Emergency Medicine by Alexandros G. Sfakianakis: Ιουνίου 2016

Πέμπτη 30 Ιουνίου 2016

Shock in the emergency department; a 12 year population based cohort study

The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated wit...

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ESO Solutions names Scott Hester as Vice President of Sales

Scott Hester joins ESO as VP of Sales, leading a nationwide team of account managers.

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How to Remove the Gamber-Johnson Console Box Faceplates & Accessories

It takes about 30 seconds to remove the faceplates from the Gamber-Johnson console box to access your electronics or swap out accessories. All you need is a Phillips head screwdriver to remove the hold-down rails, then pop off the faceplates and accessories for easy access or re-arrangement.

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How to Remove the Gamber-Johnson Console Box Faceplates & Accessories

Gamber-Johnson's Motion Attachments for Tablets, Laptops and Keyboards

The Mongoose is an easy to use, intuitive solution that places the computer in a variety of ergonomic positions. The slide arm allows you to simply push the computer back to the retracted position and automatically locks into place, preventing unwanted movement when the vehicle is in motion. The locking slide arm also can be rotated 360° locking into place at every 15° simply by pulling the front lever. With a lower profile, the Mongoose allows the driver to easily see the computer screen, while maintaining their line of sight to the road.

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How to Remove the Gamber-Johnson Console Box Faceplates & Accessories

Gamber-Johnson's Motion Attachments for Tablets, Laptops and Keyboards

How to Remove the Gamber-Johnson Console Box Faceplates & Accessories

Gamber-Johnson's Motion Attachments for Tablets, Laptops and Keyboards

How to install Gamber-Johnson's Brother Printer Armrest

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How to install the Gamber-Johnson Break away Armrest

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Gamber-Johnson's Motion Attachments for Tablets, Laptops and Keyboards

How to install Gamber-Johnson's Brother Printer Armrest

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How to install the Gamber-Johnson Break away Armrest

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Title

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How to install Gamber-Johnson's Brother Printer Armrest

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How to install the Gamber-Johnson Break away Armrest

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Firefighter Paramedic - Riverside Fire Department

RIVERSIDE FIRE DEPARTMENT 5200 SPRINGFIELD STREET SUITE 100 DAYTON, OHIO 45431 Updated: June 29, 2016 Job Classification: Full-Time Firefighter/Paramedic The City of Riverside is seeking to establish an eligibility list for the position of full-time firefighter/paramedic. City applications are due by July 22, 2016 by 4:00 pm. Candidates must also complete the FireTEAM exam through the National Testing ...

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How to install Gamber-Johnson's Brother Printer Armrest

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How to install the Gamber-Johnson Break away Armrest

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Inside EMS Podcast: EMT charged with killing firefighter; Powerball winner's generous EMS gift

Download this podcast on iTunes, SoundCloud or via RSS feed

In this week's Inside EMS Podcast, co-hosts Chris Cebollero and Kelly Grayson review this week's top news, including how an EMT shot and killed a firefighter in a "dare game," why a Powerball winner built and entire fire station, and what an EMT did when a police officer pulled him over during a patient transport. Discussion of the Istanbul airport bombing and how EMS agencies can prepare for similar incidents are also covered.

Come and join the discussion.

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8 rules for properly displaying an American flag

With the Fourth of July just around the corner, we will soon see our country’s streets lined with the American flag, our nation’s symbol. It is important to show our patriotism correctly by displaying our flag appropriately. Here are eight important rules for properly displaying the American flag.

1. It is traditional to display the flag only from sunrise to sunset; however, the flag may be displayed at night, if properly illuminated.

2. The flag should not be subject to harsh weather conditions. Unless you have an all-weather flag, it’s improper to display your flag during rain, snow and wind storms.

3. When displayed with another flag against the wall with crossed staffs, the U.S. flag should be on its own right (left to a person facing the wall), and the staff should be in front of the other flag’s staff.

4. If you are not displaying your flag on a staff, it should be displayed flat or suspended so that its folds fall free. If the flag is displayed horizontally or vertically against a wall, the union (stars) should be located on the flag’s upper right-hand corner (left to a person facing the wall).

5. When displaying a flag in a window, it should be fixed with the union to the left of the observer in the street.

6. If the American flag is displayed with a group of other flags, the American flag should be at the center, and at the highest point.

7. When the flag is displayed over the middle of the street, it should be suspended vertically. The union should be to the north in an east-west street or to the east in a north-south street.

8. When the American flag is displayed on a car, the staff should be fixed firmly to the chassis or clamped to the right fender.

Of course, the flag is not to touch the ground. Displaying a faded, torn or tattered flag is also inappropriate.

Have a safe and festive Fourth of July, and don’t forget to fold your flag properly when you are done displaying it.

For more information on flag etiquette, visit the American Legion’s Flag Code page.

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How to practice the EMS response to an MCI

The multiple casualty incident (MCI) plan for EMS is only ever as strong as the weakest link. There are a lot of links in the chain, so it is critical that every member of the EMS organization develop skills to manage his/her role in a major incident.

Jump into "Triage Tuesday"
Some agencies have developed a routine practice of triage skill practicing and testing, often coordinated with surrounding EMS agencies and destination hospitals. This process is affectionately called "Triage Tuesday" in many communities.

The goals of Triage Tuesday are several-fold. First, it allows EMS providers to become confident in the location and use of the basic tools of MCI management, such as triage tags. Second, Triage Tuesday gives providers the opportunity to discuss their patient evaluation skills with their officers, and importantly, the nurses and physicians at the emergency department. Third, Triage Tuesday helps EMS field providers, supervisors, regional coordinators and hospital staff work together to identify problems and opportunities to improve the local MCI response process before a major incident like a mass shooting, terrorism incident or building collapse.

The process of participating in Triage Tuesdays instills, and then cultivates, a culture of confidence in EMS providers and emergency department personnel.

Multiple casualty incident preparedness
EMS agencies and providers successfully use everyday operations to prepare for bigger incidents, including MCI events. Regular use of the Incident Command System for incident management is one of the most important elements of preparedness.

Formal Incident Management System training is designed to prepare providers at all levels and in all disciplines to work with providers from many different agencies, many of whom they do not normally come in contact with, but the core principle of ICS/IMS can and should be practiced on daily or routine calls.

In a similar way, EMS personnel perform patient triage — the sorting and prioritizing of medical problems — to some degree with each patient encounter. For non-MCI patient calls this is typically built around the use of ABCDE patient assessment — airway, breathing, circulation, disability and exposure — and the differentiation of all types of patients around the basic decision of "sick" and "not sick."

But triage for multiple patient incidents requires another level of decision-making by emergency personnel. Those incidents require the caregiver to clearly sort patients by determining who is sickest among them and how best to deploy the available resources to care for patients. In the worst of MCIs, someone needs to be prepared to make decisions about who should or should not be resuscitated, as well as transported.

Comfort and confidence with emergency skills like these can be developed using regular training like "Triage Tuesday."

Preparing EMS providers for multiple casualties
EMS providers feel more confident when they practice patient assessment and determination of critical illnesses or injuries with everyday patient encounters. Yet many EMS providers resist hands-on training specific to MCI incidents. There are a few reasons for this reluctance to practice:

EMS providers don't like to practice while they’re working. They often feel that everyday care is difficult enough and doesn't allow time to prepare for a big incident.
On-duty training takes time and effort. It distracts from the most important role of being an EMT or paramedic — day-to-day patient care.
Many EMS professionals don't like pretend games and get callused by daily interactions with patients and providers who "play too many games."
When things don't go well in training exercises, it can be embarrassing.
Triage training costs money to use materials like triage tags and other props.

Regular and routine triage practice
So how can EMS agencies develop a regular and routine practice of triage skill testing" First, use a defined period for use of process and real-world tools or props like triage tags, pediatric triage reference tapes and cards and patient tracking and incident management boards. While there is some cost to use disposable triage supplies, the benefit in real and tangible preparation is well worth the cost of a few tags.

Second, work with receiving hospitals and their clinicians. Collaborate during planning to set mutual goals, such as, "we are testing and updating processes to prepare for MCIs in our response area, for the mutual benefit of the patient."

Third, establish a routine practice to communicate the results of Triage Tuesday in each direction, as in "we are identifying areas of opportunity in our practice only by accepting suggestions and concerns from your personnel and hope your agency will do the same." EMS providers will appreciate feedback on alignment of the triage decision with the patient's disposition and are more likely to continue participation if hospital personnel find the triage information valuable to patient care.

In the simplest Triage Tuesday models, the agency's triage tags are applied to each patient who is transported on a given day of the week or month before arrival at the hospital. Triage practice can be done on any day of the week. Picking days other than Tuesday might allow more personnel — EMS and hospital — to participate. The tag may or may not be used for simple documentation, in addition to the routine patient care report.

The emergency department personnel, advised about the triage practice process, accept the patient and confirm the accuracy of the patient triage classification, providing simple and immediate feedback to the EMS crew.

Emergency department personnel may take advantage of the opportunity to test their own triage skills, become familiar with triage tagging systems used by different EMS agencies and use the emergency department's disaster patient tracking system.

