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Vasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to develop a model describing the likelihood of favorable neurological outcome (cerebral performance category [CPC] 1 or 2) as a function of the public safety answering point call receipt (PSAP)-to-pressor-interval (PPI) in prolonged out-of-hospital cardiac arrest.
The likelihood of favorable neurological outcome declines with increasing PPI.
This investigation was a retrospective study of cardiac arrest using linked data from the Cardiac Arrest Registry to Enhance Survival (CARES) database (Centers for Disease Control and Prevention [Atlanta, Georgia USA]; American Heart Association [Dallas, Texas USA]; and Emory University Department of Emergency Medicine [Atlanta, Georgia USA]) and the North Carolina (USA) Prehospital Medical Information System. Adult patients suffering a bystander-witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Logistic regression was used to calculate the adjusted odds ratio (OR) of neurological outcome as a function of PPI, while controlling for patient age, gender, and race; endotracheal intubation (ETI); shockable rhythm; layperson cardiopulmonary resuscitation (CPR); and field hypothermia.
Of the 2,100 patients meeting inclusion criteria, 913 (43.5%) experienced ROSC, 618 (29.4%) survived to hospital admission, 187 (8.9%) survived to hospital discharge, and 155 (7.4%) were discharged with favorable neurological outcomes (CPC 1 or 2). Favorable neurological outcome was less likely with increasing PPI (OR=0.90; P<.01) and increasing age (OR=0.97; P<.01). Compared to patients with non-shockable rhythms, patients with shockable rhythms were more likely to have favorable neurological outcomes (OR=7.61; P<.01) as were patients receiving field hypothermia (OR=2.13; P<.01). Patient gender, non-Caucasian race, layperson CPR, and ETI were not independent predictors of favorable neurological outcome.
In this evaluation, time to vasopressor administration was significantly associated with favorable neurological outcome. Among adult, witnessed, non-traumatic arrests, the odds of hospital discharge with CPC 1 or 2 declined by 10% for every one-minute delay between PSAP call-receipt and vasopressor administration. These retrospective observations support the notion of a time-dependent function of vasopressor effectiveness on favorable neurological outcome. Large, prospective studies are needed to verify this relationship.
HubbleMW, TysonC. Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest. Prehosp Disaster Med. 2017; 32(3):297–304.
Ensuring a stable Emergency Medical Services (EMS) workforce is a growing concern, and effective recruiting strategies are needed to expose young adults to the EMS profession. The objective of this study was to assess the exposure of high school allied health students to EMS as a career option, as well as measure their attitudes and beliefs about the EMS profession.
Few high school allied health students are exposed to EMS educational and career opportunities.
A convenience sample of allied health students in a rural high school system was surveyed about exposure to EMS, career intentions, factors impacting career decisions, and attitudes and beliefs about EMS. Descriptive statistics were calculated, and intention to pursue an EMS career was modeled using logistic regression.
Of 171 students enrolled in allied health courses across six high schools, 135 (78.9%) agreed to participate; 85.2% were female. Almost all (92.6%) respondents intended to pursue a health career, but only 43.0% reported that their allied health course exposed them to EMS as a profession. Few participants (37.7%) were knowledgeable about EMS associate degree or baccalaureate degree (27.4%) programs. Only 20.7% of the respondents intended to pursue EMS as a career, although 46.0% wanted to learn more about the profession. Most (68.2%) students expressed interest in an emergency medical technician (EMT) course if one were offered, and 80.0% were interested in a ride-along program. Independent predictors of pursuing an EMS career included exposure to EMS outside of high school (OR = 7.4, 95% CI = 1.7-30.4); media influence on career choice (OR = 9.6, 95% CI = 1.8-50.1); and the belief that EMS was mentally challenging (OR = 15.9, 95% CI = 1.1-216.6). Negative predictors included the beliefs that an EMS career was stimulating (OR = 0.05, 95% CI = 0.00-0.53) and physically challenging (OR = 0.06, 95% CI = 0.00-0.63); as well as prior exposure to an EMS job advertisement (OR = 0.14, 0.03-0.53).
Overall, there was a lack of exposure to career and educational options in EMS among allied health students in the school system studied, and few students intended to pursue an EMS career after graduation. However, the majority of students indicated they would like to learn more about EMS, and would enroll in an EMT course and ride-along program if available. These findings suggest that, with exposure to the profession, more allied health students could choose EMS as a career.
Holloman JB, Hubble MW. High school allied health students and their exposure to the profession of EMS. Prehosp Disaster Med. 2012;27(3):1-7.
Colleges and universities are experiencing increasing demand for online courses in many healthcare disciplines, including emergency medical services (EMS). Development and implementation of online paramedic courses with the quality of education experienced in the traditional classroom setting is essential in order to maintain the integrity of the educational process. Currently, there is conflicting evidence of whether a significant difference exists in student performance between online and traditional nursing and allied health courses. However, there are no published investigations of the effectiveness of online learning by paramedic students.
Performance of paramedic students enrolled in an online, undergraduate, research methods course is equivalent to the performance of students enrolled in the same course provided in a traditional, classroom environment.
Academic performance, learning styles, and course satisfaction surveys were compared between two groups of students. The course content was identical for both courses and taught by the same instructor during the same semester. The primary difference between the traditional course and the online course was the method of lecture delivery. Lectures for the on-campus students were provided live in a traditional classroom setting using PowerPoint slides. Lectures for the online students were provided using the same PowerPoint slides with prerecorded streaming audio and video.
A convenience sample of 23 online and 10 traditional students participated in this study. With the exception of two learning domains, the two groups of students exhibited similar learning styles as assessed using the Grasha-Riechmann Student Learning Style Scales instrument. The online students scored significantly lower in the competitive and dependent dimensions than did the on-campus students. Academic performance was similar between the two groups. The online students devoted slightly more time to the course than did the campus students, although this difference did not reach statistical significance. In general, the online students believed the online audio lectures were more effective than the traditional live lectures.
Distance learning technology appears to be an effective mechanism for extending didactic paramedic education off-campus, and may be beneficial particularly to areas that lack paramedic training programs or adequate numbers of qualified instructors.
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