique. Evidence-based, expert-validated and refined KB will provide improved EMD practice guidelines and may facilitate acceptance of the E-CAD by state-wide professionals.

Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.

Background And Objective: Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol.

Methods: Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis.

Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation.

Objective: The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR.

Methods: In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.

Cost-utility analysis of emergency department thoracotomy for trauma victims.

Background: Our objective was to assess the cost-effectiveness of emergency department thoracotomy (EDT) performed on both penetrating and blunt trauma victims, using both published survival and outcome data and previously unaccounted for data on the cost of occupational exposure.

Methods: Cost-utility analysis was performed using decision-analytic models constructed for both penetrating and blunt trauma scenarios. Survival and impairment data, the rates and costs of occupational exposure, and the utilities of neurologic impairment and provider seroconversion were all based on published literature.

Relationship between knowledge of cardiopulmonary resuscitation guidelines and performance.

Objective: Despite widespread training with CPR guidelines, CPR is often poorly performed. We explore relationships between knowledge of CPR guidelines and performance (compression rate, compression depth, compression to ventilation ratio, and ventilation volume).

Methods: Sixty professional EMTs were sampled at 26 randomly ordered EMS response stations from an urban system of 31 stations.

Procedural sedation in the acute care setting.

Many patients require sedation during diagnostic or therapeutic procedures. Ideally, procedural sedation minimizes the patient's awareness and discomfort while maintaining the patient's safety. Appropriate monitoring by trained personnel is the key to successful procedural sedation.