There are more opportunities to expand the training or add elements once a month to enhance the experience. More props can be utilized, including incident management vests, caps, signage, management boards and technology enhancements such as smartphone triage apps, barcode scanners, automatic blood pressure cuffs or RFID tags.

When agencies are using new tools for MCIs, like barcode devices or smartphone apps, practicing monthly allows more EMS providers to develop the skills in using the technology, in the field and in the ED.

An important element of these designated triage practice days is to rehearse the communication scripts. The EMS providers will be asked to use the MCI props, and also to communicate with the patient, family or emergency department personnel what the props would accomplish in a major incident.

For example: "Mr. Jones, we take care of people every day, and expand those principles when we have big incidents or multiple patients. This is one of the tools we use for big incidents, and we are using it today on all of our patients."

Some services will also have their field supervisors respond to non-critical incidents and add some elements that will still allow providers additional MCI management practice. At each incident the supervisor may inject additional information that would turn the non-critical patient into a critical one or add a virtual patient encounter to manage. The field supervisor might test the providers on what they would do if this patient encounter was part of a common or likely MCI. That way a simple patient encounter can be made more challenging and effective for the providers to manage.

Simple and technology enhancements for MCI training
Triage Tuesday allows for the development of MCI skills without moulage, fake or simulated patients and contrived scenarios. The skills of MCI management are developed, like any cognitive or kinesthetic task, through regular practice and repetition. Expand on real patient encounters by adding simulated patients with simple patient descriptor cards. This allows the EMS providers to triage multiple patients.

Triage Tuesday is also a perfect time to practice the use of emergency technology. Some EMS systems and emergency departments have new IT applications that are being utilized, sometimes with new equipment, communication processes and software.

These high-tech tools require regular practice, especially at the time of implementation. Regular MCI drills allow practice using the hardware and software tools. Practice, before an actual incident, also helps define shortcomings and bottlenecks. It is likely to greatly benefit the staff of the EMS providers and the emergency department.

Additional MCI training
EMS training officers and educators can easily create opportunities for additional triage and MCI response training. A small tabletop exercise can clarify how the incident management system functions, and the roles and responsibilities of EMS positions in triage, treatment and transport during MCI response.

A tabletop exercise can also show EMS personnel how triage, treatment and transport come together to move MCI patients constantly forward — away from the incident which is causing harm to or generating patients — and towards the destination hospitals providing definitive care. Here is a method to create a simple to use, low tech and reusable tabletop exercise with envelopes and index cards.

Use mailing envelopes to represent local EMS units — BLS and ALS ambulances, supervisor’s vehicles.
Create individual patients with small index cards. On each card, write a visual general impression — what first-arriving rescuers will see — on one side and patient details and vital signs on the other side of the card.
Create individual EMS providers, also with index cards, with details about their level of training, incident role or ICS position and their primary gear, such as stretcher, ALS or BLS bag.
Place the patient index cards, general impression facing up, on a tabletop scene. The first responding unit — an envelope with index cards for ALS/BLS providers and their gear — will arrive and establish the incident management system and begin triage.
Triage the patients following the department's preferred triage method.

These materials can be reused to run the tabletop exercise for different combinations of personnel. After triage is complete discuss the providers' reasons for assigning patients to different categories, the interventions applied during triage and likely additional treatments for each patient. The transportation destination, based on the patient's problem and local hospital capabilities can also be discussed.

A tabletop exercise is another good time to review the tools of MCI management. All providers need to know where supplies are kept and how they work. During the exercise communicate on real radios — on private talk-around channels — to practice the communication discipline that is necessary to properly coordinate a complex MCI scene which involves moving patients to ambulances and those patients to the best-available receiving facilities.

Practice with a likely real-world MCI scenario, such as a mass shooting or school bus rollover. Avoid highly unlikely though theoretically possible scenarios like a "hurricane causes a multiple school bus collision with haz-mat release.”

Straight forward scenarios allow providers to build their confidence in how the incident management system works, how effective triage helps move the right patients forward or from the scene first, and their role in MCI response and management. Seeing how real patients, providers, gear and vehicles interact emphasizes the importance of incident management before clinical care in a multiple casualty incident.

Lifesaving care during triage
Most triage methods direct rescuers to assess for patient breathing and scan for severe bleeding. If the patient is not breathing a few maneuvers can be attempted. The patient's airway can be manually opened, including insertion of an oropharyngeal airway. Rescuers, if directed by protocol, may also assess for an open chest wound and apply a chest seal.

If a rescuer observers severe bleeding from extremity hemorrhage a tourniquet should be applied proximal to the wound. The rescuer may direct the patient, a bystander or another rescuer to apply and monitor a tourniquet.

Hemostatic dressings are an additional consideration for bleeding control during an MCI. The application of hemostatic gauze and wound packing is likely best performed in the treatment area or by teams moving patients from the triage area to the treatment area.

Tourniquets and chest seals are likely used as infrequently as triage tags in most EMS systems. EMS personnel should be given regularly opportunities to review tourniquet and chest seal application. Consider using online training videos, case reviews and hands-on practice sessions with a field supervisor or training officer to maintain skill competency.

Triage and MCI supplies on every vehicle
Triage and MCI supplies should be available on every ambulance and quick response vehicle. Triage is often initiated by the first arriving EMS unit. Work with your department's supply officer to equip each vehicle with a specially marked MCI bag. The bag should contain ten or more triage tags, two or more tourniquets and at least one chest seal. Also consider including a triage officer vest, triage officer job action sheet and other supplies required by your department's MCI response protocol.

Regular drills, like Triage Tuesday, enhance training for emergency providers. With that process, the EMS agency is taking care of people, to include your providers, your patients and your support agencies. There is great benefit to having, practicing and improving the EMS MCI plan. Having each member of the EMS agency and emergency department skilled in the props, process, and practice will benefit all of the appropriate elements, especially the rescuers.

Triage Tuesday allows providers to use MCI props routinely. Vests, hats and signage all gets buried in response vehicles and mass casualty trailers without regular use. So dust off the MCI kit, write on a few envelopes and index cards and help everyone in your EMS service better prepare themselves to be the first unit arriving at an MCI, better coordinate with their EMS and health care partners and improve your department's entire MCI management process.

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Firefighter Paramedic - North Collier Fire Control District

NORTH COLLIER FIRE CONTROL & RESCUE DISTRICT 1885 VETERANS PARK DRIVE NAPLES, FLORIDA 34109 Updated: June 22, 2016 Job Classification: Firefighter/Paramedic North Collier Fire Control & Rescue District is currently building an ongoing eligibility list for Firefighter/EMT - Firefighter/Paramedic. Testing is conducted through National Testing Network (NTN). The department requires a National Testing ...

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Paramedic Training Coordinator - West Deer EMS

West Deer Emergency Medical Services, located in the North Hills / Allegheny Valley of Pittsburgh, is currently seeking qualified applicants for the following positions: EMT-Paramedic/Training Coordinator: Full Time West Deer EMS provides emergency services to the 12,000 residents and the businesses of West Deer Township, as well as providing mutual aid to surrounding communities in Allegheny & ...

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American Ambulance Association Annouces Employee Background Check Benefit for Members

AAA is excited to announce that members now received deeply discounted rates on employee background screening through Sterling Backcheck. Contact our representative, Peter Mulherin, for a fast, easy comparative quote at the AAA member discount. (Please note that our discount is only available through Peter.) Peter Mulherin AAA Sales Executive SterlingBackcheck Direct Number: 646-829-3291 Peter.Mulherin@sterlingbackcheck.com ...

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When disaster strikes in the US, the National Disaster Medical System responds

The nation's medical tactical response team answers the call when mass casualty medical care is needed

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How to practice the EMS response to an MCI

Regularly reviewing and practicing MCI skills will make sure EMS personnel are ready to act when a major incident happens

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Microbiological findings in burn patients treated in a general versus a designated intensive care unit: Effect on length of stay

Burns

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Emergent Interhospital Transport of Pediatric Patient With a Berlin Heart Device

Air Medical Journal

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The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study

European Journal of Trauma and Emergency Surgery

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Care of the Critically Ill Pregnant Patient and Perimortem Cesarean Delivery in the Emergency Department

The Journal of Emergency Medicine

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A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures

European Journal of Trauma and Emergency Surgery

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The Integration of Electronic Medical Student Evaluations Into an Emergency Department Tracking System is Associated With Increased Quality and Quantity of Evaluations

The Journal of Emergency Medicine

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People in hotter, poorer neighbourhoods at higher risk of death during extreme heat

The University of British Columbia Health News

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The influence of polyethylene glycol solution on the dissolution rate of sustained release morphine

Journal of Medical Toxicology

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Public-access AED pad application and outcomes for out-of-hospital cardiac arrests in Osaka, Japan

Resuscitation

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Management of malnutrition in geriatric trauma patients: results of a nationwide survey

European Journal of Trauma and Emergency Surgery

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Prevalence of acute kidney injury during pediatric admissions for acute chest syndrome

Pediatric Nephrology

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How does climate affect violence? Researchers offer new theory

Ohio State University News

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Admission Plasma Troponin I Is Associated With Mortality in Pediatric Intensive Care.

