Objectives: The objective was to determine if 9-1-1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment.Methods: Paramedics at two emergency medical services (EMS) agencies received a 6-hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO).Results: A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8 ⁄ 104) of the patients. Eighty-four patients had the FAST exam performed. Six exams (6 ⁄ 84, 7.1%) were read as positive for free intraperitoneal ⁄ pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO.Conclusions: This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting. ACADEMIC EMERGENCY MEDICINE2010; 17:624-630 ª 2010 by the Society for Academic Emergency MedicineKeywords: prehospital ultrasound, paramedic ultrasound, trauma care, and ultrasound P oint-of-care (POC) ultrasound (US) has significantly increased in use over the past 20 years. [1][2][3] Multiple studies have shown the efficacy and efficiency of POC US. Some studies have demonstrated improved morbidity and mortality outcomes.3-5 The use of POC US in the prehospital setting is a relatively new application of this medical technology. Small studies have shown utility in military, ground, and helicopter emergency medical services (EMS) in both Europe and the United States. [5][6][7][8][9][10][11][12][13][14][15][16][17] These studies have largely concentrated on US use for trauma evaluation and involve the application of the Focused Assessment Sonography for Trauma (FAST) or an extended FAST examination. Prehospital US use has been more fully described in Germany, France, and Italy than in the United States.

Prehospital ultrasound has been deployed in certain areas of the USA and Europe. Physicians, emergency medical technicians, and flight nurses have utilized a variety of medical and trauma ultrasound assessments to impact patient care in the field. The goal of this review is to summarize the literature on emergency medical services (EMS) use of ultrasound to more clearly define the potential utility of this technology for prehospital providers.

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Video modules can be as effective as TL when utilized to train Emergency Medicine residents in the ACEP disaster medicine core competencies of patient triage and decontamination. Curtis HA , Trang K , Chason KW , Biddinger PD . Video-based learning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.

A substantial proportion of patients surveyed in this cross sectional study agreed with a more patient-centered approach to prehospital care where a 9-1-1 call could be met with a variety of treatment and transportation options. Agreement was relatively consistent among a diverse group of patients with varying demographics, levels of acuity and EMS utilization history. MeSH Key words: emergency medical services; triage; telemedicine; surveys and questionnaires; transportation of patients.

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BackgroundTwitter is a social network where users read, send, and share snippets of text (“tweets”). Tweets can be disseminated through multiple means; on desktop computers, laptops, and mobile devices, over ethernet, Wi-Fi or cellular networks. This redundancy positions Twitter as a useful tool for disseminating information to the public during emergencies or disasters. Previous research on dissemination of information using Twitter has mostly investigated the characteristics of tweets that are most effective in raising consumer awareness about a new product or event. In particular, they describe characteristics that increase the chance the messages will be shared ("retweeted") by users. In comparison, little has been published on how information from municipal or state government agencies spreads on Twitter during emergency situations. Retweeting these messages is a way to enhance public awareness of potentially important instructions from public officials in a disaster.ObjectiveThe aim of this study is to (1) describe the tweets of select New York State and New York City agencies by public officials surrounding two notable recent winter storms that required a large-scale emergency response, and (2) identify the characteristics of the tweets of public officials that were most disseminated (retweeted).MethodsFor one week surrounding Superstorm Sandy (October 2012) and the winter blizzard Nemo (February 2013), we collected (1) tweets from the official accounts for six New York governmental agencies, and (2) all tweets containing the hashtags #sandy (or #nemo) and #nyc. From these data we calculated how many times a tweet was retweeted, controlling for differences in baseline activity in each account. We observed how many hashtags and links each tweet contained. We also calculated the lexical diversity of each tweet, a measure of the range of vocabulary used.ResultsDuring the Sandy storm, 3242 shared (retweeted) messages from public officials were collected. The lexical diversity of official tweets was similar (2.25-2.49) and well below the average for non-official tweets mentioning #sandy and #nyc (3.82). Most official tweets were with substantial retweets including a link for further reading. Of the 448 tweets analyzed from six official city and state Twitter accounts from the Nemo blizzard, 271 were related to the storm, and 174 had actionable information for the public. Actionable storm messages were retweeted approximately 24x per message, compared to 31x per message for general storm information.ConclusionsDuring two weather emergencies, New York public officials were able to convey storm-related information that was shared widely beyond existing follower bases, potentially improving situational awareness and disaster response. Official Sandy tweets, characterized by a lower lexical diversity score than other city- and Sandy-related tweets, were likely easier to understand, and often linked to further information and resources. Actionable information in the Nemo blizzard, such as specific instructions and ca...

BackgroundRecent data suggests that high-flow oxygen started promptly after stroke symptom onset salvages ischemic brain tissue. We investigated the consistency of oxygen delivery to suspected stroke patients in the pre-hospital (PH) and Emergency Department (ED) settings, and associated adverse events (AEs).MethodsWe retrospectively reviewed pre-hospital call reports of suspected stroke patients transported by our institution’s paramedics. We extracted data on oxygen delivery in the PH and ED settings, demographics, Glasgow Coma Scale score (GCS), final diagnosis, and selected AEs (mortality, seizures, worsening neurological status, new infarction, and post-ischemic hemorrhage). Patients were grouped according to ED oxygen delivery: none, low-flow (2-4 L/min), and high-flow (10-15 L/min).ResultsOxygen delivery was documented in 84% of 366 stroke transports, with 98% receiving 10-15 L/min. Our hospital received 164 patients. Oxygen delivery in the ED was documented in 150 patients, with 38% receiving none, 47% low-flow, and 15% high-flow oxygen. There were no instances of oxygen refusal, premature termination, or technical difficulties. Advanced age and low GCS predicted the use of higher flow rates. High-flow oxygen was more frequently administered to patients with symptom onset < 3 hours, and those with intracerebral hemorrhage (ICH), hypoxic-ischemic encephalopathy (HIE) or seizures (p < 0.001). More patients receiving high-flow oxygen were documented to have an AE (p = 0.02), however the low- and no-oxygen groups more frequently had multiple AEs (p = 0.01). The occurrence of AEs was predicted by the diagnosis of ICH/HIE/seizures (p = 0.013) and acute ischemic stroke (AIS)/transient ischemic attack (TIA) (p = 0.009), but not by the amount of oxygen.ConclusionsSuspected stroke patients routinely receive 10–15 L/min oxygen in the ambulance however in the ED there is wide variability due to factors such as clinical severity. Oxygen delivery appears safe in the PH and ED settings.