BACKGROUND Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement. METHODS AND RESULTS This quasi-experimental design trial tested an ap...

BACKGROUND The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to preho...

BACKGROUND Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamin...

Guidelines recommend implementing prehospital electrocardiograms (PH ECG) into systems of care for patients with suspected ST-elevation–myocardial infarction to reduce door-to-balloon time (DTB). We developed a PH ECG protocol with an affiliated emergency medical service, combining 4 features: (1) PH ECG acquisition; (2) emergency medical service interpretation without PH ECG transmission; (3) ...

Critical illness intersects with the workload of rural doctors in Australia, mostly via their on-call responsibilities to rural hospitals. A significant proportion of these are prehospital incidents - vehicle crashes, farming injuries, bushfire etc. Effective care for such patients requires an integration of prehospital ambulance services, retrieval services and tertiary level trauma services a...

Infants and children are common victims of disaster or mass casualty situations. Prehospital providers provide the initial care and stabilization at the scene of a mass casualty event. There are a number of challenges the prehospital provider faces when caring for children in a mass casualty event, among them are the following: the physiology of children differs from adults, children are partic...

Outcome from OHCA is primarily determined by prehospital events and meaningful clinical OHCA research must include data recorded in this setting. There is little evidence on which to base the practice of prehospital resuscitation and research in this area presents huge challenges but is required if survival from OHCA is to improve. This short report aims to provide a practical guide to performi...

Hydroxocobalamin, a precursor of vitamin B12, has a history of use in the prehospital setting in France for cyanide poisoning, particularly that associated with smoke inhalation. Because cyanide poisoning by ingestion is less common than smoke inhalation-associated cyanide poisoning, less information is available on prehospital use of hydroxocobalamin to treat cyanide poisoning by ingestion. Th...

We read with interest the article on prehospital thoracostomy published in the journal [1] and the correspondence that followed recently [2,3]. We work on the unit where the intervention was originally described [4]. In the last 10 years 1079 thoracostomies have been performed on prehospital patients in our system. This amounts to 9% of trauma patients attended in the same period. We are aware ...