Objectives: Assessment of whether admission plasma troponin I level is associated with mortality or requirement for vasoactive drugs in pediatric intensive care. Design: Retrospective cohort study. Setting: Single centre, tertiary referral general PICU, without a cardiac surgical program. Patients: Three hundred and nineteen patients 0-18 years old in two cohorts. Cohort 1 was admitted between January 2009 and September 2012 and the cohort 2 between April 2014 and April 2015. Interventions: None. Measurements and Main Results: Plasma troponin I was measured in patients in cohort 1 only if the attending physician ordered the test due to clinical concern regarding myocardial injury. The second cohort had plasma troponin I routinely measured at admission. The primary outcome was death during PICU admission, and the secondary outcome was maximum inotrope requirement during PICU stay, measured by Vasoactive Inotrope Score. Plasma troponin I was a discriminator for mortality in both cohorts (area under the receiver-operating characteristic curve of 0.73 and 0.86 in cohorts 1 and 2, respectively). In an adjusted analysis using Cox regression, accounting for Pediatric Index of Mortality 2 risk of mortality and age, elevated plasma troponin I was significantly associated with death in both cohorts (hazard ratio, 4.99; p = 0.033; hazard ratio, 10.5; p = 0.026 in cohorts 1 and 2, respectively). Elevated plasma troponin I was only associated with increased Vasoactive Inotrope Score following multivariate analysis in the cohort 2. Conclusions: Detectable plasma troponin I at admission to PICU is independently associated with death. The utility of troponin I as a stratification biomarker requires further evaluation. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Comparison of Intraoperative Aminophylline Versus Furosemide in Treatment of Oliguria During Pediatric Cardiac Surgery.

Objectives: To determine if intraoperative aminophylline was superior to furosemide to prevent or attenuate postoperative cardiac surgery-associated acute kidney injury. Design: Single-center, historical control, retrospective cohort study. Setting: PICU, university-affiliated children's hospital. Patients: Children with congenital heart disease in PICU who received furosemide or aminophylline to treat intraoperative oliguria. Interventions: Intraoperative oliguria was treated either with furosemide (September 2007 to February 2012) or with aminophylline (February 2012 to June 2013). The postoperative 48 hours renal outcomes of the aminophylline group were compared with the furosemide group. The primary outcomes were acute kidney injury and renal replacement therapy use at 48 hours postoperatively. Surgical complexity was accounted for by the use of Risk Adjustment for Congenital Heart Surgery-1 score. Measurements and Main Results: The study involves 69 months of observation. There were 200 cases younger than 21 years old reviewed for this study. Eighty-five cases (42.5%) developed acute kidney injury. The aminophylline group patients produced significantly more urine (mL/kg/hr) during the first 8 hours postoperatively than furosemide patients (5.1 vs 3.4 mL/kg/hr; p = 0.01). The urine output at 48 hours postoperatively was similar between the two groups. There was no difference in acute kidney injury incidence at 48 hours between the aminophylline and furosemide groups (38% vs 47%, respectively; p = 0.29). Fewer aminophylline group subjects required renal replacement therapy compared to the furosemide group subjects (n = 1 vs 7, respectively; p = 0.03). In the multi-variant predictive model, intraoperative aminophylline infusion was noted as a negative predictive factor for renal replacement therapy, but not for cardiac surgery-associated acute kidney injury. Conclusion: The intraoperative use of aminophylline was more effective than furosemide in reversal of oliguria in the early postoperative period. There were less renal replacement therapy-requiring acute kidney injury in children in the aminophylline group. Future prospective studies of intraoperative aminophylline to prevent cardiac surgery-associated acute kidney injury may be warranted. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Factors Associated With Mortality in Neonates Requiring Extracorporeal Membrane Oxygenation for Cardiac Indications: Analysis of the Extracorporeal Life Support Organization Registry Data.

Objectives: Survival among neonates supported with extracorporeal membrane oxygenation for cardiac indications is 39%. Previous single-center studies have identified factors associated with mortality, but a comprehensive multivariate analysis is not available for this population. Understanding factors associated with mortality may help design treatment strategies, determine optimal timing for cannulation, and inform patient selection. This study identifies factors associated with mortality in neonates supported with extracorporeal membrane oxygenation for cardiac indications. Design: Retrospective cohort study. Setting: Two hundred and thirty U.S. and international centers reporting extracorporeal membrane oxygenation data to the Extracorporeal Life Support Organization. Subjects: Four thousand and four seventy one neonates with congenital and acquired cardiac disease supported with extracorporeal membrane oxygenation for cardiac indications during 2001-2011. Interventions: None. Measurements and Results: The primary outcome measure was mortality prior to hospital discharge. Overall hospital mortality was 59%. Demographic and preextracorporeal membrane oxygenation factors associated with mortality were evaluated in a multivariable model. Factors associated with death prior to hospital discharge included lower body weight, earlier era, single ventricle physiology, lower preextracorporeal membrane oxygenation arterial pH, and longer time from intubation to extracorporeal membrane oxygenation cannulation. Lower pH was associated with increased mortality regardless of cardiac diagnosis and surgical complexity. The majority of survivors separated from extracorporeal membrane oxygenation less than 8 days after extracorporeal membrane oxygenation deployment. Conclusions: Mortality for neonates supported with extracorporeal membrane oxygenation for cardiac indications is high. Severity of preextracorporeal membrane oxygenation acidosis was independently associated with increased risk of mortality. Earlier initiation of extracorporeal membrane oxygenation may reduce the degree and duration of acidosis and may improve survival. Further studies are needed to determine optimal timing of cannulation in this population. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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A Pediatric Sedation Protocol for Mechanically Ventilated Patients Requires Sustenance Beyond Implementation.

Objectives: To reevaluate the effect of a nursing-driven sedation protocol for mechanically ventilated patients on analgesic and sedative medication dosing durations. We hypothesized that lack of continued quality improvement efforts results in increased sedation exposure, as well as mechanical ventilation days, and ICU length of stay. Design: Quasi-experimental, uncontrolled before-after study. Setting: Forty-five-bed tertiary care, medical-surgical-cardiac PICU in a metropolitan university-affiliated children's hospital. Patients: Children requiring mechanical ventilation longer than 48 hours not meeting exclusion criteria. Interventions: During both the intervention and postintervention periods, analgesia and sedation were managed by nurses following an algorithm-based sedation protocol with a targeted comfort score. Measurement and Main Results: The intervention cohort includes patients admitted during a 12-month period following initial protocol implementation in 2008-2009 (n = 166). The postintervention cohort includes patients meeting identical inclusion and exclusion criteria admitted during a 12-month period in 2012-2013 (n = 93). Median duration of total sedation days (IV plus enteral) was 5 days for the intervention period and 10 days for the postintervention period (p

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THE IMPACT OF PATIENT PROTECTION AND AFFORDABLE CARE ACT ON TRAUMA CARE: A STEP IN THE RIGHT DIRECTION.

Introduction: The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our level I trauma center following the ACA and this is associated with improved reimbursement. Methods: We performed a retrospective analysis of the trauma registry and financial database at our level I trauma center for a 27-month (July 2012- September 2014) period by quarters. Our outcome measures were: change in insurance status, hospital reimbursement rates (Total Payments/Expected Payments), and clinical outcomes pre and post-ACA (March 31, 2014). Trend analysis was performed to assess trends in outcomes over each quarter (3 months). Results: A total of 9,892 patients were included in the study. The overall uninsured rate during the study period was 20.3%. Post-ACA period was associated with significantly lower uninsured rate (p

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Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome.

Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome. Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies. Setting: Forty-three academic PICUs worldwide. Patients: A total of 711 subjects prospectively diagnosed with pediatric acute respiratory distress syndrome. Intervention: Subjects more than 2 years were included and categorized by Center for Disease Control and Prevention body mass index z score criteria: underweight (= +1.65). Subjects were stratified by direct versus indirect lung injury leading to pediatric acute respiratory distress syndrome. The primary outcome was in-hospital mortality. In survivors, secondary analyses included duration of mechanical ventilation and ICU length of stay. Measurements and Main Results: A total of 331 patients met inclusion criteria; 12% were underweight, 50% normal weight, 11% overweight, and 27% obese. Overall mortality was 20%. By multivariate analysis, body mass index category was independently associated with mortality (p = 0.004). When stratified by lung injury type, there was no mortality difference between body mass index groups with direct lung injury; however, in the indirect lung injury group, the odds of mortality in the obese were significantly lower than normal weight subjects (odds ratio, 0.11; 95% CI, 0.02-0.84). Survivors with direct lung injury had no difference in the duration of mechanical ventilation or ICU length of stay; however, those with indirect lung injury, the overweight required longer duration of mechanical ventilation than other groups (p

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Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults.

Objective: To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults. Design: A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows. Setting: Medical ICU in a tertiary, academic medical center. Patients: Critically ill patients 18 years old or older. Interventions: Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation. Measurements and Main Results: Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator's previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82-5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy. Conclusions: In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor-Binding Protein 7 for Risk Stratification of Acute Kidney Injury in Patients With Sepsis.

