Jeffrey M. Goodloe

Resuscitation Center Designation: Recommendations for Emergency Medical Services Practices

Abstract Regionalization of medical resources by designating specialty receiving centers, such as trauma and stroke centers, within emergency medical services (EMS) systems is intended to ensure the highest-quality patient care in the most efficient and fiscally responsible fashion. Significant advances in the past decade such as induction of therapeutic hypothermia following resuscitation from cardiac arrest and a time-driven, algorithmic approach to management of septic patients have created compelling arguments for similar designation for specialized resuscitative interventions. Resuscitation of critically ill patients is both labor- and resource-intensive. It can significantly interrupt emergency department (ED) patient throughput. In addition, clinical progress in developing resuscitation techniques is often dependent on the presence of a strong research infrastructure to generate and validate new therapies. It is not feasible for many hospitals to make the commitment to care for large numbers of critically ill patients and the accompanying investigational activities, whether in the prehospital, ED, or inpatient arena. Because of this, the question of whether EMS systems should designate specific hospitals as “resuscitation centers” has now come center stage. Just as EMS systems currently delineate criteria and monitor compliance for trauma, ST-elevation myocardial infarction (STEMI), and stroke centers, strong logic now exists to develop similar standards for resuscitation facilities. Accordingly, this discussion reviews the current applicable trends in resuscitation science and presents a rationale for resuscitation center designation within EMS systems. Potential barriers to the establishment of such centers are discussed and strategies to overcome them are proposed.

Guidance Document for the Prehospital Use of Tranexamic Acid in Injured Patients

Abstract Tranexamic acid (TXA) is being administered already in many prehospital air and ground systems. Insufficient evidence exists to support or refute the prehospital administration of TXA, and results are pending from several prehospital studies currently in progress. We have created this document to aid agencies and systems in best practices for TXA administration based on currently available best evidence. This document has been endorsed by the American College of Surgeons–Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.

Stop the Bleed Education Consortium: Education program content and delivery recommendations

Following the 2015 White House launch of the Stop the Bleed (STB) campaign various educational programs have emerged to teach hemorrhage control principles to the public. The STB campaign seeks to translate battlefield medicine successes to the civilian sector by empowering the general public to sto

EMS Stretcher "Misadventures" in a Large, Urban EMS System: A Descriptive Analysis of Contributing Factors and Resultant Injuries

Purpose. There is a paucity of data regarding EMS stretcher-operation-related injuries. This study describes and analyzes characteristics associated with undesirable stretcher operations, with or without resultant injury in a large, urban EMS agency. Methods. In the study agency, all stretcher-related “misadventures” are required to be documented, regardless of whether injury results. All stretcher-related reports between July 1, 2009 and June 30, 2010 were queried in retrospective analysis, avoiding Hawthorne effect in stretcher operations. Results. During the year studied, 129,110 patients were transported. 23 stretcher incidents were reported (0.16 per 1,000 transports). No patient injury occurred. Four EMS providers sustained minor injuries. Among contributing aspects, the most common involved operations surrounding the stretcher-ambulance safety latch, 14/23 (60.9%). From a personnel injury prevention perspective, there exists a significant relationship between combative patients and crew injury related to stretcher operation, Fishers exact test 0.048. Conclusions. In this large, urban EMS system, the incidence of injury related to stretcher operations in the one-year study period is markedly low, with few personnel injuries and no patient injuries incurred. Safety for EMS personnel and patients could be advanced by educational initiatives that highlight specific events and conditions contributing to stretcher-related adverse events.

Subcutaneous Fluid Administration: A Potentially Useful Tool in Prehospital Care

Mass casualty incidents (MCIs) and disaster medical situations are ideal settings in which there is need for a novel approach to infusing fluids and medications into a patients intravascular space. An attractive new approach would avoid the potentially time-consuming needlestick and venous cannulation requiring a trained practitioner. In multiple-patient situations, trained practitioners are not always available in sufficient numbers to enable timely placement of intravenous catheters. The novel approach for intravascular space infusion, described in this paper involves the preadministration of the enzyme, human recombinant hyaluronidase (HRH), into the subcutaneous (SC) space, via an indwelling catheter. The enzyme “loosens” the SC space effectively enhancing the absorption of fluids and medication.

