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1.
Prehosp Emerg Care ; 25(4): 588-592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32776812

RESUMO

The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of the trauma patient in both the prehospital and hospital setting.


Assuntos
Serviços Médicos de Emergência , Ketamina , Consenso , Serviço Hospitalar de Emergência , Hospitais , Humanos
2.
Prehosp Emerg Care ; 24(1): 32-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31091135

RESUMO

On March 13, 2019 the EMS Examination Committee of the American Board of Emergency Medicine (ABEM) approved modifications to the Core Content of EMS Medicine. The Core Content is used to define the subspecialty of EMS Medicine, provides the basis for questions to be used during written examinations, and leads to development of a certification examination blueprint. The Core Content defines the universe of knowledge for the treatment of prehospital patients that is necessary to practice EMS Medicine. It informs fellowship directors and candidates for certification of the full range of content that might appear on certification examinations.


Assuntos
Certificação/organização & administração , Serviços Médicos de Emergência/organização & administração , Medicina de Emergência/educação , Currículo , Avaliação Educacional , Humanos , Especialização , Estados Unidos
3.
Trauma Surg Acute Care Open ; 4(1): e000376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673635

RESUMO

This is a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians regarding the clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA. This statement addresses the system of care needed to manage trauma patients requiring the use of REBOA, in light of the current evidence available in this patient population. This statement was developed by an expert panel following a comprehensive review of the literature with representation from all sponsoring organizations and the US Military. This is an update to the previous statement published in 2018. It has been formally endorsed by the four sponsoring organizations.

4.
Prehosp Emerg Care ; 22(6): 659-661, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30091939

RESUMO

The American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have previously offered varied guidance on the role of backboards and spinal immobilization in out-of-hospital situations. This updated consensus statement on spinal motion restriction in the trauma patient represents the collective positions of the ACS-COT, ACEP and NAEMSP. It has further been formally endorsed by a number of national stakeholder organizations. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, and nurses as they strive to improve the care of trauma victims within their respective domains.


Assuntos
Consenso , Restrição Física , Coluna Vertebral , Ferimentos e Lesões , Serviços Médicos de Emergência , Humanos
8.
J Emerg Med ; 55(1): 101-109.e2, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29759656

RESUMO

BACKGROUND: The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. OBJECTIVES: This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group. METHODS: Data from five longitudinal cohorts were analyzed using descriptive statistics to assess stressors, career satisfaction, and self-reported resident well-being. Participants' answers were reported on a 5-point Likert scale. RESULTS: There were 766 residents who completed the survey in five cohorts. Respondents were 30 years old (median 29), male (66%), and predominantly White (79%). The most frequently encountered problems included "time devoted to documentation and bureaucratic issues," "knowing enough," and "crowding in the emergency department." In contrast, the least frequently reported problems included "gender discrimination," "EMS support," "minority discrimination," and "other residents." Respondents thought being an EM resident was fun and would select EM again. Less than 20% indicated they had seriously considered transferring to another EM program. Resident reports of health concerns changed over time, with fewer residents reporting they were exceptionally healthy in 2016. CONCLUSIONS: Residents are, overall, happy with their career choice. However, concern was expressed regarding continued well-being in training. Sources of stress in training are identified. Strategies should be developed to decrease identified stressors and increase well-being among EM residents.


Assuntos
Medicina de Emergência/educação , Internato e Residência/normas , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Distribuição de Qui-Quadrado , Estudos de Coortes , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/normas , Medicina de Emergência/organização & administração , Medicina de Emergência/normas , Feminino , Humanos , Internato e Residência/métodos , Satisfação no Emprego , Estudos Longitudinais , Masculino , Médicos/organização & administração , Análise de Regressão , Autorrelato , Inquéritos e Questionários , Estados Unidos
10.
Neurology ; 87(1): 19-26, 2016 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-27281534

RESUMO

OBJECTIVES: In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. METHODS: We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval). RESULTS: We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites. CONCLUSIONS: Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.


Assuntos
Computadores de Mão , Acidente Vascular Cerebral/diagnóstico , Telemedicina , Transporte de Pacientes , Comunicação por Videoconferência , Isquemia Encefálica/diagnóstico , Telefone Celular , Estudos de Viabilidade , Humanos , Neurologistas , Projetos Piloto , Análise de Regressão , Reprodutibilidade dos Testes , População Rural , São Francisco , Índice de Gravidade de Doença , Telemedicina/economia , Telemedicina/instrumentação , População Urbana , Comunicação por Videoconferência/economia , Comunicação por Videoconferência/instrumentação , Virginia
11.
Prehosp Emerg Care ; 20(5): 557-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26985786

RESUMO

Tranexamic acid (TXA) is being administered already in many prehospital air and ground systems. Insufficient evidence exists to support or refute the prehospital administration of TXA, and results are pending from several prehospital studies currently in progress. We have created this document to aid agencies and systems in best practices for TXA administration based on currently available best evidence. This document has been endorsed by the American College of Surgeons-Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.


