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.
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.
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.
OUT-of-HOSPITAL CARDIAC ARREST CARE
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest (NEJM 2018) The largest out-of-hospital epinephrine administration trial to date. 8014 patients were enrolled in the study designed to examine the effectiveness of prehospital epinephrine administration on 30-day survival with a secondary outcome being neurologically intact outcomes (modified Rankin score 3 or less). For the primary outcome, the epinephrine group had a small statistically significant increase in survival of 3.2% vs 2.4% however there was NO difference in neurologically favorable survival at hospital discharge or at 3 months. Return of spontaneous circulation in the field was much greater in the epinephrine group (36.3% vs 11.7%) however this did not translate into a neurologically favorable discharge. This study calls into question current epinephrine practically both prehospitally and within the hospital. This study also demonstrates the ability to use an EMS system for large scale, high impact research.
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.
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