Archives

Accuracy of Height Estimation Among Bystanders

Carey, DO, et al.

The height and other details of mechanism are usually reported by lay bystanders or prehospital personnel. This small observational study was designed to evaluate how accurate or inaccurate height estimation may be among typical bystanders.

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Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays

Riyapan, MD, et al.

There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.

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Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?

Volume 17. Issue 3, May 2016
Molly Furin, MD, MS et al.

Introduction: Pennsylvania, among other states, includes surgical airway management, or
cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates
paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess
clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy.
Methods: Eighty-six paramedics employed by four ground emergency medical services agencies
completed a 22-question written survey that assessed surgical airway attempts, training, skills verification,
and perceptions about procedural competency. Descriptive statistics were used to evaluate responses.
Results: Only 20% (17/86, 95% CI [11-28%]) of paramedics had attempted cricothyrotomy, most (13/17
or 76%, 95% CI [53-90%]) of whom had greater than 10 years experience. Most subjects (63/86 or 73%,
95% CI [64-82%]) did not reply that they are well-trained to perform cricothyrotomy and less than half
(34/86 or 40%, 95% CI [30-50%]) felt they could correctly perform cricothyrotomy on their first attempt.
Among subjects with five or more years of experience, 39/70 (56%, 95% CI [44-68%]) reported 0-1 hours
per year of practical cricothyrotomy training within the last five years. Half of the subjects who were able
to recall (40/80, 50% 95% CI [39-61%]) reported having proficiency verification for cricothyrotomy within
the past five years.
Conclusion: Paramedics surveyed indicated that cricothyrotomy is rarely performed, even among those
with years of experience. Many paramedics felt that their training in this area is inadequate and did not
feel confident to perform the procedure. Further study to determine whether to modify paramedic scope of
practice and/or to develop improved educational and testing methods is warranted.

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Prehospital Care

Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making

Author Affiliation Bryan E. Bledsoe, DO University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada MedicWest Ambulance/American Medical Response, Las Vegas, Nevada Chad Wasden, MD University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada Larry Johnson, NREMTP University of Nevada School of Medicine, Department of Emergency Medicine, […]

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Prehospital Care

Education On Prehospital Pain Management: A Follow-Up Study

Introduction: In a 2001 quality improvement (QI) study, we demonstrated improvement in paramedic knowledge, perceptions, and management of pain. This follow-up study examines the impact of this QI program, repeated educational intervention (EI), and effectiveness of a new pain management standard operating procedure.
Conclusion: In this follow up study, paramedics’ baseline knowledge, perceptions, and management of pain have all improved from 6 years ago.

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Prehospital Care

Comparison of Prehospital Glucose with or without IV Thiamine

Introduction: Loading of thiamine prior to glucose administration during hypoglycemia to prevent Wernicke’s encephalopathy is routine in the prehospital setting. To date no study has looked at the validity of this therapy.

Conclusion: To our knowledge this is the first study in the literature which evaluated the use of thiamine with glucose to prevent Wernicke’s encephalopathy in the prehospital setting. We found that routine administration of thiamine with glucose did not result in differences in respiratory rate, systolic blood pressure, GCS or ED hospital discharge rates. Until further research is done to validate our results emergency medical services leadership should consider whether the routine use of thiamine in the prehospital setting is appropriate for their system.

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Adoption of the 2006 Field Triage Decision Scheme for Injured Patients

When emergency medical services (EMS) providers respond to the scene of an injury, they must decide where to transport the injured patients for further evaluation and treatment. This is done through a process known as “field triage”, whereby a patient’s injuries are matched to the most appropriate hospital. In 2005–2006 the National Expert Panel on Field Triage, convened by the Centers for Disease Control and Prevention and the National Highway Traffic Safety Administration, revised the 1999 American College of Surgeons Committee on Trauma Field Triage Decision Scheme. This revision, the 2006 Field Triage Decision Scheme, was published in 2006.

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Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica

Antarctica is one of the most remote regions on Earth. Mass casualty incident (MCI) responses in Antarctica are prone to complications from multiple environmental and operational challenges. This review of the current status of MCI risks and response strategies for Antarctica focuses on aeromedical evacuation, a critical component of many possible MCI scenarios.

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International Disaster Medical Sciences Fellowship: Model Curriculum and Key Considerations for Establishment of an Innovative International Educational Program

As recent events highlight, a global requirement exists for evidence-based training in the emerging field of Disaster Medicine. The following is an example of an International Disaster Medical Sciences Fellowship created to fill this need. We provide here a program description, including educational goals and objectives and a model core curriculum based on current evidence-based literature. In addition, we describe the administrative process to establish the fellowship. Information about this innovative educational program is valuable to international Disaster Medicine scholars, as well as U.S. institutions seeking to establish formal training in Disaster Medical Sciences.

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Paramedics’ Ability to Perform Drug Calculations

The ability to perform drug calculations accurately is imperative to patient safety. Research into paramedics’ drug calculation abilities was first published in 2000 and for nurses’ abilities the research dates back to the late 1930s. Yet, there have been no studies investigating an undergraduate paramedic student’s ability to perform drug or basic mathematical calculations. The objective of this study was to review the literature and determine the ability of undergraduate and qualified paramedics to perform drug calculations.

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Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention

In 2005, Orange County California Emergency Medical Services (EMS) initiated a field 12-lead program to minimize time to emergency percutaneous coronary intervention (PCI) for field-identified acute myocardial infarction (MI). As the program matured, “false-positive” (defined as no PCI or coronary artery occlusion upon PCI) field MI activations have been identified as a problem for the program.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.