Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Although the efficacy of the administration of beta-adrenergic bronchodilators has been demonstrated, the best method available for the delivery of these drugs in the prehospital setting has not been defined. This paper compares the effects of administration of metaproterenol when administered by paramedics using either a metered-dose inhaler (MDI) or a hand-held nebulizer (HHN).
Hypothesis:
There is no difference in the effects produced in patients suffering from smooth bronchiolar muscle spasm by metaproterenol when delivered either by a standard metered-dose inhaler or with a hand-held nebulizer.
Participants:
Consecutive prehospital patients complaining of difficulty breathing with clinical evidence of bronchospasm and with a history of asthma, chronic obstructive pulmonary disease, or emphysema who were not in extremis.
Methods:
Prior to the administration of metaproterenol, a peak expiratory flow rate (PEFR) was obtained. This measurement was repeated five minutes following the conclusion of the administration of metaproterenol. Patients in Burbank, California, received the treatment using a standard metered-dose inhaler, and those in Madison, Wisconsin, received the drug using a hand-held nebulizer. Peak expiratory flow rates were compared using Student's t-tests with Bonferroni's correction. Statistical significance was set at p <0.05.
Results:
Data were collected from 36 consecutive patients by the paramedics of the Burbank Fire Department and from 32 consecutive patients by the paramedics of the Madison Fire Department. For the metered-dose inhaler group, the mean value for peak expiratory flow rate for the pre-treatment test was 95.4 ±88.1 1/min, and after treatment was 109.4 ±89.3 1/min (p <0.001). For the hand-held nebulizer group, the mean value for peak expiratory flow rate before the administration of the metaproterenol was 96.1 ±76.3 1/min and following the treatment was 149.1 ±92.9 1/min (p <0.001). The mean values for the differences between the control peak expiratory flow rate and the post-treatment peak expiratory flow rate for the metered-dose inhaler group was +14.0 ±27.4 1/min, and for the hand-held nebulizer group was +53.0 ±69.1 1/min (p <0.003).
Conclusions:
In the prehospital setting the administration of metaproterenol using a hand-held nebulizer is more effective than delivering the drug using a metered-dose inhaler. The hand-held nebulizer is easier to use and delivers a higher dose of the drug than is convenient using the metered-dose inhaler.
Research repeatedly has demonstrated that organisms exhibit adaptive physiological, emotional, and behavioral responses when exposed to noxious or threatening environmental stimuli. However, when the noxious stimuli are excessive or prolonged, efforts to cope may become overwhelmed, and the adaptive responses can turn into maladaptive reactions (e.g., illness, depression, and impaired performance). According to this model of stress, people who work in occupations that continually place them in danger or repeatedly force them to encounter psychologically demanding or distressing situations would appear to be at greater risk for developing adverse stress reactions.
Both anecdotal evidence and empirical research suggest that prehospital emergency medical services (EMS) may be a particularly high-stress field, placing emergency medical technicians (EMTs) at risk for developing such maladaptive stress reactions. This article reviews and synthesizes the empirical literature investigating the sources of stress among EMTs, and concludes with critical comments and guidelines for future research. The authors intend this review to be a resource for investigators conducting research in this area, as well as a convenient summary for anyone interested in learning more about the stressors EMTs experience, particularly mental health professionals and EMS administrators coordinating stress-management programs for EMTs.
Critical thinking has become a buzzword, especially in medical education. The challenge is first to determine what skills compose critical thinking and what teaching techniques promote critical-thinking skills, and then to determine how to apply these techniques effectively and efficiently to a given population in the classroom.
This article begins with a working definition of critical thinking and explores the parameters and skills implied or stated in the definition. Then a teaching environment constructed around a model of critical thinking and characteristics of the audience is described. A specific teaching method, suggested by research and designed to exercise critical-thinking skills, is then applied to a specific patient problem in a continuing education class. Preliminary outcomes are presented.
The purpose of this article is to propose a productive and efficient educational method for promoting and enhancing critical-thinking skills appropriate for paramedic-level continuing education.
The purpose of this study was to determine whether basic life support, prehospital emergency medical care in a rural area affects the hospital course of patients with respiratory distress.
Methods:
Medical records for patients admitted from the emergency department with a discharge diagnosis related to respiratory disease were reviewed. Data collected included: 1) mode of arrival; 2) initial symptom; 3) vital signs; 4) prehospital interventions applied; 5) hospital days; 6) discharge status; and 7) principal diagnosis. Multiple logistic regression analysis was used to predict length of hospital stay.
Results:
Charts for 603 patients were reviewed. Complete data for all variables included in the logistic regression analysis were available for 471 patients (78.1%). Because 55 patients died, only 416 (69.0%) were included in the multiple regression analysis conducted to predict length of hospital stay. Logistic regression analysis demonstrated that patients who arrived by ambulance and older patients were more likely to die; patients with higher systolic blood pressures were more likely to survive. Only patient age predicted length of hospital stay, with older patients having longer stays.
Conclusions:
Basic life support prehospital care in this rural emergency medical services system does not result in a lower mortality rate or a shorter hospital stay for a broad group of patients with respiratory distress who require hospital admission. Although this study is limited to a single population and a single emergency medical services system, it is one of only a few studies of outcome in basic life support systems.
