The Hazards of Providing Care in Emergency Vehicles: An Opportunity for Reform

Slattery, David; Silver, Annemarie

doi:10.1080/10903120802706104

Cited by 75 publications

(53 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…140 Multiple randomized trials have shown that mechanical chest compression devices are not demonstrably better than optimized manual CPR. 141 However, these devices may have a role in reducing risks to EMS providers associated with performing manual compressions in a moving vehicle 142 or in facilitating emergent coronary angiography in a patient with ongoing cardiac arrest and a high likelihood of acute coronary occlusion. 143 Although the acceptance of regionalized approaches to systems of care and designated centers has increased, some EMS systems remain challenged by local concerns related to bypassing closer hospitals and the resultant loss in patient volume and case-mix index.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

View full text Add to dashboard Cite

ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

show abstract

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

View full text Add to dashboard Cite

show abstract

“…In order to perform compressions at least one member of the ambulance crew must remain standing and un-restrained next to the victim. A systematic examination of ambulance crash data identified that travelling with emergency lights and sirens increases the risk of an accident and standing, un-restrained in the back of the ambulance vehicle as important risk factors for injury and death [54]. Ambulance crews may also sustain back strain injuries as a consequence of prolonged chest compression in cramped circumstances [55][56].…”

Section: Transportationmentioning

confidence: 99%

Mechanical chest-compression devices: current and future roles

Perkins

Brace

Gates

2010

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review:It is recognised that the quality of CPR is an important predictor of outcome from cardiac arrest yet studies consistently demonstrate that the quality of CPR performed in real life is frequently sub-optimal. Mechanical chest compression devices provide an alternative to manual CPR. This review will consider the evidence and current indications for the use of these devices. Recent findings:Physiological and animal data suggest that mechanical chest compression devices are more effective than manual CPR. However there is no high quality evidence showing improved outcomes in humans. There are specific circumstances where it may not be possible to perform manual CPR effectively e.g. during ambulance transport to hospital, en-route to and during cardiac catheterisation, prior to organ donation and during diagnostic imaging where using these devices may be advantageous. Summary:There is insufficient evidence to recommend the routine use of mechanical chest compression devices. There may be specific circumstances when CPR is difficult or impossible where

show abstract

“…These ambulance personnel are at least 4 times more like to have a fatal or incapacitating injury than personnel that are restrained. Mechanical CPR also allows high quality CPR to be performed while the personnel are restrained, reducing risk to the crew, (27,28) and thereby saving valuable EMS resources. Finally, mechanical devices can improve cost effectiveness of EMS systems by reducing the number of personnel needed to be present during resuscitative efforts, since separate personnel are no longer needed to perform manual CPR.…”

Section: Cost Effectiveness Of Mechanical Cprmentioning

confidence: 99%

Mechanical CPR devices

2010

View full text Add to dashboard Cite

show abstract

The Hazards of Providing Care in Emergency Vehicles: An Opportunity for Reform

Cited by 75 publications

References 33 publications

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Mechanical chest-compression devices: current and future roles

Mechanical CPR devices

Contact Info

Product

Resources

About