Objectives: To examine the performance of the urinary biomarker panel tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with sepsis at ICU admission. To investigate the effect of nonrenal organ dysfunction on tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in this population. Method: In this ancillary analysis, we included patients with sepsis who were enrolled in either of two trials including 39 ICUs across Europe and North America. The primary endpoint was moderate-severe acute kidney injury (equivalent to Kidney Disease Improving Global Outcome stage 2-3) within 12 hours of enrollment. We assessed biomarker performance by calculating the area under the receiver operating characteristic curve, sensitivity, specificity, and negative and positive predictive values at three cutoffs: 0.3, 1.0, and 2.0 (ng/mL)2/1,000. We also calculated nonrenal Sequential Organ Failure Assessment scores for each patient on enrollment and compared tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 results in patients with and without acute kidney injury and across nonrenal Sequential Organ Failure Assessment scores. Finally, we constructed a clinical model for acute kidney injury in this population and compared the performance of the model with and without tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7. Results: We included 232 patients in the analysis and 40 (17%) developed acute kidney injury. We observed significantly higher urine tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with acute kidney injury than without acute kidney injury in both patients with low and high nonrenal Sequential Organ Failure Assessment scores (p

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Bone Failure in Critical Illness.

Objectives: The origin of systemic inflammatory response syndrome and multiple organ dysfunction syndrome is poorly understood but remains a fundamental concern in the ICU. This paper provides a critical appraisal on whether bone failure may represent an unrecognized component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome. Data Sources, Data Selection, and Data Extraction: Search of the PubMed database and manual review of selected articles investigating bone pathophysiology in critical illness. Data Synthesis: Bone hyperresorption is highly prevalent among critically ill patients. Bone breakdown releases numerous systemically active cytokines and bone-sequestered toxins, with the capacity to fuel inflammatory hypercytokinaemia and metabolic toxaemia. Anti-resorptive medication inhibits bone break down and preadmission anti-resorptive use is associated with superior survival among critically ill patients. Conclusions: We propose that hyperresorptive bone failure is an unrecognised component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome that is causal to critical illness progression. If this hypothesis is valid, bone preservative strategies could reduce the risk of osteoporosis/fractures among ICU survivors, as well as decreasing critical illness mortality. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Sex-related differences in emergency department renal colic management: Females have fewer CT scans but similar outcomes

Abstract

Background

Sex-related differences occur in many areas of medicine. ED studies have suggested differences in access to care, diagnostic imaging use, pain management, and intervention. We investigated sex-based differences in the care and outcomes for ED patients with acute renal colic.

Methods

This was a multi-center population-based retrospective observational cohort study using administrative data and supplemented by structured chart review. All patients seen in Calgary Health Region (CHR) emergency departments between January 1, 2014 and December 31, 2014 with an ED diagnosis of renal colic based on the following ICD-10 codes were eligible for inclusion: calculus of kidney (N200), calculus of ureter (N201), calculus of kidney with calculus of ureter (N202), hydronephrosis with renal and ureteral calculous obstruction (N132), unspecified renal colic (N23), and unspecified urinary calculus (N209). ED visit data and test results were accessed in the regional ED clinical database. Stone characteristics were captured from diagnostic imaging reports. Regional hospital databases were used to identify subsequent ED encounters, hospital admissions and surgical procedures within 60 days. Outcomes were stratified by sex. The primary outcome, intended as a marker of overall effectiveness of ED care, was the unscheduled 7-day ED revisit rate among patients who were discharged home after their index ED visit. Secondary outcomes included ED pain management as reflected by administration of narcotics or IV nonsteroidals; the performance of advanced imaging—either ultrasound (US) or computed tomography (CT); and the proportion of patients who required hospitalization or surgical intervention within 60 days.

Results

From January 1 to December 31, 2014, 3104 eligible patients were studied: 1111 women (35.8%) and 1993 men (64.2%). Baseline characteristics, access times, analgesic use and admission rates were similar in both groups. Men were more likely to have CT (68.9% vs. 58.5%; difference, 10.4%; 95% CI, 6.8, 14.0) while women were more likely to have US (20.8% vs. 9.6%, difference 11.2%, 95% CI, 8.4, 13.9). At 7 days, 17.9% of women and 19.0% of men who were discharged after their index ED visit required an ED revisit (difference=1.1%; 95% CI –2.8, 4.9). Men were more likely to be hospitalized at 7 days (9.8% vs. 6.5%; difference, 3.3%; 95% CI, 0.6, 6.0).

Conclusion

This study shows greater reliance on ultrasound in females but no other sex-specific differences in the management of ED patients with acute renal colic. Higher CT use in men was not associated with improved outcomes, and we found no important differences in access to care, diagnostic or treatment intensity, or revisit rates as a marker of care effectiveness.

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Τετάρτη 29 Ιουνίου 2016

How to use the MIST for an EMS radio report

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The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming

The prognosis in hypothermic cardiac arrest is frequently good despite prolonged period of hypoperfusion and cardiopulmonary resuscitation. Apart from protective effect of hypothermia itself established protoc...

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Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study

This study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medica...

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How to use the MIST for an EMS radio report

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How to use the MIST for an EMS radio report

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How to use the MIST for an EMS radio report

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12-Lead ECG case: When is a heartbeat not a mechanical heartbeat?

Learn to distinguish and verify electrical and mechanical capture when using a transcutaneous pacemaker on a patient with symptomatic bradycardia

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PulmCrit: We should engineer a new crystalloid

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Considering the importance of crystalloid in critical care, one might expect crystalloid composition to be meticulously engineered and updated. However, our crystalloid choices remain archaic. Normal saline and Lactated Ringers (LR) were developed in the 1800s, whereas Plasmalyte and Normosol emerged in the 1970s.

EMCrit by Josh Farkas.

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PulmCrit: We should engineer a new crystalloid

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EMCrit by Josh Farkas.

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Tim Tebow leads prayer as flight attendants perform CPR

ATLANTA — During a Delta flight from Atlanta to Phoenix, ex-NFL quarterback Tim Tebow huddled with family and bystanders when a passenger went into cardiac arrest.

The flight crew began performing CPR and administered a defibrillator when a man lost consciousness after an apparent heart attack, reported The Inquirer.

Concerned passengers looked on, when Tebow approached the area to meet with the man’s family and lead a prayer.

“He met with the family as they cried on his shoulder,” Richard Gotti, a passenger on the flight, wrote on his Facebook page. “I watched Tim pray with the entire section of the plane for this man. He made a stand for God in a difficult situation.”

After speaking with both Tim Tebow's reps and Delta Air Lines, ABC News can confirm this account is accurate. http://pic.twitter.com/aNZfzAhtMq
— Jeffrey Cook (@JeffreyCook_) June 27, 2016

Once the plane landed, Gotti reported that the crew was able to find the man’s pulse.

Apart from providing emotional support during the incident, Tebow reportedly helped the man’s family debark the plane, took their luggage and accompanied them to the hospital. While there, Tebow waited with the family until they received word that the man did not survive.

I sat right behind #timtebow on my @delta to #Phoenix! We had a medical emergency on the flight. Tim helped the family deplane with their baggage. So #compassionate! #ihadtoask #dontwatchfootball

A photo posted by Pamela Rainey (@pamela.rainey) on Jun 26, 2016 at 4:02pm PDT

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Emergency Medical Services Coordinator - City of Torrance

POSITION OVERVIEW The Emergency Medical Services (EMS) Coordinator is a professional level civilian position responsible for ensuring quality emergency medical care services are provided by Fire Department personnel in conformance with regulatory requirements and internal standards. The EMS Coordinator will work closely with the Fire Captain and Assistant Fire Chief assigned to the EMS program to provide ...

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10 obsolete EMT skills

It got me to thinking how different the EMS profession is now from what it was when my career began. Medicine is a continually evolving process, and advances in technology come so rapidly that the current generation of EMS providers is working with a markedly different knowledge base and set of skills than the last one.

So gather around the campfire children and let Uncle Kelly tell you how we did it in the old days. Each of these 10 skills is something we used to commonly do, but are rarely, if ever, used any longer.

10. Pneumatic Anti-Shock Garments
I only spell it out because if I said MAST or PASG, I’d still have to explain it to you young whippersnappers. See, back in the day we used to put these inflatable Velcro pants on shock patients, and when inflated, it raised their blood pressure. It did raise blood pressure very well — to the point that the patient bled pink from all the IV fluids we gave, but those magic pants sucked at saving lives.

Not only did we have to know the different methods of applying them, like the diaper method and the pajama method, we also had to memorize the criteria for removal. Dinosaurs, say them with me now: “Bilateral large bore IV access, two units of typed and matched blood, surgical team on standby, deflate the abdominal section for 10 seconds, recheck the blood pressure …”

9. Manual defibrillation paddles
You kids these days with your hippity-hop music and your iThings and your hands-free multifunction electrodes.… Why, in my day, when we wanted to defibrillate someone, we had these things called paddles. And you had to apply conductive gel to them and smear it around; then you had to press them on the chest with at least 25 pounds of paddle pressure

And you had your energy select dial and defib button right there on the paddles. And you did this thing called a quick look, so that you could immediately shock the patient, like, three times in a row, before you even attached the monitor leads.

And by God, we were grateful.

8. Esophageal Obturator Airways
Imagine if a Combitube and a BVM had a baby, and the airway baby inherited the worst features of each. The EOA was a supraglottic airway that was bulky, often caused trauma on insertion, did a poor job of isolating the trachea and protecting against aspiration and still required that you maintain a mask seal.

