AEDR 2014 Vol. 2 Issue 1

A Silent But Deadly Aortic Dissection

It was fairly early one day when a young man about 40 years of age called in to the 112 emergency line and asked for an ambulance. The reason was chest pains. He was very calm and “showed“ no signs through the phone that he was in pain or any kind of distress. So I asked him if the patient was himself or if he had someone with him that he was calling for. He replied that he was indeed the patient, and when asked about the chest pain, he said that he had had some discomfort since late the night...

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An Unorthodox Delivery: “I’ve Never Done One of These Before”

This case study is based on a call handled at the Emergency Services Telecommunications Authority, Victoria. The Authority handles 42,000 emergency ambulance calls per month in an area of 237,629 km², with a population of 6 million. The third party caller was the mother of a patient who was in labor with her first baby and had an undiagnosed true footling breech presentation. The patient was at home alone in an isolated rural area. This breech case was the call taker’s first in six years of...

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Triage Nurse in a 911 Center Effectively Handles Case of Insect Bites

On June 26th, mid-morning, a 47 year old male patient called into the 911 center with a complaint of being bitten by insects all over his body. Initially the caller wanted an ambulance to take him to the emergency room (ER), but he had advised the emergency medical dispatcher (EMD) that the rash and bites had been going on for a while. In Louisville, all medical 911 calls are triaged at the MetroSafe 911 center by a certified EMD using the Medical Priority Dispatch System™ (MPDS®)...

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Why Evidence-Based Decision-Making Matters

One of my former mentors, Deputy Chief (Ret.) Jim Graham of the Chesterfield County (VA) Fire and EMS Department, was a huge proponent of the use of information, whether on a fireground operation, developing a new training program, or addressing budget reductions.  One of his favorite sayings—one that stays with me to this day—was “We must constantly strive to become better at data-driven decision making, instead of following the ‘I think, I feel, or I believe’ model.” However,...

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SO WHERE DO YOU THINK YOU ARE?: LOCATION IDENTIFICATION IN NORTH WALES.

Unlike calls from landline telephones, mobile phones do not provide EMS call handlers with a full address, and positional estimates from mobile phone signals can have a margin of error of up to 3000m (approx.. 9900 feet) in rural areas. We noticed that mountain casualties attending our Emergency Department in North Wales often struggle to pronounce Welsh-language place names. We wished to determine whether the ability of 999 callers to accurately pronounce (or describe)...

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THE CAPABILITY OF PROFESSIONAL AND LAY RESCUERS TO ESTIMATE THE GIVEN CHEST COMPRESSION TARGET DEPTH

There is an on-going discussion on quality of cardiopulmonary resuscitation (CPR) as related to guideline target values for chest compression depth. Deeper compression depth is generally understood to be more effective. Interestingly, the American Heart Association (AHA) guideline requests a compression depth of “at least 5cm” whereas the European Resuscitation Council (ERC) guideline requests “at least 5 cm, but not to exceed 6 cm”. It is unknown which recommendation is...

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STROKE ALERT NOTIFICATION BY EMERGENCY MEDICAL DISPATCH: ZERO MINUTE STROKE PREDICTABILITY.

MEDIC EMS, headquartered in Davenport, IA, is a non-profit emergency medical services (EMS) corporation.  MEDIC EMS serves a population base of approximately 175,000 people, and its primary 911 ambulance coverage area is approximately 375 (82%) of Scott County’s 456 total square miles.  All MEDIC EMS System Status Controllers are Certified Emergency Medical Dispatchers (EMDs) through the International Academies of Emergency Dispatch (IAED).  The aim of this study,...

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COMPRESSION DEPTH DURING PROTOCOL-DRIVEN TELEPHONE-ASSISTED CARDIOPULMONARY RESUSCITATION IS NOT IMPROVED BY REPETITIVE OR INTENSIFIED INSTRUCTIONS.

In telephone-assisted cardiopulmonary resuscitation (T-CPR), protocols are used to help the bystander via standardized instructions. However, the requested compression depth is rarely achieved. This study was designed to investigate the effect of intensified wording and/or repetitive target depth instructions on compression depth. Methods: In this investigator-blinded, randomized, 4- armed, factorial study, 32 volunteers were requested to perform 10 minutes of...

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