Paramedic Application Research Articles

Evaluating the paramedic application of the prehospital Canadian C-Spine Rule in sport-related injuries.

We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury. We reviewed data from the prospective paramedic Canadian C-Spine Rule validation and implementation studies in 7 Canadian cities. A trained reviewer further categorized sport-related mechanisms of injury collaboratively with a sport medicine physician using a pilot-tested standardized form. We compared the Canadian C-Spine Rule's recommendation to immobilize sport-related versus non-sport-related patients using Chi-square and relative risk statistics with 95% confidence intervals. There were 201 sport-related patients among the 5,978 included. Sport-related injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs. 46.8%) than non-sport-related patients. Paramedics did not miss any C-Spine injury when using the Canadian C-Spine Rule. C-Spine injury rates were similar between sport (2/201; 1.0%) and non-sport-injured patients (47/5,777; 0.8%). The Canadian C-Spine Rule recommended immobilization equally between groups (46.4% vs. 42.5%; RR 1.09 95%CI 0.93-1.28), most commonly resulting from a dangerous mechanism among sport-injured (68.7% vs. 54.5%; RR 1.26 95%CI 1.08-1.47). The most common dangerous mechanism responsible for immobilization in sport was axial load. Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.

P036: Sensitivity and false negatives in the use of a prehospital sepsis alert

Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.

Field Paramedic Application of Sepsis Triage

Field Paramedic Application of Sepsis Triage

Paramedic Application of a Triage Sieve: A Paper-Based Exercise.

The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates. Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire. The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups. This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A "just-in-time" educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI. Cuttance G , Dansie K , Rayner T . Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3-13.

Part 13: First Aid

Part 13: First Aid

Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

ObjectivesRecently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting...

A prospective evaluation of prehospital 12-lead ECG application in chest pain patients

The objective of this study was to prospectively determine the utility, efficiency, and reliability of early prehospital 12-lead electrocardiogram (ECG) application, the improvement in prehospital diagnostic accuracy, and paramedic and base physician opinions regarding early application of prehospital 12-lead ECGs in a broad range of stable chest pain patients. The patient population consisted of cooperative, stable adult prehospital patients with a chief complaint of nontraumatic chest pain of presumed ischemic origin. From July 17, 1989 through January 1, 1990 paramedics acquired prehospital 12-lead ECGs on 680 stable adult chest pain patients. Factors affecting prehospital 12-lead ECG application were evaluated. Paramedic application of prehospital 12-lead ECGs was found to be efficient and reliable, and it can be applied to most cooperative stable adult prehospital chest pain patients. Prehospital 12-lead ECGs significantly improve base physicians' diagnostic accuracy in myocardial infarction, angina, and nonischemic chest pain patients. Paramedic and base physicians' opinions regarding early application of prehospital 12-lead ECGs during patient evaluation were favorable.

Reevaluation of plastic tubings currently used in medical and paramedical applications.

AbstractA tissue culture test and a 7 day implantation method in rabbits were used to screen the toxic potential of 50 tubings used in one or more medical or paramedical applications. Results of the tests revealed that approximately 32% of the tubings contained one or more ingredients which, when released to cells or tissue, caused a toxic response. A similar study six years previously showed that 52% of the tubings tested had toxic potential. It is apparent that improvements have been made in the medical tubings (from point of view of safety), but steps must still be taken to reduce the potential risk to levels approaching zero.

Plasticizers in medical application I Analysis and toxicity evaluation of dialkyl benzenedicarboxylates

A series of dialkyl and dicycloalkyl benzenedicarboxylates (phthalates, isophtha-lates, terephthalates), of which some have been employed as plasticizers, were synthesized and purified. Thin-layer chromatography and infrared spectrometry were employed as methods of detection and identification of these compounds. Toxicity tests were conducted using mammalian cell cultures and limited mouse studies. The low molecular weight esters and their isomers manifested toxic responses while the esters containing alkyl groups C₆ to C₉ were devoid of toxic effect. The di-n-decyl phthalate and terephthalate also elicite toxic actions to cells. Results from this study indicate the need for good quality control procedures to prevent the access of potentially toxic plasticizers in devices for medical and paramedical applications.

Effect of Diester Type Plasticizers on the Differential Thermal Spectrum of a Polyvinyl Chloride System

One of the most successful formulated plastics for medical and paramedical applications is the polyvinyl chloride (PVC) family. A variety of excellent properties is possible by incorporating other agents such as plasticizers into PVC. Plasticized systems are currently being used for flexible tubings, blood bags, various types of catheters, and protective materials. Because of the lack of published information on the effects of plasticizers on the thermal spectra of PVC and the paucity of data on this polymer using differential thermal analysis, a study was initiated to note what effects a group of plasticizers would have on the thermal behavior of formulated PVC systems. A group of diester plasticizers was used to note how each member of the series would influence the depolymerization process. Results of this study suggest a method of predicting whether a plasticizer will increase or decrease the tendency of the polymer to degrade.