Assuntos
Antifibrinolíticos/uso terapêutico , Serviços Médicos de Emergência/métodos , Hemorragia/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Ferimentos e Lesões/tratamento farmacológico , Antifibrinolíticos/efeitos adversos , Humanos , Ácido Tranexâmico/efeitos adversos
12.
Am J Emerg Med ; 34(3): 459-63, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26763824

RESUMO

INTRODUCTION: Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care. METHODS: Data on 2012 ED visits to a rural Level I Trauma Center and public safety net hospital were collected through a deidentified patient database. Transport data and 2012 Medicare Reimbursement Schedules were used to estimate the cost of EMS transport. Health information, outcomes, and costs were compared to find differences between the FP and non-FP group. RESULTS: This study identified 1242 FPs who visited the ED 5 or more times in 2012. Frequent patients comprised 3.25% of ED patients but accounted for 17% of ED visits and 13.7% of hospital costs. Frequent patients had higher rates of chronic disease, severity scores, and mortality. Frequent patients arrived more often via ambulance and accounted for 32% of total transports at an estimated cost of $2.5-$3.2 million. Hospital costs attributable to FPs were $29.1 million, bringing the total cost of emergency care to $31.6-$32.3 million, approximately $25,000 per patient. CONCLUSIONS: This study demonstrates that the inclusion of a prehospital cost estimate adds approximately 10% to the cost of care for the FP population. In addition to improving care for a sick population of patients, programs that reduce frequent EMS and ED use have the potential to produce a favorable cost benefit to communities and health systems.


Assuntos
Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/economia , Custos Hospitalares , Provedores de Redes de Segurança/economia , Centros de Traumatologia/economia , Adulto , Comorbidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino
13.
Telemed J E Health ; 22(6): 507-13, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26600433

RESUMO

BACKGROUND: The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology. MATERIALS AND METHODS: We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments. RESULTS: Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance. CONCLUSIONS: In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.


Assuntos
Ambulâncias , Consulta Remota/instrumentação , Consulta Remota/organização & administração , Computadores de Mão , Humanos , Consulta Remota/economia , Consulta Remota/normas , Reprodutibilidade dos Testes , População Rural , Fatores de Tempo
14.
Prehosp Emerg Care ; 18(1): 98-105, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24156509

RESUMO

Emergency medical services (EMS) became an American Board of Medical Specialties (ABMS) approved subspecialty of emergency medicine in September 2010. Achieving specialty or subspecialty recognition in an area of medical practice requires a unique body of knowledge, a scientific basis for the practice, a significant number of physicians who dedicate a portion of their practice to the area, and a sufficient number of fellowship programs. To prepare EMS fellows for successful completion of fellowship training, a lifetime of subspecialty practice, and certification examination, a formalized structured fellowship curriculum is necessary. A functional curriculum is one that takes the entire body of knowledge necessary to appropriately practice in the identified area and codifies it into a training blueprint to ensure that all of the items are covered over the prescribed training period. A curriculum can be as detailed as desired but typically all major headings and subheadings of the core content are identified and addressed. Common curricular components, specific to each area of the core content, include goals and objectives, implementation methods, evaluation, and outcomes assessment methods. Implementation methods can include simulation, observations, didactics, and experiential elements. Evaluation and outcomes assessment methods can include direct observation of patient assessment and treatment skills, structured patient simulations, 360° feedback, written and oral testing, and retrospective chart reviews. This paper describes a curriculum that is congruent with the current EMS core content, as well as providing a 12-month format to deploy the curriculum in an EMS fellowship program. Key words: curriculum; education; emergency medical services; fellowships and scholarships.


Assuntos
Currículo , Auxiliares de Emergência/educação , Medicina de Emergência/educação , Humanos , Estados Unidos
16.
Prehosp Emerg Care ; 16(3): 309-22, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22233528

RESUMO

On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.


Assuntos
Certificação , Serviços Médicos de Emergência/normas , Competência Clínica , Especialização , Estados Unidos
17.
Emerg Med Clin North Am ; 30(1): 13-23, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22107971

RESUMO

Myocardial disease and death from cardiac arrest remain significant public health problems. Sudden death events and out-of-hospital cardiac arrests (OHCA) are encountered frequently by emergency medical services. Despite more than 30 years of research, survival rates remain extremely low. This article reviews access and presentations, demographics, OHCA outcomes, and response systems and processes in treatment of patients with arrest in this setting.


Assuntos
Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/organização & administração , Parada Cardíaca Extra-Hospitalar/terapia , Serviços Médicos de Emergência/métodos , Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos/epidemiologia
18.
Ann Emerg Med ; 57(5): 526-34, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21513832

RESUMO

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2011 annual report on the status of US emergency medicine training programs.


Assuntos
Comitês Consultivos , Medicina de Emergência/educação , Internato e Residência , Conselhos de Especialidade Profissional , Adulto , Bolsas de Estudo , Feminino , Médicos Graduados Estrangeiros/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Estados Unidos , Recursos Humanos , Adulto Jovem
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