Objective: To determine the rate of unrecognized endotracheal tube misplacement when performed by emergency medical services (EMS) personnel in a mixed urban and rural setting.
Methods: The authors conducted a prospective, observational analysis of out-of-hospital endotracheal intubations (EIs) performed by EMS personnel serving a mixed urban, suburban, and rural population. From July 1, 1998, to August 30, 1999, emergency physicians assessed and recorded the position of out-of-hospital EIs using auscultation, direct laryngoscopy, infrared CO(2) detectors, esophageal detector devices, and chest x-ray. The state EMS database also was reviewed to determine the number of EIs involving patients transported to the authors' medical center and paramedic assessment of success for these encounters.
Results: A total of 167 out-of-hospital EIs were recorded, of which 136 (81%) were deemed successful by EMS personnel. Observational forms were completed for 109 of the 136 patients who arrived intubated to the emergency department. Of the studied patients, 12% (13 of 109) were found to have misplaced endotracheal tubes. For the patients with unrecognized improperly placed tubes, 9% (10 of 109) were in the esophagus, 2% (2 of 109) were in the right main stem, and 1% (1 of 109) were above the cords. Paramedics serving urban and suburban areas did not perform significantly better (p < 0.05) than intermediate-level providers serving areas that are more rural.
Conclusions: The incidence of unrecognized misplacement of endotracheal tubes by EMS personnel may be higher than most previous studies, making regular EMS evaluation and the out-of-hospital use of devices to confirm placement imperative. The authors were unable to show a difference in misplacement rates based on provider experience or level of training.
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http://dx.doi.org/10.1111/j.1553-2712.2003.tb00652.x | DOI Listing |
South Dakota's Emergency Medical Services (EMS) volunteer participation is declining, and projected to further decrease over the next decade. To minimize this deficit, South Dakota's Department of Health recommends that rural firefighters assist EMS in high-acuity calls to decrease the burden on EMS personnel in an effort to improve volunteer retention. Bridging the Gap from Rural Trauma to Rural Healthcare aimed to create educational training opportunities for firefighters when assisting EMS.
View Article and Find Full Text PDFBMJ Open
January 2025
Canterbury Christ Church University, Canterbury, Kent Devon, UK.
Objective: To map what is currently known about knowledge translation (KT) in Anglo-American paramedicine. The review focuses on reported barriers and facilitators to the implementation of new knowledge, and the use of models, theories and frameworks to guide implementation practice.
Design: Scoping review reported as per both the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines.
J Appl Stat
May 2024
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.
Ischemic stroke is responsible for significant morbidity and mortality in the United States and worldwide. Stroke treatment optimization requires emergency medical personnel to make rapid triage decisions concerning destination hospitals that may differ in their ability to provide highly time-sensitive pharmaceutical and surgical interventions. These decisions are particularly crucial in rural areas, where transport decisions can have a large impact on treatment times - often involving a trade-off between delay in pharmaceutical therapy or a delay in endovascular thrombectomy.
View Article and Find Full Text PDFBMJ Open
December 2024
School of Public Health, Texas A&M University, College Station, Texas, USA.
Objective: Examine how the characteristics of border communities along the US southern land border impact Emergency Medical Services (EMS) personnel in these border communities.
Design: Using phenomenological approach, we conducted face-to-face, one-on-one interviews using a semistructured interview methodology.
Setting: All participants worked as EMS providers in a city fire department along the Texas-Mexico border.
Heart Lung
January 2025
Sakarya University, Faculty of Medicine, Department of Emergency, Sakarya, Türkiye. Electronic address:
Background: While clinical indicators for synchronized cardioversion in regular supraventricular tachycardias are well-established, their application by prehospital emergency medical services (EMS) still needs to be explored.
Objective: The purpose of this study was to evaluate the factors influencing the decision-making process of prehospital EMS personnel to perform synchronized cardioversion in adults with narrow QRS regular tachyarrhythmias.
Methods: This descriptive study included 598 paramedics actively engaged in prehospital EMS.
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