With medicine and EMS being a
constantly-changing and evolving science, I believe that it is imporant for
pre-hospital personnel to stay informed of current trends in medicine and adjust
protocols accordingly. The articles below either reflect some of the
latest in research and trends in pre-hospital emergency medicine (or are
of particular interest to me) and are good examples of
where medical directors and EMS leadership get information to write
Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular Fibrillation
Christenson, J., Andrusiek, D., Everson-Stewart, S., Kudenchuk, P., Hostler, D., Powell, J., ... & Berg, R. (2009). Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation, 120(13), 1241-1247.
This article shows an increased rate of survival for cardiac arrest patients who recieve minimal interruptions in chest compressions
Chest Compression Rates and Outcomes From Cardiac Arrest
Idris, A. H., Guffey, D., Aufderheide, T. P., Brown, S., Morrison, L. J., Nichols, P., ... & Nichol, G. (2012). Relationship between chest compression rates and outcomes from cardiac arrest. Circulation, 125(24), 3004-3012.
Chest Compression Rate: Where Is the Sweet Spot?
Nolan, J. P., Perkins, G. D., & Soar, J. (2012). Chest Compression Rate Where Is the Sweet Spot?. Circulation, 125(24), 2968-2970.
This explains why the optimal rate for chest compressions in CPR is 100-120 beats per minute
Spinal Precautions and the Use of the Long Backboard
National Association of EMS Physicians, & American College of Surgeons Committee on Trauma. (2013). EMS Spinal Precautions and the Use of the Long Backboard.
This is the official position paper of the NAEMSP on long backboards
Spinal cord injury without radiographic abnormality: results of the
National Emergency X-Radiography Utilization Study in blunt cervical trauma
Hendey, G. W., Wolfson, A. B., Mower, W. R., Hoffman, J. R., & National Emergency X-Radiography Utilization Study Group. (2002). Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. Journal of Trauma-Injury, Infection, and Critical Care, 53(1), 1-4.
This is the "NEXUS study" that you may have heard about. It is what got the ball rolling on the trend of field C-spine clearance that is just now becoming mainstream in EMS. Notice the publication date... the study it started 4 years prior to publication
EMS-initiated refusal of transport: the current state of affairs
Knapp, B. J., Kerns, B. L., Riley, I., & Powers, J. (2009). EMS-initiated refusal of transport: the current state of affairs. The Journal of emergency medicine, 36(2), 157-161.
This article takes a look at systems which allow EMS providers to refuse to transport patients who are determined by providers not to need emergency department care.