Didactic Curriculum
Regions Hospital Department of Emergency Medicine Prehospital Medicine/EMS Fellowship
Philosophy:
The Regions Prehospital Medicine/EMS Fellowship will provide a broad based educational experience in key areas of prehospital medicine. The areas of focus will include EMS, disaster medicine and event or mass gathering medicine. The Fellow will gain exposure to the broad components of these three key areas while allowing a self directed and individualized experience that suits the Fellow’s career goals. Clinical experiences will be combined with research, administration and educational responsibilities. Successful completion of the Regions Prehospital Medicine/EMS fellowship will prepare the fellow for a career in EMS medical direction in a wide range of service models.
Three Broad Categories of Prehospital Medicine:
1. Emergency Medical Systems: The Fellow will work with EMS systems including urban and rural, paid and volunteer, fire, police, third service and hospital based in both single and multi-tiered systems. Experience with 9-1-1- services will be stressed but the fellow will also gain exposure to interfacility transport. 4 main components within the EMS portion of the fellowship:
a. Point of Care Field Observation: The fellow will have access to an emergency response vehicle for scene response. They will be expected to spend 40 hours per month responding to scene calls. Their time should be divided among the various services under Regions medical direction. Specifically, the fellow should spend time with EMS services representing each of the EMS delivery systems described above. Dedicated shifts will also be spent with Emergency Medical Dispatchers at the Ramsey county public safety answering point (PSAP) and with operators at the East Metro Medical Resource Control Center (MRCC).
Demonstrate clinical competency in the prehospital management of the following:
1. Medical Emergencies:
a. Cardiac Arrest
b. Cardiac
i. Undifferentiated Chest Pain
ii. STEMI
iii. Acute decompensated CHF
iv. Malfunctioning implantable cardioverter-defibrillators
c. Respiratory Distress and Failure
d. Sepsis
e. Submersion Incidents
f. Shock
g. Altered Mental Status
h. Stroke
i. Seizure
j. Diabetic emergencies (hypo/hyperglycemia)
k. Hypothermia/Frostbite
l. Hyperthermia/Heat Stroke/Heat Exhaustion
m. Abdominal Pain
n. End of Life/Palliative care
i. termination of resuscitation
o. Communicable disease
p. Universal Precautions
i. Occupational exposures
ii. Post exposure prophylaxis
2. Traumatic Emergencies:
i. Multisystem Trauma
ii. Fracture Management
iii. Assault (including elder and child abuse)
iv. Pediatric Trauma
v. Trauma in the obstetrical patient
3. Obstetrical/Gynecological Emergencies
a. Ectopic Pregnancy
b. Normal spontaneous vaginal delivery
c. Perinatal complications
i. threatened abortion
ii. complications of induced abortion
iii. vaginal bleeding in pregnancy
d. Placental abruption
e. Placenta previa
f. Prolapsed cord
g. Postpartum Hemorrhage
h. Eclampsia
4. Toxicological Emergencies:
a. Recognition of specific toxidromes
i. Cholinergic
ii. Anticholinergic
iii. Narcotic
iv. Sympathomemetic
v. Serotonin syndrome
vi. Neuroleptic malignant syndrome
b. Management of specific ingestions/exposures including decontamination
i. Carbon monoxice
ii. Cyanide
iii. Hydroflouric Acid
iv. Organophosphates
v. Hydrocarbons
vi. Caustic substances
c. Psychiatric Emergencies
i. Agitated Delirium
ii. Psychosis
iii. Active suicidal/homicidal ideation
iv. Acute mania
v. Physical restraints, their indications and complications
1. tazer
d. Chemical restraints, their indications, doses, required monitoring and complications
i. neuroleptics
ii. ketamine
iii. benzodiazepines
iv. acute dystonic reactions
5. Procedural Competency:
a. Airway management
i. BLS airway skills
ii. Advanced airway skills
1. Rapid Sequence Intubation
2. supraglottic airway placement
3. endotracheal intubation