Optimizing neurologically intact survival from sudden cardiac arrest: a call to action.

The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function.

EMERGENCY MEDICAL TECHNICIAN-BASIC ACQUISITION AND TRANSMISSION OF 12-LEAD ECG USING A NOVEL DEVICE (READYLINK™)

Early detection of ST segment elevation myocardial infarction (STEMI) by emergency medical services (EMS) can improve timeliness of definitive interventional care. Many EMS systems lack paramedics, operating solely with Emergency Medical Technician (EMT) - Basics. This studys purpose is to evaluate

Patients Refusing Prehospital Transport Are Increasingly Likely to Be Geriatric

Objective. Elderly patients are becoming an increasingly larger proportion of our population, and there is a paucity of data regarding the epidemiology of geriatric patients refusing transport. Treatment refusal rates range from 5% to 15% in many studies. This study sought to test the hypothesis that geriatric patients constituted an increasing proportion of those persons refusing prehospital transport. Methods. This study was a retrospective analysis of data from a query of a large urban EMS service. Results. There were a total of 22,347 adult transport refusals recorded during the 16-month study period. Multivariate logistic regression incorporating covariates for sex, race, season, chief complaint, metropolitan region, and whether any treatment occurred prior to transport refusal confirmed the increasing likelihood of Period 2 patients being geriatric, as compared with Period 1 (OR 1.24, 95% CI 1.14–1.35, Wald P < .001). Conclusion. This data shows that despite controlling for these covariates, patients refusing transport in the second period of this study were nearly 25% more likely to be geriatric as compared to those in the initial 8 months of the study.

Tulsa oklahoma oktoberfest tent collapse report.

Background. On October 17, 2007, a severe weather event collapsed two large tents and several smaller tents causing 23 injuries requiring evacuation to emergency departments in Tulsa, OK. Methods. This paper is a retrospective analysis of the regional health systems response to this event. Data from the Tulsa Fire Department, The Emergency Medical Services Authority (EMSA), receiving hospitals and coordinating services were reviewed and analyzed. EMS patient care reports were reviewed and analyzed using triage designators assigned in the field, injury severity scores, and critical mortality. Results. EMTs and paramedics from Tulsa Fire Department and EMSA provided care at the scene under unified incident command. Of the 23 patients transported by EMS, four were hospitalized, one with critical spinal injury and one with critical head injury. One patient is still in ongoing rehabilitation. Discussion. Analysis of the 2007 Tulsa Oktoberfest mass casualty incident revealed rapid police/fire/EMS response despite challenges of operations at dark under severe weather conditions and the need to treat a significant number of injured victims. There were no fatalities. Of the patients transported by EMS, a minority sustained critical injuries, with most sustaining injuries amenable to discharge after emergency department care.

Metrics save lives: value and hurdles faced

Purpose of review Affirmation of the importance of precision in fundamentals of resuscitation practices with improving neurologically intact survival from sudden cardiac arrest, correlated with both measurements of resuscitation metrics generically and recently further refined metric parameters specifically. Recent findings Quality of baseline cardiopulmonary resuscitation (CPR) in historic intervention trials may not be ‘high quality’ as once assumed. Optimal chest compression rates are within the narrow spectrum of 106–108/min for adults. Optimal ventilation rates remain within the 8–10/min range. Summary Although traditional CPR teaching of ‘hard and fast’ chest compressions has promoted a relatively easy to remember directive, the reality is that laypersons and medical professionals alike may unwittingly provide markedly suboptimal chest compression depths and rates. Prior resuscitation studies that focused upon airway adjuncts, defibrillation strategies, and/or pharmaceutical interventions that did not simultaneously gauge the underlying CPR chest compression rates, chest compression fraction of time, and ventilation rates should be cautiously interpreted in light of discovery that assumption of ‘high-quality CPR’ without measurement of the metrics of such is likely a faulty assumption.