Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle.

Introduction: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.

Quality of Life Differences in Children and Adolescents With 0, 1 to 2, or 3+ Persistent Postconcussion Symptoms.

Context: Persistent postconcussion symptoms (PPCSs) are associated with lower health-related quality of life (HRQoL) in children and adolescents. Despite commonly cited criteria for PPCSs involving 3 or more complaints, many individuals experience just 1 or 2 symptoms that may still negatively affect HRQoL.

Objective: To determine differences in HRQoL between children and adolescents with 0, 1 to 2, or 3+ parent-reported persistent symptoms at 1 month postconcussion.

Individual Symptom Report Prevalence in Children and Adolescents With One, Two, and Three or More Persistent Symptoms After Concussion: A Brief Report.

Objective: To examine differences in individual symptom report prevalence between children and adolescents experiencing 1 to 2 versus ≥3 persistent postconcussion symptoms.

Design: A prospective cohort study.

Setting: Three community practice concussion clinics within a family practice network.

A CIRCULATION-FIRST APPROACH FOR RESUSCITATION OF TRAUMA PATIENTS WITH HEMORRHAGIC SHOCK.

The original guidelines of cardiopulmonary resuscitation focused on the establishment of an airway and rescue breathing before restoration of circulation through cardiopulmonary resuscitation. As a result, the airway-breathing-circulation approach became the central guiding principle of resuscitation. Despite new guidelines by the American Heart Association for a circulation-first approach, Advanced Trauma Life Support guidelines continue to advocate for the airway-breathing-circulation sequence.

Presence of Persistent Parent Reported Emotional and Behavioral-Related Concussion Symptoms Is Associated with Lower Health-Related Quality of Life in Adolescent Athletes.

Persistent concussion symptoms in adolescents are associated with lower health-related quality of life (HRQOL). The association between persistent emotional and behavioral-related concussion symptoms (EBS) and HRQOL is unknown, however. This study was a prospective cohort of adolescent athletes presenting to a concussion clinic within three days post-concussion and completing a one-month follow-up.

Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document.

Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. Multiple cardiac arrest airway management techniques are available to EMS clinicians including bag-valve-mask (BVM) ventilation, supraglottic airways (SGAs), and endotracheal intubation (ETI). Important goals include achieving optimal oxygenation and ventilation while minimizing negative effects on physiology and interference with other resuscitation interventions.

The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput.

Study Objective: We assess the effect of emergency department (ED) operational stressors on clinician scheduling and throughput.

Methods: We evaluated 2014 to 2018 data from a national ED group. Operational stressors included measures of workload, patient acuity, and complexity.

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.

Objective: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators.

Characteristics of Pediatric and Adolescent Concussion Clinic Patients With Postconcussion Amnesia.

Objective: The current study examines the demographics, injury characteristics, and outcomes associated with the presence of postconcussion amnesia in young concussion clinic patients.

Design: Cross-sectional, retrospective clinical cohort.

Setting: Concussion services clinic.

Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases.

Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks.

Retrospective Validation of a Protocol to Limit Unnecessary Transport of Assisted-living Residents Who Fall.

Abstract Objective. Emergency medical services (EMS) often transports patients who suffer simple falls in assisted-living facilities (ALFs). An EMS "falls protocol" could avoid unnecessary transport for many of these patients, while ensuring that patients with time-sensitive conditions are transported.

Variability in discharge instructions and activity restrictions for patients in a children's ED postconcussion.

Objective: The objective of this study was to describe discharge instructions given to school-aged patients evaluated in a children's emergency department (ED) following concussion.

Methods: This was a retrospective cohort study of children 6 to 18 years evaluated in a dedicated children's ED at a level I trauma center in 2008 following acute head trauma regardless of mechanism, identified by any of 27 International Classification of Disease, Ninth Revision diagnoses for head injury, concussion, or skull fracture. Included were those presentations consistent with the Zurich definition for concussion.

Epidemiology of out-of hospital pediatric cardiac arrest due to trauma.