4. vidolaryngscope assisted intubation
5. surgical airway
b. Needle thoracostomy
c. Tube thoracostomy
d. IV access
e. IO access, know multiple sites
f. Pericardiocentesis
g. Conscious sedation
h. Bedside ultrasound
1. FAST Exam
2. Eval for pneumothorax
3. AAA
4. Foreign body
i. Application of traction devices
j. Control of arterial hemorrhage
k. Advanced wound care
l. Fracture immobilization
m. Spinal Immobilization
n. Vehicle Extrication
o. Incident Command System
p. Normal spontaneous vaginal deliver
i. delivery of breech presentation
ii. perimortum Cesarean section
6. Unique EMS Environments
a. Hazmat
i. decontamination
ii. setting up hot and cold zones
iii. resuscitation in hot zone
b. Tactical
i. Ramsey County Swat or Oak Park Heights State Prison
c. Confined space medicine
d. Airline/Cruse ship medicine
i. including diversion of craft due to unstable patient
e. Wilderness medicine
7. Air Medical Transport
Indications, risks, benefits
Apparatus for fixed wing and rotor transport
Effect of altitude on patient management
Boyle's, Dalton's, Henry's and Charles's laws.
8. Communications
a. Be familiar with UHF, VHF, 800mHZ and cellular communications
b. Emergency Medical Dispatch
i. Spend 3, 4 hour shifts with an Emergency Medical Dispatcher at a local PSAP
ii. Spend 2, 4 hour shifts with an operator at East Metro Medical Resource Control Center
9. System Design
a. Fire based, private, third service, Police integrated, hospital based, for-profit
b. Urban, suburban and rural services
c. Volunteer vs paid professional
d. In house staffing vs home response
10. Scope of Practice for Prehospital Personnel:
a. EMT-B, EMT-P, EMT-CC, EMT-P/RN, CEN, CCRN
b. PA, NP, MD prehospital involvement
c. national registry vs state license
11. Labor Relations
a. Critical incident stress debriefing
b. Occupational medicine
c. Hiring/firing
b. Research: The fellow will be expected to produce a research project that will be publishable in a peer review journal or presented at a national meeting. The fellow will be supported by the Regions EMS research staff which has a documented track record of producing high quality peer reviewed publications.
c. Administration: The fellow will learn about the administrative components of medical direction by attending meetings and assisting with system wide operational issues, protocol development and review. Instruction in controlled substance tracking will be given. Budget development and financial management of EMS systems including billing for services will be discussed. The fellow will be required to maintain a minimum of 75% attendance across the following meetings: EMS Operations, EMS Administration, St. Paul Fire Administration, East Metro Prehosiptal Advisory Committee, Metro Region EMS Committee, Regions hospital disaster committee and Life Link 3 Medical Direction.
On scene medical control will occur during scene responses and staffing of specified mass gatherings (MN state fair, event medicine events). On-line control will occur via shifts at MRCC and when working as a staff physician in the Regions ED. Off line medical control responsibilities will include review and updating of policies and procedures to reflect the best available science.
d. Education: The Fellow will be responsible for coordinating the EM Residency Associate Medical Director program which is an option for Regions EM residents as their required scholarly project. Meetings with each associate medial director should take place at least quarterly. The fellow will coordinate an East Metro Prehospital journal club to be presented every other month. Attendance at quality improvement/critical case review , simulation exercises and critical thinking labs for EMS services and instruction at our affiliated paramedic class will be expected. There will be a requirement to attend the Thursday EM resident conference twice a month and act as an "EMS Consultant" for presented cases.
