Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T05:04:13.381Z Has data issue: false hasContentIssue false
  • English
  • Français

Out-Of-Hospital Research in the Urban Environment

Published online by Cambridge University Press:  17 February 2017

Paul E. Pepe
Paul E. Pepe*
Affiliation:
Center for Resuscitation and City of Houston EMS, Departments of Medicine, Surgery, and Pediatrics, Baylor College of Medicine, Houston Tex.
*
City of Houston, Center for Resuscitation and EMS, 410 Bagby, Suite 300, Houston, TX 77002-1595, USA
Get access Rights & Permissions [Opens in a new window]

Extract

The urban prehospital setting is one of the best venues in which to examine life-saving resuscitation interventions. When the entire catchment of the urban emergency medical services (EMS) system is used, large-population patient studies can be generated. Certain unique features give several urban centers the ability to conduct clinical trials in the out-of-hospital setting. Without resuscitation at the scene, it is rare for cardiac arrest patients to survive. In the case of trauma resuscitation, prehospital care can impact outcome significantly. Since coronary artery disease and trauma kill nearly one-million persons annually in the United States, prehospital care research is a worthwhile endeavor. This rationale for prehospital care research is strengthened by the relatively high potential for full recovery.

Keywords

Clinical TrialsCardiopulmonary ResuscitationTraumaResearchPrehospitalEmergency Medical ServicesParamedics
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 8 , supplement S1: Research in Prehospital Care Systems , March 1993 , pp. S20 - S24
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bonnin, MJ, Pepe, PE, Clark, PS: Key role of prehospital resuscitation in survival from out-of-hospital cardiac arrest. Ann Emerg Med 1990; 19:466.Google Scholar
2. Pepe, PE: Controlled studies in the prehospital setting: A viable, important venue for clinical research. Prehospital and Disaster Medicine 1990;5:285–288.CrossRefGoogle Scholar
3. Weaver, WD, Cobb, LA, Copass, MK, Hallstrom, AP: Ventricular fibrillation—A comparative trial using 175-J and 320-J shocks. N Engl J Med 1982;307:1101–1106.Google Scholar
4. Haynes, RE, Chinn, TL, Copass, MK, Cobb, LA: Comparison of bretylium tosylate and lidocaine in management of out-of-hospital ventricular fibrillation: A randomized clinical trial. Am J Cardiol 1981;48:353–356.Google Scholar
5. Mattox, KL, Maningas, PA, Moore, EE, et al: Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension—the U.S.A. multi-center trial. Ann Surgery 1991;213:482–491.Google Scholar
6. Pepe, PE, Bass, RR, Mattox, KL: Clinical trials of the pneumatic antishock garment in the urban prehospital Setting. Ann Emerg Med 1986;15:1407–1410.Google Scholar
7. Bickell, WH, Pepe, PE, Wyatt, CH, et al: The effect of anti-shock garments on patients with penetrating abdominal injuries. Ann Emerg Med 1987;16:653–658.Google Scholar
8. Stueven, HA, Thompson, B, Aprahamian, C, et al: The effectiveness of calcium chloride in refractory electromechanical dissociation. Ann Emerg Med 1985;14:626–629.Google Scholar
9. Maningas, PA, Mattox, KL, Pepe, PE, et al: Hypertonic saline dextran solutions for the prehospital management of traumatic hypotension. Am J Surgery 1989;157:528–534.CrossRefGoogle ScholarPubMed
10. Weaver, WD, Cergueira, M, Hallstrom, AP, et al: Results of the myocardial infarction triage and intervention (MITI) trial. Presented at the 1992 annual meeting of the American College of Cardiology, Dallas, Texas, 04 1992.Google Scholar
11. Brown, CG, Martin, DR, Pepe, PE, et al: Standard versus high-dose epinephrine in out-of-hospital cardiac arrest—a controlled clinical trial. N Engl J Med 1992; 327:1051–1055.Google Scholar
12. Martin, RR, Bickell, WH, Pepe, PE, Mattox, KL: Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury. J Trauma 1992;33:354–362.Google Scholar
13. Kellermann, AL, Staves, DR, Hackman, BB: Inhospital resuscitation following unsuccessful prehospital advanced cardiac life support: “Heroic efforts” or an exercise in futility? Ann Emerg Med 1988;17:589–594.CrossRefGoogle ScholarPubMed
14. Mclntyre, KM, Crimmins, TJ, Safar, P, et al. Ethical considerations in resuscitation; Part VIII. Emergency Cardiac Care Committee and Sul-committees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1992;208:2282–2288.Google Scholar
15. Gray, WA, Capone, RJ, Most, AS: Unsuccessful emergency medical resuscitation: are continued efforts in the emergency department justified? N Engl J Med 1991;325:1393–1398.Google Scholar
16. Pepe, PE, Copass, MK: Prehospital Care. In: Early Care of the Injured. American College of Surgeons Committee on Trauma, 1990. Philadelphia: B.C. Decker, 1990, pp 51–55.Google Scholar
