Readings in Emergency Medical Services
The following readings and articles are intended to complement the experience in prehospital care and emergency medical services.
I. Emergency Medical Services Systems and Structure
- STEMI care in the United States: an overview (Am J Emerg Med, 2014)
A report from the Mission:Lifeline registry describing the current state of regionalized systems of STEMI care.
- Overview of Maryland EMS system and providers
Brief powerpoint that reviews the various levels of Maryland EMS providers. The presentation includes information on EMS section faculty and outlines basic educational requirements for emergency medical technicians and paramedics.
- Overview of Emergency Medical Services Systems (RI Medical Journal, 2013)
This article provides a brief description of the history of EMS and outlines the traditional levels of prehopital care. Though some information is specific to the structure of EMS systems in Rhode Island, the article nevertheless represents a respectable introduction.
II. Clinical Aspects of Prehospital Medicne
AIRWAY MANAGEMENT IN CARDIAC ARREST
- Airway management in cardiac arrest: results from the CARES registry (Resuscitation, 2014)
This large, retrospective analysis of data entered into the Cardiac Arrest to Improve Survival (CARES) registry examined over 10,000 patients. The study looked at the association between advanced airway management, mortality, and neurologic outcome. Patients who received a supraglottic airway or who were managed via bag valve mask were also included in the analysis.
- Supraglottic airway placement and out of hospital cardiac arrest (Resuscitation, 2012)
Dr. Wang and colleagues report on data from the Resusitation Outcomes Consortium. This study compared the outcomes of patients who received airway management via an endotracheal tube or with a supraglottic airway.
THERAPEUTIC HYPOTHERMIA AND POST ARREST CARE
- Effect of hypothermia initiated in the prehospital environment (JAMA, 2014)
A study published in the 2014 issue of JAMA suggest caution with respect to the widespread adoption of prehospital hypothermia. Prehospital patients randomized to 2 liters of chilled saline experienced (1) a greater incidence of re-arrest and (2) an increased risk for pulmonary edema. The study found no survival or neurologic benefit linked to hyopthermia initiated in the prehospitla environment.
- CRASH-2 Trial Webpage
Informative page dedicated to the results of the "CRASH-2" trial. The Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage (CRASH) trial examined the use of tranexamic acid for significant hemorrhage. Endpoints of this trial included mortality and the requirement for blood products. Emergency medical services systems have incorporated tranexamic acid (TXA) protocols into their formularies, and the CRASH-2 trial established the foundation for this medicine's use.
- Integration of TXA into a prehospital aeromedical program (Air Medical Journal, 2013)
Small study that describes how an air medical program implemented protocols for the administration of transexamic acid. The study affirms that TXA can be rapidly administered to a select population of patients.
III. Medical Direction and Oversight of Emergency Medical Services
- Evidence based performance measures in EMS
Dr. J Brent Myers (medical director of Wake EMS) and colleagues discuss the recent shift towards evidence based system metrics. As opposed to response time, Myers and colleagues propose clinically oriented metrics for system evaluation
- Response times and their lack of association with favorable outcomes
In 2009,Blackwell et al published a study on the link between response times and patient outcomes. There is little evidence to support the widespread adoption of amblance response time as a validated performance metric.
- Introduction to physician medical direction of EMS (RI Medical Journal, 2013)
Brief description of "on line" and "off-line" modes of medical control. The article also reviews core components of physician medical direction
IV. Special Operations in Emergency Medical Services