1. Education of prehospital providers will include:
a. Critical Case Reviews - 2-3 hours per month
b. Simulation based critical thinking labs - 4 hours per month
c. Journal clubs - monthly
d. EKG reviews, current topics in EMS,
e. Incorporate online materials into an integrated education system utilizing the RegionsEMS web site and facebook page
2. Disaster Medicine: The Fellow will participate on the hospital, local and state level to coordinate disaster planning and response.
a. Medical Resource Control Center (MRCC): Two 4 hour shifts over the course of the fellowship as acting MRCC operator
b. Understand the implementation of the incident command system
c. Regions Hospital Disaster Committee: 75% attendance at meetings
d. MN-DMAT1: An option for fellows who have had a medical license at least 6 months prior to the start of the fellowship
e. Review, update and implement hospital disaster plans
f. Regional chemical weapons response plan including ChemPack storage, contents and deployment indications
g. Hazmat Training: Give Chem/Bio/Nuclear core competency lectures to EM residents
i. The fellow will show proficiency in:
1. Incident Command System (ICS)
2. National incident management system
a. federal, state, local resources and response to mass casulity events
b. MnTRAC system: Minnesota system for tracking resources, alerts and communications
c. ChemPacks: their locations, equipment, indications for use and deployment plans in the state of Minnesota
3. Triage
4. Mass casulity management
5. Chemical/Biological/Nuclear agent identification/treatment
a. Recognize patterns of emerging epidemic
b. Quarantine
c. Pandemic viral illnesses
d. Bioterrorism
i. Tuluremia
ii. Smallpox
iii. Anthrax
iv. Plague
v. Nerve agents
vi. Blistering agents
vii. Botulism
viii. Viral Hemorrhagic Fever
e. Chemical warfare agents
i. Blistering agents
ii. Nerve agents
iii. Asphyxants
iv. Caustics
v. Choking agents
vi. Riot control agents
vii. Minnesota ChemPack storage and deployment plan
6. Blast injuries
7. Casulty evacuation
3. Event or Mass Gathering Medicine: Gain experience in planning, deploying, implementing and analyzing medical coverage for scheduled events with large gatherings of people
a. MN State Fair: The fellow will be the on-line medical resource for providers at the MN State Fair. They will be "on call" for this duty during 7 out of the 10 days of the fair. They will also be expected to attend the daily 10 AM command briefing at the fairgrounds and to assist, supervise and coordinate medical care on the fair grounds.
b. Twin Cities Marathon: The fellow will serve as the liaison for the Regions EMS team and will coordinate with the St. Paul Fire Dept and Regions Hospital ED to provide on site medical coverage for this event. Pre event planning, procurement of equipment and staffing will be included in the responsibilities. The Fellow will be expected to work in the critical care area of the medical tent during the fair. They will supervise ED residents and RN staff at the fair.
c. Stillwater Marathon: Similar to TCM but with less time commitment as this is a much smaller marathon.
d. Review the planning and implementation for RNC medical coverage
National/Regional Conferences:
1. NAEMSP: the Fellow will attend the Medical Directors course at the annual NAEMSP conference.
2. MN Medical Directors Conf: the fellow will present data on ongoing EMS research projects
3. Additional conferences as directed by the Fellow's individual interest such as:
Air Medical conference
Hazmat conferences
National Incident Management System
Advanced Disaster Life Support
Didactic Education:
The didactic education curriculum was based off of published recommendations in peer reviewed Emergency Medicine Journals[1],[2],[3] [4]. The required readings are heavily based in the primary peer reviewed EMS and Emergency Medicine literature. These readings will be supplemented by formal text books in Emergency and Disaster Medicine. In addition, the fellow will be expected to present topics on EMS to the EM residents during select Thursday conferences. Finally, a journal club will be lead by the fellow and will include pre-hospital and ED personnel.
Didactic Curriculum:
Text Book: Emergency Medical Services: Clinical Practice and Systems Oversight. By NAEMSP.