17. Copass, MK, Oreskovich, MR, Bladergroen, MR, et al: Prehospital cardiopulmonary resuscitation of the critically injured patient. Am J Surgery 1984;148:20–26.Google Scholar
18. Durham, LA, Richardson, RJ, Wall, MJ, et al: Emergency center thoracotomy: Impact of prehospital resuscitation. J Trauma 1992;32:775–779.Google Scholar
19. Pepe, PE. The past, present, and future of emergency medical services. Prehospital and Disaster Medicine 1989;4:47–49.Google Scholar
20. Emergency Cardiac Care Committee and Subcommittees, American Heart Association: Standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care, I: Introduction. JAMA 1992;268:2172–2183.Google Scholar
21. Myerburg, RJ, Conde, CA, Sung, RJ, et al: Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med 1980;68:568.Google Scholar
22. Safar, P: Cerebral resuscitation after cardiac arrest: Summaries and suggestions. Am J Emerg Med 1983;2:198–214.Google Scholar
23. Pepe, PE, Bonnin, MJ, Mattox, KL: Regulating the scope of EMS. Prehospital and Disaster Medicine 1990;5:59–63.Google Scholar
24. Pepe, PE, Mattox, KL, Duke, JH, et al: The impact of full-time specialized physician supervision on the success of a large urban emergency medical services system. Crit Care Med 1993 (in press).Google Scholar
25. Becker, LB, Ostrander, MP, Barrett, J, Rondos, GT: Survival from cardiopulmonary resuscitation in a large metropolitan area: Where are the survivors? Ann Emerg Med 1991;20:355–361.Google Scholar
26. Abramson, NS, Safar, P: Brain Resuscitation Clinical Trial II Study Group: Deferred consent: Use in clinical resuscitation research. Ann Emerg Med 1990;19:781–784.Google Scholar
27. Pepe, PE, Bickell, WH, Mattox, KL: The ef fect of anti-shock garments on prehospital survival: The need for controlled clinical studies. Prehospital and Disaster Medicine 1987;3:40–45.Google Scholar
28. Cobb, LA Alvarez, H, Copass, MK: A rapid response system for out-of-hospital cardiac emergencies. Med Clin N Amer 1976;60: 283–290.Google Scholar
29. Weaver, WD, Cobb, LA, Hallstrom, AP, et al: Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med 1986; 15:1181.CrossRefGoogle ScholarPubMed
30. Cobb, IA, Weaver, WD, Fahrenbuch, CE, et al: Community-based interventions for sudden cardiac death: Impact, limitations and changes. Circulation 1992;85 (suppl 1):98–102.Google Scholar
31. Pepe, PE: Roots and philosophy of EMS. In: National EMS Medical Director's Course Syllabus. National Association of EMS Physicians, Pittsburgh, and Florida College of Emergency Physicians, Orlando, Fla., 1990, pp 2–12.Google Scholar
32. Pepe, PE: Current standard and future directions of advanced cardiopulmonary resuscitation. In: Vincent, JL (ed): Update in Emergency and Intensive Care. Berlin: Springer-Verlag, 1990, pp 565–585.Google Scholar
33. Cummins, RO, Ornato, JP, Thies, WH, Pepe, PE: State-of-the-Art Review—Improving survival from sudden cardiac arrest: The “Chain of Survival” concept. A statement for Health Professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991;83:1832–1847.Google Scholar
34. Eiscnberg, MS, Bergner, L, Hallstrom, A: Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation. Am J Public Health 1979;69:30–38.Google Scholar
35. Eisenberg, MS, Copass, MK, Hallstrom, AP, et al: Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med 1980;302:1379–1383.Google Scholar
36. Emergency Medical Services in the City of Houston. Houston: City of Houston Fire Department, 1993.Google Scholar
37. Pepe, PE, Curka, PA: Scene supervision of EMS. In Swor, R (ed). Management in Prehospital Care. Philadelphia: CV Mosby and Co., 1993, (in press).Google Scholar
38. McManus, WF, Tresch, DD, Darin, JC: An effective prehospital emergency system. J Trauma 1977;17:304–310.Google Scholar
39. Pepe, PE, Stewart, RD: Role of the physician in the prehospital setting. Ann Emerg Med 1986;15:1480–1483.CrossRefGoogle ScholarPubMed
40. Warlike, WJ, Bonnin, MJ: Direction and motivation of prehospital personnel to do research: How to do it better. Prehospital and Disaster Medicine 1992:7:79–84.Google Scholar
41. Heller, MB, Melton, JB, Kaplan, RM, et al. Data collection by paramedics for prehospital research. Ann Emerg Med 1988;17:414–415.Google Scholar
42. Cummins, RO, Chamberlain, DA, Abramson, NS, et al: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein Style. Ann Emerg Med 1991;20:861–874.Google Scholar
43. Burney, RE. Studies involving commercial products: Caveat investigator. Ann Emerg Med 1992;21:1368–1369. Editorial.Google Scholar
44. Petersdorf, RG: The Kennedy Lecture: The place of emergency medicine in the academic community. Proceedings of the Annual Meeting of the Society for Academic Emergency Medicine, 14 05 1991, Washington, D.C. Ann Emerg Med 1992;21:193–200.Google Scholar