And to think that nobody uses these beauties anymore! Crazy, right"

7. Oral screws
Picture — because I am afraid of what you might stumble across if you Google "oral screws" — if you will a little plastic doohickey shaped like a miniature ice cream cone with threads on the outer surface and a T-handle on the large end. And what you did was insert the small end of this doohickey between someone’s teeth when their jaws were clenched, and screwed it in until it forced their jaws apart.

We used to do this whenever someone had a seizure, in the mistaken belief that if we didn’t get their mouth open, they’d swallow their tongue.

But the real reason was that it gave paramedics with a juvenile sense of humor the opportunity to hold out their hands and bark, "Gimme an oral screw!"

I’m telling you, that one never got old.

6. Taping stuff down
When I was a paramedic student, my instructor took great pains to show us how to tear thin little strips of adhesive tape to secure IV catheters and endotracheal tubes. We fashioned elegant little chevrons of tape over the wings on our IV catheter hubs (seriously, they had wings) to secure them without obscuring the cannulation site. And we used to tear a one-inch strip of tape longitudinally for a few inches, wrapping one strip around the endotracheal tube and the other across the face like a big mustache.

And then someone would promptly rip our IV or endotracheal tube out while we were loading the patient, so we got to do it again.

Nowadays we have tube holders and IV dressings, and taping is a lost art like calligraphy and darning your socks.

5. Rotating tourniquets
Once upon a time, we used to think that acute pulmonary edema and decompensated congestive heart failure was caused by too much blood re-entering the lungs. We thought that if we could trap blood in the extremities, we’d reduce preload enough to relieve the pulmonary edema.

So we applied humongous blood pressure cuffs on three of the patient's four extremities, inflated them to just above diastolic pressure, and rotated them around the patient's extremities every 15 minutes.

And it took us only a generation or so to discover that it was stupid and didn’t work.

4. Trendelenburg position
For many years we fervently believed the Trendelenburg position was a vital treatment for shock. We thought that elevating the feet higher than the head raised blood pressure, and maybe even caused a couple units of blood to flow from the legs to the trunk.

Turns out it doesn’t really do those things, and instead caused respiratory decompensation and a rise in intracranial pressure. Still, that doesn’t keep some EMTs working for the EMS Agency That Time Forgot from carefully applying and documenting "patient placed in Trendelenburg position."

3. Standing takedowns
Now that our current understanding of spinal cord injury acknowledges that prehospital spinal immobilization on backboards has virtually no supporting evidence and probably does more harm than good, we’re boarding far fewer people these days.

While the adage holds true that “absence of evidence does not mean evidence of absence,” and there may be some yet-undiscovered tiny subset of patients that benefit from strapping a curved body to a flat board, it’s a pretty safe bet that subset does not include people walking around the scene under their own power.

2. External jugular IV access
Honestly, I really miss this one. The EJ used to be my go-to vein in a code. I was already right there at the head intubating, and all it took was turning the patient’s head to one side a bit, sinking a 14-gauge in that fat, engorged vein, and you had the mother of all peripheral IV accesses.

You know, we did this so all those questionably beneficial drugs we gave could reach the heart that much faster. Now, with mechanical IO devices like the EZ-IO in my repertoire, I can’t remember the last time I started an EJ.

Adult IO devices have really revolutionized emergency peripheral vascular access. And not a moment too soon, either, before this intracavernous technique really caught on.

1. Radio 10 codes
Once upon a time, we used to take sadistic pleasure in rapid fire broadcasting to the brand-new dispatcher, "Dispatch, we’re 10-98, 10-8, 10-19, 10-18 to our 10-42, where we’ll be 10-7 for a few minutes for a 10-33 10-100. If we’re not 10-2 on that, we’ll be happy to 10-9."

Now that we communicate in plain English because 10 codes are confusing and vary between agencies, we get to say, "Dispatch, we’ve completed our last assignment and are available for call, but we’re heading to our station as soon as possible because my partner will be out of service taking an emergency all-he-could-eat taco buffet poop. If you didn’t copy all that, I’m willing to repeat it."

Or at least we get to say that once.

I could think of a few more EMT skills that may soon become obsolete if we don’t get better at applying them, but that’s my list of top 10 obsolete EMT skills.

Got any to add to the list" Chime in with yours in the comments.

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10 obsolete EMT skills

Nothing makes me feel older than when I drop a casual reference to an EMT skill in a continuing education class and several bewildered young EMTs raise their hands hesitantly and ask, "Kelly, what are MAST pants"" It got me to thinking how different the EMS profession is now from what it was when my career began. Medicine is a continually evolving process, and advances in technology come so ...

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Private equity struggles to make EMS profitable – Is anyone surprised?

Here are four takeaways from The New York Times investigation into the failed private equity investments and mismanagement of EMS businesses

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Association of Lower Quarter Y-Balance Test with lower extremity injury in NCAA Division 1 athletes: An independent validation study

Physiotherapy

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Successful endoscopic hemostasis is a protective factor for rebleeding and mortality in patients with nonvariceal upper gastrointestinal bleeding

Digestive Diseases and Sciences

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Consensus-based recommendations for an emergency medicine pain management curriculum

The Journal of Emergency Medicine

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Admission of out-of-hospital cardiac arrest victims to a high volume cardiac arrest center is linked to improved outcome

Resuscitation

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Do patients prefer optional follow-up for simple upper extremity fractures: A pilot study

Injury

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Arterial blood gases during and their dynamic changes after cardiopulmonary resuscitation: A prospective clinical study

Resuscitation

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Gender gap found in cardiac arrest care, outcomes

American Heart Association News

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Development of a rapid response plan for intraoperative emergencies: The Circulate, Scrub, and Technical Assistance Team (C-STAT)

The American Journal of Surgery

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Subconcussive blows to the head: a formative review of short-term clinical outcomes

Journal of Head Trauma Rehabilitation

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Heart rate response to therapeutic hypothermia in infants with hypoxic-ischaemic encephalopathy

Resuscitation

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Cervical myelopathy doubles the rate of dislocation and fracture after total hip arthroplasty

Journal of Arthroplasty

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Physiologic monitoring of CPR quality during adult cardiac arrest: A propensity-matched cohort study

Resuscitation

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Primary bacterial gluteal pyomyositis: a rare disease in temperate climates presenting as suspected septic arthritis of the hip

The Journal of Emergency Medicine

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Relationship between perceived risk of falling and adoption of precautions to reduce fall risk

Journal of the American Geriatrics Society

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Digital strategies show promise for emergency heart and stroke care

American Heart Association News

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Private equity struggles to make EMS profitable – Is anyone surprised?

A sweeping New York Times investigation of private equity investment into and management of businesses providing emergent and non-emergent medical services in communities across the United States revealed some troubling, but not surprising findings.

EMS broadly reflects the communities we serve and is influenced by the invisible forces of macroeconomics that impact all organizations. Businesses of all types fail because of absent leadership and short-term emphasis on profits.

Politicians at every level of government have a tendency to over-promise, under-deliver and duck difficult decisions. There are several reasons private equity firms get into the business of emergency medical care and firefighting:

Replace failed leadership unable to balance the budget.
Exploit marketplace inefficiency.
Service communities with no regulatory or statutory requirement to provide fire suppression or 911 emergency medical response.
Invest in future trends like the growing population of Medicare- or Medicaid-eligible Americans with an ever-worsening list of health conditions.

The Times investigation into private equity investment in public safety looked at "cost cuts, price increases, lobbying and litigation." We have previously covered and often commented on those topics — the sudden closure of TransCare EMS, the acquisition of Rural/Metro by AMR's parent company, the off-shoring of EMS patient billing, mergers and consolidations and the unscrupulous practice of overbilling for non-emergent transports are a few examples.

To know one EMS system is to only know one EMS system. National media investigative coverage of EMS potentially informs and misinforms your agency's stakeholders, payers and customers. It also creates an opportunity for EMS leaders to communicate their value, for owners and operators to assess the balance of short-term and long-term economics and for field providers to take stock of their employment conditions.

Here are four things those leading and working for EMS agencies should be thinking about following the Times investigation.

1. Tell your story
Assume your municipal leaders read the Times article and that you have civilians in your response area wondering about who will respond and how quickly an ambulance will arrive if they were to call 911.

Invite your local media to report a story on how EMS is funded locally, the challenges of collecting payment for services and the relationships between EMS, other public safety agencies and hospitals to achieve the best possible patient outcomes. Point out your differences and the patient-centric business decisions your agency has made.

2. Diversify revenue
Private equity firms are able to take a risk on EMS agency investments because they own a diverse portfolio of businesses with exposure to multiple markets, customer bases and product lines. In addition to TransCare, Patriach Partners owned 70 other businesses.

Every EMS agency should examine how it is funded and if the mix of reimbursement from taxes, patient billing, grants and other sources is adequate to meet short-term cash flow needs and long-term mission sustainment.

3. Invest in the money makers
Every business has personnel who make direct contributions to revenue and personnel who support the money makers through indirect contributions to revenue. EMTs and paramedics are money makers with every patient contact.

The money makers need ongoing reinvestment and support through education and training, as well as programs to increase their morale, health and longevity with the organization.

The Times critique of the Rural/Metro "Do the Write Thing" missed the point of an important training program. Teaching EMS personnel the importance of good documentation and its connection to payment for services is critical for every type of EMS agency.