Selected Papers from the Peer Reviewed Literature
1. History of EMS:
· Military casuality evacuation evolution:
o MCM Bricknell. The Evolution Of Casualty Evacuation In The BritishArmy 20th Century. 5 part series. J R Army Med Corps
o Eiseman. Combat Casualty Management in Vietnam. Journal of Trauma, 1967, Vol 7:53-63
o Eastridge, BJ et al. Trauma System Development in a Theater of War: Experiences From Operation Iraqi Freedom and Operation Enduring Freedom. The Journal of Trauma: Injury, Infection, and Critical Care: December 2006 - Volume 61 - Issue 6 - pp 1366-1373
· 1966 White Paper: Accidental Death and Disability: The Neglected Disease of Modern Societ. Available for free at: www.nap.edu
· 1973 EMS act (Public Law 93-154), 1976 and 1979 ammendments
· 1986 EMS-C funding and demonstration grants
· Current federal/state heirachy: Federal DOT Nat Highway Safety Admin, MN-EMSRB
2. EMS System Design:
· Types of EMS systems: public/private, fire vs EMS alone, paid/ volunteer, tiered, hospital based
· Regionalized systems: trauma, burn, neonatal/peds, STEMI, CVA, tox, psych,
o Criteria for transport to the above specialty centers
· Hospital designations: base hosp, referral hospital
o designation vs categorization vs verification
· Staffing designs: EMT/EMT-P, 2 medic, volunteer driver/provider, total # of crew, PD-EMTP
· Rural EMS: in house providers vs paging out for calls, work absenteeism policy for volunteers
· Public Access Defibrillation
o Hallstrom, A.P., J.P. Ornato, M. Weisfeldt, A. Travers, J. Christenson, M.A. McBurnie, R. Zalenski, et al. (2004). Public-access defibrillation and survival after out-of-hospital cardiac arrest. The New England Journal of Medicine 351, 637-646
3. EMS Personel:
· DOT/MN training requirements: (Emerg Vehicle Operator, EM-dispatch, First Responder, EMT-B, EMT-I, EMT-P, flight RN). http://www.nhtsa.dot.gov
· Capabilities of each training level, BLS vs ALS, EMD, vehicle opearators
· EMD phone instructions and triage system
· Specialized training: HAZMAT, Tactical, Flight RN, medic/firefighter, medic/police
· CME requirements
· Staff health/longevity: debriefing, recognize stress/EtOH/drug use
· Labor issues, disciplinary policies, due process
4. EMS Equipment:
· State mandated equipment for BLS vs ALS ambulance, first response vehicle
o Medical equipment, vehicle characteristics, warning lights/sirens, volunteer response
· ALS drugs including controlled substance tracking, QI, disposal
· Airway and Breathing equipment: CPAP, ALS airway devices, RSI medications
· Chemical restraint agents
· Ambulance types (I, II, III), warning lights/sirens
· Extrication equipment, additional equipment supplied by fire department
· Splinting devices: rigid boards, vaccum, traction, SAM, improvised (ie pillows for ankle)
· Development of procedures for approving new equipment\
· Pediatric specific equipment: spinal immobilizers
5. Communications:
· 911 vs enhanced 911, calls from land lines vs cell phones
· VHF vs UHF
· Radio, cell phone, satellite
· Telemetry transmitting EKG to hospitals
· New communication techniques: ie digital photos, video, HIPPA concerns, benefits
6. Air Medical
· Indications, contraindications, risks, benefits
· Staffing models, RN/EMT-P, flight MD
o Thomas, S.H. & K.A. Williams. (2002). FLIGHT PHYSICIAN TRAINING PROGRAM-CORE CONTENT. Prehospital Emergency Care 6, 458-460
