Prehospital airway management on rescue helicopters in the United Kingdom
26 of 27 identified UK rescue helicopter bases responded to a questionnaire sent by German anaesthesiologists on the airway equipment they carried. The take home message is that there were some important gaps: not all carried equipment for establishing a surgical airway and not all had a means of capnometry. Pull your socks up guys the Germans are watching.
Anaesthesia. 2009 Jun;64(6):625-31
http://www.ncbi.nlm.nih.gov/pubmed/19453316
Tag Archives: EMS
Tourniquets Revisited
A volunteer study showed that tourniquets were just as effective at occluding distal blood flow measured by doppler signal when placed below the elbow or knee compared with above those joints. A makeshift windlass tourniquet, a rubber tube tourniquet, and a blood pressure cuff were all effective. Digital ‘pressure point control’ failed to maintain control of brachial or femoral artery flow.
Tourniquets Revisited
J Trauma. 2009 Mar;66(3):672-5
Passenger Compartment Intrusion and Kids
The presence and degree of compartment intrusion (from crash investigation data) was correlated with the likelihood of serious injury in 880 children from age 0-15 years, and odds for presence of serious injury increased for each centimetre of compartment intrusion.
Passenger Compartment Intrusion as a Predictor of Significant Injury for Children in Motor Vehicle Crashes
J Trauma. 2009 Feb;66(2):504-7
Paramedics control space
Paramedics practice ‘‘in the street’’ and perform in ‘‘a context rife with chaotic, dangerous, and often uncontrollable elements with which hospital-based practitioners need not contend’ We knew that, but what isn’t known is how more experienced or expert paramedics differ from novices in scene management. This qualitative study involving interviews of 24 paramedics describes the ‘space control theory’ – how paramedics establish control over their immediate workspace to effectively deliver patient care. It’s not big on detail, but at least this paper documents for hospital-based ambulance medical advisors that there is more to paramedicine than purely clinical factors, which is why insistence on hospital-derived clinical treatment algorithms might sometimes be inappropriate in the field. I’ve emailed the author for more details.
Introduction to the ‘‘space-control theory of paramedic scene management’’
Emerg Med J. 2009 Mar;26(3):213-6
Pre-hospital arterial lines
Arterial lines in the field? You’ve got to be nuts, or…..French! Yep, the SAMU boys and girls put in 94 arterial lines in pre-hospital cases over two years, and found big differences between invasive and non-invasive arterial pressures in systolic and diastolic pressures. What about mean pressures though, which we’d expect to be more closely correlated? They didn’t say. An interesting paper, but I don’t think I can use it.
Emerg Med J. 2009 Mar;26(3):210-2
Invasive arterial blood pressure monitoring in an out-of-hospital setting: an observational study
Air medical intubation success
In contrast to literature showing high intubation failure rates by ground paramedics, a review over eight years of 369 intubations by flight paramedics and nurses showed successful tracheal intubation in 92.1% cases. Of the 369 intubation encounters, rapid sequence medications were given in 345. The authors ascribe their success to both initial training and mandatory ongoing practice and demonstration of competencies.
Performance of endotracheal intubation and rescue techniques by emergency services personnel in an air medical service
Prehosp Emerg Care. 2009 Jan-Mar;13(1):44-9
BIS+HEMS
Bispectral index monitoring (BIS) was applied to 57 intubated patients transported by a Helcopter Emergency Medical Service (HEMS), demonstrating (1) that the patients were adequately sedated, (2) BIS works in helicopters, and (3) there is enormous scope for publishing work related to the retrieval environment – anything is of interest!
Bispectral index monitoring in helicopter emergency medical services patients
Prehosp Emerg Care. 2009 Apr-Jun;13(2):193-7
Airtraq use by paramedics
Paramedics intubated simulated patients positioned supine on the floor by direct laryngoscopy (DL) and by using the Airtraq device. Ventilation was achieved more quickly with the Airtraq in a difficult airway scenario (tongue oedema), and after a short training period the Airtraq was faster at intubating a ‘normal’ airway.
Comparison of use of the Airtraq with direct laryngoscopy by paramedics in the simulated airway.
Prehosp Emerg Care. 2009 Jan-Mar;13(1):75-80
Physicians in pre-hospital care
This systematic review by Scandinavian authors examined controlled studies comparing physician with non-physician treatment in pre-hospital care. Fourteen of the 26 studies identified demonstrated significantly improved survival in the intervention (physician-treated) group. Most survival benefit has been demonstrated in trauma and cardiac arrest, reflecting the fact that these two areas are the most studied. The authors rightly remind us of the paucity of pre-hospital controlled studies of sufficient quality and strength.
A systematic review of controlled studies: do physicians increase survival with prehospital treatment?
Scand J Trauma Resusc Emerg Med. 2009 Mar 5;17(1):12
Full text available at http://www.sjtrem.com/content/pdf/1757-7241-17-12.pdf
Neonatal prostaglandin E1 and apnoea
The risk of apnoea in neonates requiring prostaglandin E1 infusions for duct-dependent congenital heart disease is well described and often results in the recommendation to intubate prior to transfer. An American study of 202 transported infants on PGE1 shows a higher rate of transport-related complications in those that had been intubated. None of the 73 (36%) unintubated patients required intubation for apneoa during transport. These data are in keeping with a previous Australian study of 300 infants receiving PGE1 in which only 2 of 78 unintubated patients experienced apnoea.
To intubate or not to intubate? Transporting infants on prostaglandin E1
Pediatrics. 2009 Jan;123(1):e25-30