Objective: To determine the epidemiology and survival of pediatric out-of-hospital cardiac arrest (OHCA) secondary to trauma.

Methods: The CanAm Pediatric Cardiac Arrest Study Group is a collaboration of researchers in the United States and Canada sharing a common goal to improve survival outcomes for pediatric cardiac arrest. This was a prospective, multicenter, observational study.

Air medical providers' physiological response to a simulated trauma scenario.

Introduction: We assessed heart rate as a surrogate measure of psychological response to determine whether high-fidelity simulation reproduces a stressful atmosphere for air medical providers.

Methods: A prospective simulation study of air-medical providers at a level 1 trauma center randomized to adult or pediatric trauma scenarios in an ambulance. Continuous closed circuit video and wireless heart rate monitoring was conducted from the time of initial patient simulator contact to completion of packaging for transport.

Field-induced therapeutic hypothermia for neuroprotection after out-of hospital cardiac arrest: a systematic review of the literature.

Background: Emergency Medical Services (EMS) has started to embrace the early use of therapeutic hypothermia as standard treatment to improve neurological recovery in out-of hospital cardiac arrest (OHCA) survivors.

Objective: We conducted a systematic review to provide an overall description of the current literature on the use of therapeutic hypothermia in OHCA and to identify possible gaps in the literature.

Methods: Comprehensive searches of MEDLINE, PubMed, CINAHL, and ISI Web of Science from 1950 to March 2009, and EMBASE from 1988 to March 2009 were performed.

Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions, ventilations, and induced hypothermia: the Wake County experience.

Study Objective: We assess survival from out-of-hospital cardiac arrest after community-wide implementation of 2005 American Heart Association guidelines.

Methods: This was an observational multiphase before-after cohort in an urban/suburban community (population 840,000) with existing advanced life support. Included were all adults treated for cardiac arrest by emergency responders.

Impact of the privacy rule on the study of out-of-hospital pediatric cardiac arrest.

Introduction: The Privacy Rule, a follow-up to the Health Insurance Portability and Accountability Act, limits distribution of protected health information. Compliance with the Privacy Rule is particularly challenging for prehospital research, because investigators often seek data from multiple emergency medical services (EMS) and receiving hospitals.

Objective: To describe the impact of the Privacy Rule on prehospital research and to present strategies to optimize data collection in compliance with the Privacy Rule.

A simulation trial of traditional dispatcher-assisted CPR versus compressions--only dispatcher-assisted CPR.

Objectives: Growing evidence indicates that it may not be essential to deliver ventilations in the first few minutes of CPR. We compared time to delivery of first compression in traditional CPR with ventilations and compressions to compression-only CPR performed by untrained laypersons assisted by a mock 911 dispatcher.

Methods: This randomized-controlled simulation study included a convenience sample of English-speaking emergency department visitors during a 6-month period.

Advanced cardiac life support in out-of-hospital cardiac arrest.

Background: The Ontario Prehospital Advanced Life Support (OPALS) Study tested the incremental effect on the rate of survival after out-of-hospital cardiac arrest of adding a program of advanced life support to a program of rapid defibrillation.

Methods: This multicenter, controlled clinical trial was conducted in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. Of those patients, 1391 were enrolled during the rapid-defibrillation phase and 4247 during the subsequent advanced-life-support phase.

Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates.

Study Objective: Many centers optimize their emergency medical services (EMS) systems to achieve a target defibrillation response interval of "call received by dispatch" to "arrival at scene by responder with defibrillator" in 8 minutes or less for at least 90% of cardiac arrest cases. The objective of this study was to analyze survival as a function of time to test the evidence for this standard.

Methods: This prospective cohort study included all adult, cardiac etiology, out-of-hospital cardiac arrest cases from phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) study.

Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival.

Study Objective: The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group.

Methods: This prospective cohort included all adults with an EMS-witnessed cardiac arrest in the 21 communities of the Ontario Prehospital Advanced Life Support (OPALS) study.

A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest.

Study Objective: More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic review of treatments for sudden cardiac arrest was limited by suboptimal data.