o Thomson, D.P. & S.H. Thomas. (2003). GUIDELINES FOR AIR MEDICAL DISPATCH. Prehospital Emergency Care 7, 265-271
· Aircraft type, speeds, load restrictions
· Specialized equipment: ventilators, IV pumps
· Expanded ALS supplises, drugs, airway devices etc
· Physiologic changes associated with flight, conditions that mandate Rx before flight
· Preparing a landing zone, packaging a patient for transport
· Scene vs interfacility transports
7. Medical Command
· On-line vs off line
· Qualifications, responsibilities, authority
· On-line control at destination facility vs centralized location which may not receive pt
· Standing orders vs protocol
· Quality assurance, case review, protocol compliance
· On scene (bystander) physician issues
8. Legal Issues
· Vicarious liability
· DNR, field termination of resuscitation
o Ruygrok, M.L., R.L. Byyny & J.S. Haukoos. (2009). Validation of 3 Termination of Resuscitation Criteria for Good Neurologic Survival After Out-of-Hospital Cardiac Arrest. Annals of Emergency Medicine 54, 239-247
o Morrison, L.J., L.M. Visentin, A. Kiss, R. Theriault, D. Eby, M. Vermeulen, J. Sherbino, et al. (2006). Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. New England Journal of Medicine 355, 478
· Refusal of care, pediatric patients, intoxicated or incompetent patients
· On scene, (bystander) physician
· Omnibus reconciliation act
· Risk management
o Slattery, D.E. & A. Silver. (2009). The Hazards of Providing Care in Emergency Vehicles: An Opportunity for Reform. Prehospital Emergency Care 13, 388-397
o Wang, H.E., R.J. Fairbanks, M.N. Shah, B.N. Abo & D.M. Yealy. (2008). Tort claims and adverse events in emergency medical services. Annals of Emergency Medicine 52, 256-262
o Wang, H., M. Weaver, B. Abo, R. Kaliappan & R. Fairbanks. (2009). Ambulance stretcher adverse events. British Medical Journal 18, 213
· Physical/chemical restraint of the violent/agitated patient
9. Patient Care Topics:
· Mecanical devices for chest compressions
Abella, B.S., J.P. Alvarado, H. Myklebust, D.P. Edelson, A. Barry, N. O'Hearn, T.L. Vanden Hoek, et al. (2005). Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. Jama 293, 305
Care 9, 61-67Casner, M., D. Andersen & S.M. Isaacs. (2005). The impact of a new CPR assist device on rate of return of spontaneous circulation in out-of-hospital cardiac arrest. Prehospital Emergency
o Hallstrom, A., T.D. Rea, M.R. Sayre, J. Christenson, A.R. Anton, V.N. Mosesso Jr, L. Van Ottingham, et al. (2006). Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. Jama 295, 2620
o Halperin, H.R., N. Paradis, J.P. Ornato, M. Zviman, J. LaCorte, A. Lardo & K.B. Kern. (2004). Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest:: Improved hemodynamics and mechanisms. Journal of the American College of Cardiology 44, 2214-2220
o Krep, H., M. Mamier, M. Breil, U. Heister, M. Fischer & A. Hoeft. (2007). Out-of-hospital cardiopulmonary resuscitation with the AutoPulse TM system: A prospective observational study with a new load-distributing band chest compression device. Resuscitation 73, 86–95
o Ong, M.E.H., A. Annathurai, A. Shahidah, B.S.H. Leong, V.Y.K. Ong, L. Tiah, S.H. Ang, et al. (2010). Cardiopulmonary resuscitation interruptions with use of a load-distributing band device during emergency department cardiac arrest. Annals of Emergency Medicine
o Wigginton, J.G., S.M. Isaacs & J.J. Kay. (2007). Mechanical devices for cardiopulmonary resuscitation. Current Opinion in Critical Care.13, 273.