Patients have a right to the coverage they are eligible to receive — private insurance, Medicare or Medicaid — and EMS agencies should collect payment for the services they provide.

4. Field providers need to get out before investors
When a private equity investor cuts its losses and liquidates a poorly performing investment, we can be confident those investors have other income streams, will not be seeking unemployment insurance or be looking for job retraining. They have more likely successfully lobbied for regulations to protect their liability from those poorly performing investments.

It is the field providers who have likely hung with a terrible employer for far too long and acutely feel the pain of job loss. The Times investigation gave a useful list of symptoms that should trigger any EMS provider to get off a sinking ship as quickly as they can.

Stealing supplies: "Paramedics in New York had to covertly swipe medical supplies from a hospital to restock their depleted ambulances after emergency runs."
Mandated shifts: "Bryson said she had worked two 24-hour shifts back to back before the call about Ms. Maher came in. Ms. Bryson was technically off the clock, she said, but a replacement hadn’t yet arrived."
Ambulances don't run: "On the day TransCare filed for bankruptcy, more than 30 percent of the company’s vehicles were out of service, some for hundreds of days."
Supervisors pay for supplies: "Supervisors regularly paid for supplies out of their own pockets and hoped for reimbursement."
Paychecks bounce: "Worried the checks might bounce, some (TransCare employees) piled into emergency vehicles and raced to a 24-hour check-cashing store."

Loyalty is admirable and honorable. But there is a big difference between helping your EMS employer navigate troubled waters and staying with your employer as the ship augers into the bottom of the ocean.

If you are on a ship heading for the sea floor, the short-term inconvenience of job searching and potentially moving is much better than waiting until you are out of work with no income to find a job. Your safety — physical and fiscal — should always be your top priority.

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Impact of Different Diagnostic Criteria on the Reported Prevalence of Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.

Objectives: Junctional ectopic tachycardia is a frequent complication after pediatric cardiac surgery. A uniform definition of postoperative junctional ectopic tachycardia has yet to be established in the literature. The objective of this study is to analyze differences in the general and age-related prevalence of postoperative junctional ectopic tachycardia according to different diagnostic definitions. Design: Data files and electrocardiograms of 743 patients (age, 1 d to 17.6 yr) who underwent surgery for congenital heart disease during a 3-year period were reviewed. The prevalence of postoperative junctional ectopic tachycardia in this cohort was determined according to six different definitions identified in the literature and one definition introduced for analytical purposes. Agreement between the definitions was analyzed according to Cohen [kappa] coefficients. A receiver operating characteristic analysis was performed to determine the ability of different definitions to discriminate between patients with increased postoperative morbidity and without. Setting: A university-affiliated tertiary pediatric cardiac PICU. Patients: Infants and children who underwent heart surgery. Interventions: None. Measurements and Main Results: The prevalence of postoperative junctional ectopic tachycardia ranged from 2.0% to 8.3% according to the seven different definitions. Even among definitions for which the general prevalence was almost equal, the distribution according to age varied. Most definitions used a frequency criterion to define postoperative junctional ectopic tachycardia. Definitions based on a fixed frequency criterion did not identify cases of postoperative junctional ectopic tachycardia in patients older than 12 months. The grade of agreement was moderate or poor between definitions using a fixed or dynamic frequency criterion and those not based on a critical heart rate ([kappa] = 0.37-0.66). In the receiver operating characteristic analysis, the definition with a fixed frequency criterion of 180 beats/min or an age-related frequency criterion according to the 95th percentile showed the optimal cut-off value to determine increased postoperative morbidity. Conclusions: Different definitions of junctional ectopic tachycardia after pediatric cardiac surgery lead to relevant differences in the reported prevalence and age distribution pattern. A uniform definition of postoperative junctional ectopic tachycardia is needed to provide comparable study results and to improve the diagnosis of junctional ectopic tachycardia in pediatric patients. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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The Impact of Clinical Trials Conducted by Research Networks in Pediatric Critical Care.

Objectives: Research networks in adult and neonatal critical care have demonstrated collaborative and successful execution of clinical trials. Such networks appear to have been relatively recently established in the field of pediatric critical care. The objective of this study was to evaluate the productivity and impact of randomized controlled trials conducted by pediatric critical care research networks, compared with nonnetwork trials. Data Sources, Study Selection, and Data Abstraction: We searched multiple online databases including MEDLINE, reference lists of randomized controlled trials, and relevant systematic reviews. Independent pairs of reviewers identified published randomized controlled trials administering any intervention to children in a PICU and abstracted data. A research network was defined as a formal consortium or collaborative research group established for the purpose of conducting clinical research. Data were independently abstracted in duplicate. Main Results: There were 288 pediatric critical care randomized controlled trials published in English between 1986 and July 2015, of which 15 randomized controlled trials (5.2%) were conducted by a total of five research networks. Network randomized controlled trials were more often multicentered, multinational, and larger in size (p

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Differences in Impact of Definitional Elements on Mortality Precludes International Comparisons of Sepsis Epidemiology-A Cohort Study Illustrating the Need for Standardized Reporting.

Objectives: Sepsis generates significant global acute illness burden. The international variations in sepsis epidemiology (illness burden) have implications for region specific health policy. We hypothesised that there have been changes over time in the sepsis definitional elements (infection and organ dysfunction), and these may have impacted on hospital mortality. Design: Cohort study. Setting: We evaluated a high quality, nationally representative, clinical ICU database including data from 181 adult ICUs in England. Patients: Nine hundred sixty-seven thousand ive hundred thirty-two consecutive adult ICU admissions from January 2000 to December 2012. Interventions: None. Measurements and Main Results: To address the proposed hypothesis, we evaluated a high quality, nationally representative, clinical, ICU database of 967,532 consecutive admissions to 181 adult ICUs in England, from January 2000 to December 2012, to identify sepsis cases in a robust and reproducible way. Multinomial logistic regression was used to report unadjusted trends in sepsis definitional elements and in mortality risk categories based on organ dysfunction combinations. We generated logistic regression models and assessed statistical interactions with acute hospital mortality as outcome and cohort characteristics, sepsis definitional elements, and mortality risk categories as covariates. Finally, we calculated postestimation statistics to illustrate the magnitude of clinically meaningful improvements in sepsis outcomes over the study period. Over the study period, there were 248,864 sepsis admissions (25.7%). Sepsis mortality varied by infection sources (19.1% for genitourinary to 43.0% for respiratory; p

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Histone Deacetylase Inhibition Protects Mice Against Lethal Postinfluenza Pneumococcal Infection.

Objectives: Secondary bacterial pneumonia following influenza virus infection is associated with high mortality, but the mechanism is largely unknown. Epigenetic gene regulation appears to play key roles in innate and adaptive immunity. We hypothesized that histone acetylation, a major epigenetic mechanism associated with transcriptionally active chromatin, might contribute to the poor outcome of postinfluenza pneumonia. Design: Prospective experimental study. Setting: University research laboratory. Subjects: C57BL/6 male mice. Interventions: Mice were infected intranasally with 1.0 x 104 colony-forming units of Streptococcus pneumoniae, 7 days after intranasal inoculation with five plaque-forming units of influenza virus A/H1N1/PR8/34. The mice were intraperitoneally injected with the histone deacetylase inhibitor trichostatin A (1 mg/kg) or vehicle once a day from 1 hour after pneumococcal infection throughout the course of the experiment. The primary outcome was survival rate. Measurements and Main Results: Trichostatin A significantly suppressed histone deacetylase activity and significantly improved the survival rate of mice (56.3%) after postinfluenza pneumococcal infection when compared with vehicle-treated mice (20.0%), which was associated with a significant decrease in the total cell count of the bronchoalveolar lavage fluid. The interleukin-1[beta] level in the serum and the number of natural killer cells in the lungs were significantly lower in the trichostatin A-treated group. Conclusions: The histone deacetylase inhibitor trichostatin A protects mice against postinfluenza pneumonia possibly through multiple factors, including decreasing local cell recruitment into the lungs and suppressing systemic inflammation. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Cumulative Fluid Balance and Mortality in Septic Patients With or Without Acute Kidney Injury and Chronic Kidney Disease.

Objective: Incident acute kidney injury and prevalent chronic kidney disease are commonly encountered in septic patients. We examined the differential effect of acute kidney injury and chronic kidney disease on the association between cumulative fluid balance and hospital mortality in critically ill septic patients. Design: Retrospective cohort study. Setting: Urban academic medical center ICU. Patients: ICU adult patients with severe sepsis or septic shock and serum creatinine measured within 3 months prior to and 72 hours of ICU admission. Patients with estimated glomerular filtration rate less than 15 mL/min/1.73 m2 or receiving chronic dialysis were excluded. Interventions: None. Measurements and Main Results: A total of 2,632 patients, 1,211 with chronic kidney disease, were followed up until hospital death or discharge. Acute kidney injury occurred in 1,525 patients (57.9%), of whom 679 (44.5%) had chronic kidney disease. Hospital mortality occurred in 603 patients (22.9%). Every 1-L increase in cumulative fluid balance at 72 hours of ICU admission was independently associated with hospital mortality in all patients (adjusted odds ratio, 1.06 [95% CI] 1.04-1.08; p

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Τρίτη 28 Ιουνίου 2016

Veteran Emergency Medical Technician Support Act: Policy implications

By Allison G. S. Knox, EMT-B, faculty member at American Military University

On May 12, the Veterans Emergency Medical Technician Support Act passed the U.S. House of Representatives. This legislation, H.B. 1818, “assists military medic veterans to efficiently transition their military medical training into a civilian workforce and addresses the shortage of emergency medical technicians in states.”