Part I of this series of articles about stress among emergency medical technicians (EMTs) reviewed the potential sources of EMT stress. This article investigates the other side of the stress equation and provides a critical review of the empirical literature on the effects of stressors on EMTs. It is subdivided into sections corresponding to trends in the research, including: 1) predictors of higher stress levels; 2) differences in stress responses among EMTs, other health professionals, and firefighters; and 3) various physiologic, psychologic, and job performance responses. It identifies some of the methodologic flaws found in the EMT-stress literature that are noted in Part I, and provides further direction for future research. To maintain homogeneity, this review is limited to those articles published in scholarly journals. Studies investigating constructs such as job dissatisfaction and burnout were not included unless the study also included a measure of stress or stressors.
Considerable attention is being addressed to injury prevention. This study addresses the acceptance of a home injury-prevention survey as an injury-prevention tool in rural communities.
Purpose:
The purpose of this study was to evaluate public acceptance of a home injury-prevention survey as a tool to educate and enlighten the public about home injuries.
Methods:
All patients with home injuries who came to Wetzel County Hospital Emergency Department were asked if they would participate in a home injury-prevention survey. The study was conducted from 01 May to 01 July 1995. Paramedics were used as interviewers because of the closeness they enjoy with the community.
Results:
During the study period, 2,104 patients came to the emergency department of Wetzel County Hospital. Of these, 386 sought care because of an injury sustained in their homes. From this group, 23 (5.9%) patients agreed to participate in a home injury-prevention study; 363 (94.1%) refused.
Conclusion:
A home injury-prevention survey alone does not seem to be an effective tool to aid in the reduction of home injuries, because it is not embraced by the general public.
Hazardous materials incidents result from the release of materials considered to be harmful or potentially harmful to human beings or the environment. This article describes a train derailment and subsequent hazardous materials release with the evacuation of approximately 50,000 citizens. The hazardous materials release took five days to control and resulted in 561 patient visits to local emergency departments for symptoms related to chemical exposure. The evacuation and emergency medical operations are described and serve as a model for developing community emergency preparedness plans and managing victims involved in hazardous materials incidents.
Purpose: The purpose of this study was to determine if there were differences in tidal volume (Vt), minute volume (MV), average mask leak per breath (ML), gastric insufflation (GI), and peak airway pressure (PAP) when ventilating a non-intubated mannikin with a bag-valve (BV), manually triggered ventilator (MTV) and automated ventilator (AV). Our hypothesis was that there would be no differences among devices for any of these variables.
Methods: This was a prospective in vitro experimental model. A convenience sample of 19 emergency medical technicians (EMTs) ventilated a non-intubated mannikin-mechanical test lung model with BV, MTV (flow rate 40 L/min; pressure relief 55 cm H2O), and AV (800 ml/breath; rate 12). Each subject, blinded to volume and pressure gauges, used each device for two minutes at both normal (0.1 cm H2O) and poor (0.04 cm H2O) compliances. Vt, MV, GI, and PAP were measured directly and ML was calculated. Data were analyzed with repeated measures ANOVA and Bonferoni-Dunn multiple comparison test with alpha set at 0.05.
Objective: To determine the frequency and nature of patient complaints in a large urban Fire Rescue system.
Methods: A two year retrospective review of all unsolicited patient complaints received from any source either internal or external, through our full-time customer service personnel. All customer complaints, concerns and interactions are documented on an interaction form which we reviewed. All complaints were resolved with disposition related to the customer prior to our retrospective study inclusion.
Results: During the study period our Fire Rescue system responded to a total of 169,651 calls for medical assistance. Our division customer service personnel received a total of 87 unsolicited customer complaints (n = 87) regarding the service encounter with Fire Rescue/EMS. This accounts for a 0.0005% rate of customer complaints captured in correlation to total incidents during the study period. The majority of complaints, 27% were related to lost or missing goods. Service that was perceived as uncourteous or inconsiderate after calling 911, accounted for 25% of complaints. Complaints regarding not being transported after calling 911 accounted for 18%. Uncourteous driving or noise of sirens accounted for 7% of complaints. 7% of complaints resulted from not being transported to the hospital of their choice. Actual care received concerns were only 3% of total. Leaving medical objects behind was 2% of the total volume and 4% fit no specific trend.
Purpose: To determine the prevalence of gastric trauma and pulmonary aspiration after cardiopulmonary resuscitation (CPR) and to examine factors which may be associated with increased prevalence of these complications.
Methods: Retrospective review of 1,928 consecutive autopsy reports in a suburban teaching hospital from January 1, 1977 – June 1, 1986 of which 860 received CPR and 1,037 did not. Of the 860 who received CPR, 527 received prehospital CPR and 333 arrested in hospital and received only hospital CPR. Thirty-one cases were excluded because of inability to accurately examine the stomach.
Results: There were 3 cases of stomach mucosal laceration and 4 cases of through and through laceration of the stomach in the CPR group and only one occurred in the non-CPR group (p <0.03). All gastric trauma in the CPR group occurred in the prehospital group (p <0.05). Pulmonary aspiration occurred in 31% of prehospital CPR patients and only 10% of hospital CPR patients (p <0.0001). The prehospital group differed from the hospital group in the following factors: longer basic life support times without intubation, 14.0 minutes vs. 2.0 minutes (p <0.0001) and longer total resuscitation time 46.9 minutes vs. 34.6 minutes (p <0.0001).