· Cardio-cerebral resuscitation
o Hinchey, P.R., J.B. Myers, R. Lewis, V.J. De Maio, E. Reyer, D. Licatese, J. Zalkin, et al. (2010). Improved Out-of-Hospital Cardiac Arrest Survival After the Sequential Implementation of 2005 AHA Guidelines for Compressions, Ventilations, and Induced Hypothermia: The Wake County Experience. Annals of Emergency Medicine 56, 348-357
o Bobrow, B.J., L.L. Clark, G.A. Ewy, V. Chikani, A.B. Sanders, R.A. Berg, P.B. Richman, et al. (2008). Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. Jama 299, 1158
o Bobrow, B.J., G.A. Ewy, L. Clark, V. Chikani, R.A. Berg, A.B. Sanders, T.F. Vadeboncoeur, et al. (2009). Passive Oxygen Insufflation Is Superior to Bag-Valve-Mask Ventilation for Witnessed Ventricular Fibrillation Out-of-Hospital Cardiac Arrest. Annals of Emergency Medicine 54, 656-662
o Davis, D.P. (2009). Cardiocerebral resuscitation: a broader perspective. Journal of the American College of Cardiology. 53, 158
o Ewy, G.A. & K.B. Kern. (2009). Recent advances in cardiopulmonary resuscitation: cardiocerebral resuscitation. Journal of the American College of Cardiology 53, 149
o Kellum, M.J., K.W. Kennedy, R. Barney, F.A. Keilhauer, M. Bellino, M. Zuercher & G.A. Ewy. (2008). Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest. Annals of Emergency Medicine 52, 244-252
o Wang, H.E., S.J. Simeone, M.D. Weaver & C.W. Callaway. (2009). Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubation. Annals of Emergency Medicine 54, 645-652
o McNally, B., A. Stokes, A. Crouch & A.L. Kellermann. (2009). CARES: Cardiac Arrest Registry to Enhance Survival. Annals of Emergency Medicine 54, 674-683
o (2008). Progress in Improving Neurologically Intact Survival From Cardiac Arrest. Annals of Emergency Medicine 52, 244-252.
Active compression-decompression CPR with Impedance Threshold Devices
o Frascone, R.J., D. Bitz & K. Lurie. (2004). Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device: state of the art. Current Opinion in Critical Care 10, 193
o Plaisance, P., K.G. Lurie, E. Vicaut, D. Martin, P.Y. Gueugniaud, J.L. Petit & D. Payen. (2004). Evaluation of an impedance threshold device in patients receiving active compression– decompression cardiopulmonary resuscitation for out of hospital cardiac arrest. Resuscitation 61, 265-271
o Wolcke, B.B., D.K. Mauer, M.F. Schoefmann, H. Teichmann, T.A. Provo, K.H. Lindner, W.F. Dick, et al. (2003). Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation 108, 2201
· ACLS Medications for Cardiac Arrest
o Wenzel, V., A.C. Krismer, H.R. Arntz, H. Sitter, K.H. Stadlbauer & K.H. Lindner. (2004). A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. The New England Journal of Medicine 350, 105
o Stiell, I.G., G.A. Wells, B. Field, D.W. Spaite, L.P. Nesbitt, V.J. De Maio, G. Nichol, et al. (2004). Advanced cardiac life support in out-of-hospital cardiac arrest. New England Journal of Medicine 351, 647
o Olasveengen, T.M., K. Sunde, C. Brunborg, J. Thowsen, P.A. Steen & L. Wik. (2009). Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial. JAMA: The Journal of the American Medical Association 302, 2222-2229
· Post resuscitation care
o Sunde, K., M. Pytte, D. Jacobsen, A. Mangschau, L.P. Jensen, C. Smedsrud, T. Draegni, et al. (2007). Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73, 29-39
o Neumar, R.W., J.P. Nolan, C. Adrie, M. Aibiki, R.A. Berg, B.W. Bottiger, C. Callaway, et al. (2008). Post-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation. Circulation 118, 2452
· Regionalized Post-Resuscitation Care Centers
o Spaite, D.W., B.J. Bobrow, T.F. Vadeboncoeur, V. Chikani, L. Clark, T. Mullins & A.B. Sanders. (2008). The impact of prehospital transport interval on survival in out-of-hospital cardiac
arrest: Implications for regionalization of post-resuscitation care. Resuscitation 79, 61-66
o Spaite, D.W., I.G. Stiell, B.J. Bobrow, M. de Boer, J. Maloney, K. Denninghoff, T.F. Vadeboncoeur, et al. (2009). Effect of Transport Interval on Out-of-Hospital Cardiac Arrest Survival in
the OPALS Study: Implications for Triaging Patients to Specialized Cardiac Arrest Centers. Annals of Emergency Medicine 54, 248-255
· Therapeutic Hypothermia
o Alzaga, A.G., M. Cerdan & J. Varon. (2006). Therapeutic hypothermia. Resuscitation 70, 369-380
o Bernard, S.A., T.W. Gray, M.D. Buist, B.M. Jones, W. Silvester, G. Gutteridge & K. Smith. (2002). Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. The New England Journal of Medicine 346, 557
o Care, P.E. (2008). Induced Therapeutic Hypothermia in Resuscitated Cardiac Arrest Patients. Prehospital Emergency Care 12, 393-394
· Prehospital EKG’s for STEMI
o Diercks, D.B., M.C. Kontos, A.Y. Chen, C.V. Pollack, S.D. Wiviott, J.S. Rumsfeld, D.J. Magid, et al. (2009). Utilization and Impact of Pre-Hospital Electrocardiograms for Patients With
o Acute ST-Segment Elevation Myocardial Infarction Data From the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. Journal of the American College of Cardiology 53, 161-166.