This legislation will help streamline the process for former military medics to join the civilian workforce. Under this bill, it will now be easier for veterans who have completed military EMT training to meet state requirements for EMT certification and licensure.

This bill has the potential to be tremendously beneficial to local governments. First of all, it will save localities money by freeing them from having to retrain military EMTs on skills they’ve already been performing. In the last few years, many local governments have suffered from slashed budgets, which have reduced funding for the expensive process of training medics.

Full story: Veteran Emergency Medical Technician Support Act: Policy implications

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Police Support Manager - Dispatch - City of Fairfield, California

City of Fairfield, California Police Support Manager - Dispatch Annual salary range: $79,940 to $97,169 DOQ The City provides an attractive benefit package. Application deadline: Monday, August 1, 2016 The City of Fairfield Police Department is seeking an experienced public communications professional to lead the Department’s Communications Center team as its new Dispatch Manager (newly-created ...

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Emergency Department Paramedic - Spectrum Healthcare Resources

Spectrum Healthcare Resources has an opportunity for Emergency department Paramedics (EMT-P) at Keller Army Hospital in West Point, NY. The paramedic position offers: Part time and PRN positions available 12 hour shifts Competitive salary The Emergency Department Paramedics (EMT-P) will have the following requirements: Graduation from an accredited EMT-paramedic (EMT-P) certification program Current ...

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Ambulance Operator - City of Culver City

Provide basic medical care and transportation to ill and injured persons as an Emergency Medical Technician (EMT). Responds to emergency medical calls and provides basic life support services. Safely operates an emergency vehicle to and from the scene of the emergency. Provides emergency medical care to the ill and injured within the scope of an Emergency Medical Technician (EMT) and in accordance with ...

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New devices causing "paradigm shift" in stroke care

Loyola University Health System

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Forecasting the emergency department patients flow

Journal of Medical Systems

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Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review

International Journal of Cardiology

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Metformin and contrast-induced acute kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction: A multicentre study

International Journal of Cardiology

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Use of hematopoietic growth factors and risk of thromboembolic and pulmonary toxicities in elderly patients with advanced ovarian cancer

Women's Health Issues

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When to expect aortoduodenal fistula as a cause of abdominal pain in ED patients

The American Journal of Emergency Medicine

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Risk factors for bleeding after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

Gastrointestinal Endoscopy

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Researchers discover the 2009 swine flu pandemic originated in Mexico

The Mount Sinai Hospital

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Perioperative risk factors impact outcomes in emergency versus nonemergency surgery differently: Time to separate our national risk-adjustment models?

The Journal of Trauma and Acute Care Surgery

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Chronic impact of traumatic brain injury on outcome and quality of life: A narrative review

Critical Care

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Intensive treatment and severe hypoglycemia among adults with type 2 diabetes

JAMA Internal Medicine

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Automated external defibrillation skills by naive schoolchildren

Resuscitation

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Foremen's intervention to prevent falls and increase safety communication at residential construction sites

American Journal of Industrial Medicine

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Case report: A rare case of attempted homicide with Gloriosa superba seeds

BMC Pharmacology & Toxicology

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An analysis of fatal and non-fatal injuries and injury severity factors among electric power industry workers

American Journal of Industrial Medicine

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Amid terrorism fears, promising leads in hunt for radiation antidote

University of Virginia Health System News

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Extraversion, neuroticism and secondary trauma in Internet child abuse investigators

Occupational Medicine

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UAB study showcases poisoning risk to small children from laundry pods

UAB Medicine

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Structure, Organization, and Delivery of Critical Care in Asian ICUs.

Objectives: Despite being the epicenter of recent pandemics, little is known about critical care in Asia. Our objective was to describe the structure, organization, and delivery in Asian ICUs. Design: A web-based survey with the following domains: hospital organizational characteristics, ICU organizational characteristics, staffing, procedures and therapies available in the ICU and written protocols and policies. Setting: ICUs from 20 Asian countries from April 2013 to January 2014. Countries were divided into low-, middle-, and high-income based on the 2011 World Bank Classification. Subjects: ICU directors or representatives. Measurements and Main Results: Of 672 representatives, 335 (50%) responded. The average number of hospital beds was 973 (SE of the mean [SEM], 271) with 9% (SEM, 3%) being ICU beds. In the index ICUs, the average number of beds was 21 (SEM, 3), of single rooms 8 (SEM, 2), of negative-pressure rooms 3 (SEM, 1), and of board-certified intensivists 7 (SEM, 3). Most ICUs (65%) functioned as closed units. The nurse-to-patient ratio was 1:1 or 1:2 in most ICUs (84%). On multivariable analysis, single rooms were less likely in low-income countries (p = 0.01) and nonreferral hospitals (p = 0.01); negative-pressure rooms were less likely in private hospitals (p = 0.03) and low-income countries (p = 0.005); 1:1 nurse-to-patient ratio was lower in private hospitals (p = 0.005); board-certified intensivists were less common in low-income countries (p

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Effect of Continuous Renal Replacement Therapy on Outcome in Pediatric Acute Liver Failure.

Objectives: To establish the effect of continuous renal replacement therapy on outcome in pediatric acute liver failure. Design: Retrospective cohort study. Setting: Sixteen-bed PICU in a university-affiliated tertiary care hospital and specialist liver centre. Patients: All children (0-18 yr) admitted to PICU with pediatric acute liver failure between January 2003 and December 2013. Interventions: Children with pediatric acute liver failure were managed according to a set protocol. The guidelines for continuous renal replacement therapy in pediatric acute liver failure were changed in 2011 following preliminary results to indicate the earlier use of continuous renal replacement therapy for both renal dysfunction and detoxification. Measurements and Main Results: Of 165 children admitted with pediatric acute liver failure, 136 met the inclusion criteria and 45 of these received continuous renal replacement therapy prior to transplantation or recovery. Of the children managed with continuous renal replacement therapy, 26 (58%) survived: 19 were successfully bridged to liver transplantation and 7 spontaneously recovered. Cox proportional hazards regression model clearly showed reducing hyperammonemia by 48 hours after initiating continuous renal replacement therapy significantly improved survival (HR, 1.04; 95% CI, 1.013-1.073; p = 0.004). On average, for every 10% decrease in ammonia from baseline at 48 hours, the likelihood of survival increased by 50%. Time to initiate continuous renal replacement therapy from PICU admission was lower in survivors compared to nonsurvivors (HR, 0.96; 95% CI, 0.916-1.007; p = 0.095). Change in practice to initiate early and high-dose continuous renal replacement therapy led to increased survival with maximum effect being visible in the first 14 days (HR, 3; 95% CI, 1.0-10.3; p = 0.063). Among children with pediatric acute liver failure who did not receive a liver transplant, use of continuous renal replacement therapy significantly improved survival (HR, 4; 95% CI, 1.5-11.6; p = 0.006). Conclusion: Continuous renal replacement therapy can be used successfully in critically ill children with pediatric acute liver failure to provide stability and bridge to transplantation. Inability to reduce ammonia by 48 hours confers poor prognosis. Continuous renal replacement therapy should be considered at an early stage to help prevent further deterioration and buy time for potential spontaneous recovery or bridge to liver transplantation. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Δευτέρα 27 Ιουνίου 2016

Paramedic - Baker Emergency Medical Services INC.

Seeking Full-Time and Part-Time Paramedic's to work in Baker and Needles CA.

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Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study

Research Articles
Samuel Racine, Marcel Émond, Jean-Sébastien Audette-Côté, Natalie Le Sage, Chantal Guimont, Lynne Moore, Jean-Marc Chauny, Éric Bergeron, Laurent Vanier
Canadian Journal of Emergency Medicine,FirstView Article(s), 9 pages

Abstract

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London Trauma Conference 2015

I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015

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EMS for Children Program Manager - Baylor College of Medicine; EMS for Children State Partnership Texas

Description: The Emergency Medical Services for Children (EMSC) State Partnership in Texas is seeking a new Program Manager. Purpose: EMSC is a federally-funded program, and it aims to ensure that state-of-the-art emergency medical care is available to children when needed, that pediatric services are well integrated into the existing state emergency medical services (EMS) system, and that the entire ...

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Preanalytical conditions of point-of-care testing in the intensive care unit are decisive for analysis reliability

Point-of-care testing (POCT) systems enable a wide range of tests to be rapidly performed at the bedside and have attracted increasing interest in the intensive care unit (ICU). However, previous studies compa...

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Firefighter Paramedic - Polk County Fire District #1

POLK COUNTY FIRE DISTRICT NO 1 1800 MONMOUTH STREET INDEPENDENCE, OREGON 97351 Updated: June 22, 2016 Job Classification: Firefighter/Paramedic Polk County Fire District No 1 is currently building an ongoing eligibility list for Firefighter/Paramedic. Testing is conducted through National Testing Network (NTN). Salary Information: Firefighter/Paramedic salary range is $4765.76 - $5575.27 effective 7/1/2016 ...

