2010: the emergency medical services literature in review.

Emergency physicians, specialists, and primary care doctors across the health care delivery spectrum remain actively engaged in the provision of medical oversight for emergency medical services (EMS) systems, a vital link in the medical continuum of care. Practicing emergency physicians, regardless of their level of formal EMS training, interface with EMS system components and providers on a regular basis. It is important to remain aware of trends and practice patterns that have the potential to affect the care of emergency patients. PubMed was used to find articles for this review. The authors included EMS articles from 2010 felt applicable to all emergency physicians that fit the general topics discussed in this review. Some key articles from 2009 were also included. Case series were generally excluded. The selection is by no means an attempt to single out the best research articles. Like a single 12-lead electrocardiographic (ECG) tracing, this review represents a "snapshot" of current discussions in the EMS community. Prehospital medicine is a dynamic discipline, and its practice patterns are not identical to those found in a hospital emergency department (ED). The purpose of this literature review is to familiarize emergency physicians with some of the ongoing discussions in the prehospital literature.

Ambulance diversion and emergency department offload delay: resource document for the National Association of EMS Physicians position statement.

The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. Ambulance offload delay, the time it takes to transfer a patient to an ED stretcher and for the ED staff to assume the responsibility of the care of the patient, may have more impact on ambulance turnaround time than ambulance diversion. EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time. Key words: ambulance; EMS; diversion; bypass; offload; delay.

The evolution of electrocardiographic changes in ST-segment elevation myocardial infarction.

Acute myocardial infarction (AMI) is a not uncommon diagnosis in the emergency department. During ST-segment elevation AMI (STEMI), the electrocardiogram (ECG) typically follows a progression of abnormality, beginning with hyperacute T waves and culminating with ST-segment elevation; pathologic Q waves can appear early and/or late in the process. Other findings include T-wave inversion and ST-segment depression which can occur before, during, or after the STEMI event. The evolution of ECG through these changes can occur rapidly after coronary artery occlusion. The emergency physician should be aware of the ECG findings that characterize the evolution of an STEMI with a sound understanding of the associated pathophysiology and clinical implication. This review discusses the changing ECG during an AMI. The pathogenesis of these findings is discussed. Finally, the clinical implications at each stage are reviewed.