N. Heramba Prasad

Is Ambulance Transport Time With Lights and Siren Faster Than That Without

STUDY OBJECTIVE To determine whether ambulance transport time from the scene to the emergency department is faster with warning lights and siren than that without. DESIGN In a convenience sample, transport times and routes of ambulances using lights and sirens were recorded by an observer. The time also was recorded by a paramedic who drove an ambulance without lights and siren over identical routes during simulated transports at the same time of day and on the same day of the week as the corresponding lights-and-siren transport. SETTING An emergency medical service system in a city with a population of 46,000. PARTICIPANTS Emergency medical technicians and paramedics. RESULTS Fifty transport times with lights and siren averaged 43.5 seconds faster than the transport times without lights and siren [t = 4.21, P = .0001]. CONCLUSION In this setting, the 43.5-second mean time savings does not warrant the use of lights and siren during ambulance transport, except in rare situations or clinical circumstances.

Environmental temperature variations cause degradations in epinephrine concentration and biological activity

This study determined the biological consequence of temperature induced epinephrine degradation. Two different epinephrine preparations (1:1,000 and 1:10,000) were exposed to either cold (5 degrees C) or hot (70 degrees C) temperature. The exposure occurred for 8-hour periods each day in 4-, 8-, and 12-week intervals. Samples and identical controls were then chemically evaluated using high-pressure liquid chromatography (HPLC), and biological activity of samples showing chemical degradation was assessed in conscious rats. Epinephrine (1:10,000) underwent a significant degradation and a loss of concentration of the parent compound after 8 weeks of heat treatment. By 12 weeks, 64% of the epinephrine was degraded. A smaller (30%) but significant loss of cardiovascular potency was determined by blood pressure and heart rate responses in conscious rats. The degradation of epinephrine (1:1,000) was not statistically significant even after 12 weeks of heat exposure. No change was noted from control in either epinephrine concentration when exposed to cold temperatures. In conclusion, epinephrine (1:10,000) deteriorates in the presence of elevated temperature and should be protected from high temperatures when carried by EMS providers. The degradation products may possess biological activity.

Public perceptions of a rural emergency medical services system.

INTRODUCTION To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system. HYPOTHESIS Citizens and physicians are unaware of the capabilities of the EMS system. METHODS Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p < 0.01. RESULTS A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p < 0.001). CONCLUSION This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.

Does basic life support in a rural ems system influence the outcome of patients with respiratory distress

PURPOSE The purpose of this study was to determine whether basic life support, prehospital emergency medical care in a rural area affects the hospital course of patients with respiratory distress. METHODS Medical records for patients admitted from the emergency department with a discharge diagnosis related to respiratory disease were reviewed. Data collected included: 1) mode of arrival; 2) initial symptom; 3) vital signs; 4) prehospital interventions applied; 5) hospital days; 6) discharge status; and 7) principal diagnosis. Multiple logistic regression analysis was used to predict length of hospital stay. RESULTS Charts for 603 patients were reviewed. Complete data for all variables included in the logistic regression analysis were available for 471 patients (78.1%). Because 55 patients died, only 416 (69.0%) were included in the multiple regression analysis conducted to predict length of hospital stay. Logistic regression analysis demonstrated that patients who arrived by ambulance and older patients were more likely to die; patients with higher systolic blood pressures were more likely to survive. Only patient age predicted length of hospital stay, with older patients having longer stays. CONCLUSIONS Basic life support prehospital care in this rural emergency medical services system does not result in a lower mortality rate or a shorter hospital stay for a broad group of patients with respiratory distress who require hospital admission. Although this study is limited to a single population and a single emergency medical services system, it is one of only a few studies of outcome in basic life support systems.

Poster 011. Do ALS Providers Need Vital Signs to Assess and Manage Prehospital Patients

Purpose: Routine vital signs (VS) assessment is considered a fundamental component of patient assessment. This study was undertaken to determine if advanced life support EMS providers can manage patients without VS. Methods: Twenty-seven paramedics and 37 intermediates were presented with 20 randomized patient scenarios that did not include VS. They were asked to identify all interventions they would perform for each patient. Six weeks later, the same scenarios were presented in a new order, with VS, and the participants again identified the interventions they would perform. The frequency of specific interventions for each patient in the no-VS group was compared to the frequency in the VS group using chi-square or Fishers Exact test. Results: There were two cases for which paramedics significantly changed their interventions when given VS. They were more likely to run IVs wide open in an unresponsive 86-year-old woman with an unobtainable blood pressure ( p = 0.024), and less likely to immobilize a 65-year-old man who had fallen the night before ( p = 0.001). There were three cases for which intermediates significantly changed their interventions when given VS. They were more likely to start two IVs for a 69-year-old with near syncope ( p = 0.020), less likely to run IVs wide open for a 32-year-old gunshot victim ( p = 0.016), and they, too, were less likely to immobilize the 65-year-old man who had fallen the night before ( p = 0.013). Conclusion: Vital signs do not significantly affect interventions for most prehospital patients, and may not be necessary.