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Table of Contents

Sep 2009
Supplement, Driving the Course of Care
  • Introduction

    In the early years of EMS, the only advanced assessment and clinical items crews used were BP cuffs, three-lead ECG units, manual defibrillation and, in some systems, rotating tourniquets for congestive heart failure cases. Telemetry was primitive and often inaccurate, making Emergency Department (ED) physicians reluctant to order advanced treatment until they saw the patient.

  • The Most Important Test

    The clinical presentation of acute myocardial infarction (AMI) varies greatly among individuals and requires consideration of clinical findings, electrocardiographic (ECG) features and the presence of myocardial cell death.(1) Of these, the ECG is most important, because it can quickly identify ST elevation myocardial infarction (STEMI, a subset of AMI). This is especially important since STEMI patients are ideal candidates for time-critical interventions, such as coronary artery catheterization or fibrinolytic therapy.

  • Regionalized Cardiac Arrest Care

    Several systems have successfully incorporated therapeutic hypothermia into their resuscitation efforts as part of many significant efforts made in recent years to improve cardiac arrest outcomes. But across the country, the use of hypothermia has not yet become an accepted standard; regionalization of cardiac arrest management remains the subject of discussions in the literature.(1–5)

  • The Electronic Crossroads

    It was a dark and stormy night. One of the largest hurricanes in recorded history curved through the Gulf of Mexicotoward southern states terrified and cowering at its approach, and crashed into Louisiana and Mississippi on Aug. 29, 2005, evoking a blackout of agonizing proportions.

  • The Value of CPAP

    In EMS, we must always be careful about making grandiose claims. However, I don’t think it’s going too far to say that in Houston, CPAP is revolutionizing patient care, from reducing intubations to improving the rate of patient recovery, all while reducing costs.

  • Critical Changes

    Over the last two decades, technological advancements have allowed EMS systems to increase their focus on diagnostic and therapeutic interventions in addition to transport considerations. Modern technologies now also allow EMS systems to communicate with receiving hospitals in real time.

  • Strengthening the Chain of Survival

    On Jan. 31, 2009, as a US Airways flight taxied on the Philadelphia airport runway, its passengers turned off cell phones just before their flight to the Caribbean.Among them, a 60-year-old man and his wife were eagerly awaiting departure for their anniversary celebration. The woman glanced over at her husband and noticed he’d stopped breathing.


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