· Prehospital Endotracheal Intubation and RSI
o Bernard, S.A., Nguyen, V., Cameron, P., et al. (2010) Prehospital Rapid Sequence Intubation Improves Functional Outcome for Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial. Annals of Surgery 2010;252:959-965.
o Burton, J.H. (2006). Out-of-hospital endotracheal intubation: half empty or half full? Annals of Emergency Medicine 47, 542-544
o Guyette, F.X., M.J. Greenwood, D. Neubecker, R. Roth & H.E. Wang. (2007). Alternate Airways in the Prehospital Setting (Resource Document to NAEMSP Position Statement). Prehospital Emergency Care 11, 56-61
o Jacoby, J., M. Heller, J. Nicholas, N. Patel, M. Cesta, G. Smith, S. Jacob, et al. (2006). Etomidate versus midazolam for out-of-hospital intubation: a prospective, randomized trial. Annals of Emergency Medicine 47, 525-530
o Ochs, M., D. Davis, D. Hoyt, D. Bailey, L. Marshall & P. Rosen. (2002). Paramedic-performed rapid sequence intubation of patients with severe head injuries. Annals of Emergency Medicine 40, 159-167
o Wang, H.E., D.P. Davis, R.E. O'Connor & R.M. Domeier. (2006). Drug-assisted intubation in the prehospital setting (Resource document to NAEMSP position statement). Prehospital Emergency Care 10, 261-271
o Arslan Hanif, M., A.H. Kaji & J.T. Niemann. (2010). Advanced Airway Management Does Not Improve Outcome of Out‐of‐hospital Cardiac Arrest. Academic Emergency Medicine 17, 926-931
o Berg, R.A., K.B. Kern, R.W. Hilwig, M.D. Berg, A.B. Sanders, C.W. Otto & G.A. Ewy. (1997). Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation. Circulation 95, 1635
o Davis, D.P., D.B. Hoyt, M. Ochs, D. Fortlage, T. Holbrook, L.K. Marshall & P. Rosen. (2003). The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. The Journal of Trauma 54, 444
· NIPPV (CPAP/BiPAP)
o Thompson, J., D.A. Petrie, S. Ackroyd-Stolarz & D.J. Bardua. (2008). Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial. Annals of Emergency Medicine 52, 232-241
10. Disaster Medicine:
· Incident command system
· Triage
o Jenkins, J.L., M.L. McCarthy, L.M. Sauer, G.B. Green, S. Stuart, T.L. Thomas & E. Hsu. (2008). Mass-casualty triage: time for an evidence-based approach. Prehospital and Disaster
Medicine 23, 3.
o Kahn, C.A., C.H. Schultz, K.T. Miller & C.L. Anderson. (2009). Does START triage work? An outcomes assessment after a disaster. Annals of Emergency Medicine 54, 424-430.
o MNTRAC
Different roles of EMS/PD/FD/med examiner
Federal, state, local resources
National Disaster Medical System
HAZMAT
· Disaster plan development, implementation and staff training
·
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