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Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

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Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

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Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

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Russian kickboxers assault paramedics

Two Russian kickboxers attacked paramedics that were called to help them after losing a fight were arrested and charged with assault.

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TEXAS CERTIFIED EMT TEMPLE TX PT - U.S. Safety Services

U.S. Safety Services is a San Antonio based company that has a contract to provide BLS medical services to the HEB Manufacturing site in Temple Texas. Currently looking for applicants available for weekends, 2 shifts 7:30am-3:30pm and 3:30 pm - 12:00am. Applicants need to be at a minimum, a Texas Certified EMT with a valid CPR/AED card, valid driver’s license & social security card. Applicants ...

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Director of EMS-Dallas Texas - Acute Medical Services LLC

Essential Functions: * Typically oversees the supervision of a team of EMTs within a region * Dual role combines clinical, professional expertise (i.e., EMT) and supervisory responsibilities * Fulfills the job expectations of an EMT or EMT-P dedicating an agreed upon percentage of time to clinical duties * Manages a limited number of employees – responsible for following appropriate processes ...

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Director of EMS-Dallas Texas - Acute Medical Services LLC

Podcast 176 – Updated EMCrit Rapid Sequence Intubation Checklist

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The new improved version of the EMCrit RSI checklist

EMCrit by Scott Weingart.

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Podcast 176 – Updated EMCrit Rapid Sequence Intubation Checklist

Checkboxed-Checklist-2016-05-03.png?resi

The new improved version of the EMCrit RSI checklist

EMCrit by Scott Weingart.

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Ground Paramedic - Regional West Medical Center

JOB SUMMARY The Ground Paramedic will work under the supervision of the Program Manager. The Ground Paramedic delivers care to critically ill or injured patients. Patients may be transported between medical facilities or directly from the scene of an accident or illness. The Ground Paramedic assists with marketing and public relations activities of the program. The Ground Paramedic also may be called ...

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Reality training: Administering pediatric medication

Use this hands-on training exercise to improve equipment familiarity, reinforce medication cross-check processes and increase provider confidence to treat sick kids

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Philip F. Stahel. Blood, Sweat and Tears: Becoming a Better Surgeon

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Management of malnutrition in geriatric trauma patients: results of a nationwide survey

Abstract

Purpose

Prevalence of malnutrition in geriatric trauma patients ranges between 30 and 50 % in Germany. Malnutrition is associated with impaired wound healing, a prolonged in-hospital stay, reduced post-traumatic mobility, as well as a higher mortality. Thus, detection and improvement of nutritional status could be a fundamental contribution in optimizing the treatment of these patients.

Methods

We sent a web-based questionnaire to 579 German hospitals with traumatological expertise, seeking information on the institutional care level, number of beds, use of nutritional assessments, and use of defined laboratory parameters for the detection of malnutrition. Furthermore, we focused on the presence and frequency of nutrition ward rounds on the intensive care unit.

Results

We received 151 answers. Nutritional status was analysed in one-third (N = 50). The half of these 50 clinics (54 %, N = 27) were using the body mass index (BMI), 20 % (N = 10) were using the nutritional risk screening (NRS), and 14 % (N = 7) used the mini nutritional assessment. 38 hospitals indicated a regular nutrition ward round; 63 % of them occurred daily, 13 % had a weekly frequency, and 24 % were on demand. Laboratory parameters were used inhomogeneously. Except for the more frequent use of the NRS (p = 0.026) in local trauma centres, we found no significant difference in the detection of malnutrition according to the care level.

Conclusions

Although we know malnutrition is a frequent condition in geriatric patients, a minority of clinics considered it. The BMI and the NRS showed acceptance in practice; other parameters were used inhomogeneously. Although these findings may be limited in their significance, they indicate that the detection of malnutrition needs further investigation.

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Reality training: Administering pediatric medication

Administering pediatric medication can be one of the most dangerous and anxiety-provoking procedures paramedics perform. It is also a situation that is rarely encountered by most paramedics, which leaves few opportunities to practice and to build confidence.

Studies on medication administration, in real and simulated pediatric patients, show frequent and sometimes fatal medication errors even when reference tools are used. Paramedics and students need realistic training to help prepare for these high-risk, low-frequency situations.

One study found that over one-third of the 360 medications administered to children over two years were incorrect. Eighteen percent of those patients received a dose greater than 20 percent outside of the correct dose range. Paramedics also rarely performed pediatric medication administration in this study.

In another retrospective chart review study, children under 12 years old who received a medication made up less than 1 percent of EMS responses, and only one-third of paramedics administered any medications to children over the study period [1].

A study of a simulated pediatric anaphylaxis scenario found that over half of paramedics administered an incorrect dose of epinephrine, and 20 percent administered a higher epinephrine dose than an adult in cardiac arrest should receive. This was despite paramedics using a number of reference tools during the scenario [2].

Weight-based pediatric medication administration involves several steps, and there are opportunities for error at each one. Pediatric emergencies are also stressful situations, which further compromises cognitive skills. A study examining the root causes of errors in pediatric simulation identified these nine causes.

Incorrect use of the Broselow length-based resuscitation tape.
Impaired calculation ability under stress.
Inaccurate weight estimate.
Faulty recall of doses.
Unaided calculations.
Wrong milligram/kilogram dose for route of administration.
Errors converting the dose in milligrams to volume administered in milliliters.
Volume measured from wrong end of prefilled syringe.
Failure to cross-check calculations.

Two of the author's recommendations are to provide "hands on continuing education of pediatric medications and drug dilutions, using syringes to draw calculated volumes of medications in the context of a simulated case," and "periodic competency testing on the use of medication dosing reference cards or other cognitive aids" [3].

Hands-on training
Here is one exercise that gives participants several opportunities to practice the steps of medication administration and to gain experience using reference tools for children of different ages and sizes in a short period of time.

First, make index cards with a medication and a condition it is used to treat. Some examples are:

Epinephrine: one card for cardiac arrest and another for anaphylaxis.
Benzodiazepines: Midazolam, lorazepam, or diazepam for seizure treatment.
Dextrose: for hypoglycemia (which may need to be diluted from a 50 percent to 25 percent concentration).
Fentanyl or morphine: for pain management.
Naloxone: for opioid overdose reversal.
Diphenhydramine: antihistamine for allergic reaction.
Adenosine: for supraventricular tachycardia.
Amiodarone: for cardiac arrest.

Next, get a supply of expired medications, fill empty medication vials with fluid or label training vials with the medications you plan to use in the training session. Store the medications in drug kits similar to ones used in the field.

Then recruit some pediatric volunteers. Have training participants bring their children to training, have an open house or community outreach activity at a station or arrange a visit to a school or daycare center. Give each child one of the cards. Instruct the children to hand the card to a team of two paramedics or students.

Using reference tools, have the team practice estimating the child’s weight, determining the dose of the medication on the child’s card in milligrams, the volume of medication in milliliters that should be administered and the route of administration.

Have one participant draw the amount of the simulated medication into a syringe (or identify the volume if the medication is supplied in a prefilled syringe), verbalize and confirm with a partner the dose, volume and route to administer, and waste the fluid in to a sink or garbage can.

Teach your students or personnel to use this medication cross-check process (also see video at the end of this article) or something similar and specific to your department’s protocols.

Give the children different cards throughout the exercise and have them rotate among the paramedic teams. This training exercise exposes participants to a variety of conditions, patient sizes and medication doses to calculate.

Here are seven tips to make the exercise a success.

Make it fun for the kids. Incorporate the exercise into a station open house or community outreach activity. Rent an inflatable bounce house, hand out coloring books and junior paramedic stickers, or use it as an opportunity to promote bike or pool safety.
Use blunt tips for syringes instead of needles to make sure the children are not fearful of getting an injection.
Use the exercise to identify areas for system improvement not to punish individuals for making mistakes.
Test different strategies in crew resource management and medication cross checks, and measure how long it takes to determine the accurate dose of the medication.
Get samples of pediatric medication reference tools to pilot during the exercise and see which one works best for your service.
Investigate how pediatric equipment is organized in bags.
Debrief after the exercise. Ask participants how comfortable they feel administering medications to children and how the process can be improved.

In the comments share your experience with this training activity or something similar, as well as your questions for improving pediatric medication administration.

References:

Hoyle JD, Davis AT, Putnam KK, Trytko JA, Fales WD. (2012) Medication dosing errors in pediatric patients treated by emergency medical services. Prehospital Emergency Care, 16:1, 59-66.
Lammers R, Willoughby-Byrwa M, Fales W. (2014). Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehospital Emergency Care, 18:2, 295-304.
Lammers R, Byrwa M, Fales W. (2012). Root causes of errors in a simulated prehospital pediatric emergency. Academic Emergency Medicine 19:37-47

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Πληροφορίες

Πέμπτη 30 Ιουνίου 2016

Abstract

Background

Methods

Results

Conclusion

Τετάρτη 29 Ιουνίου 2016

Τρίτη 28 Ιουνίου 2016

Δευτέρα 27 Ιουνίου 2016

Abstract

Purpose

Methods

Results

Conclusions

Δημοφιλείς αναρτήσεις