Subject(s)
Disease Management , Emergency Medical Services , Ill-Housed Persons , Nursing Assessment , HumansSubject(s)
Bariatric Surgery/methods , Emergency Medical Services/methods , Equipment and Supplies, Hospital/standards , Obesity, Morbid/complications , Postoperative Complications/diagnosis , Ambulances , Bariatric Surgery/adverse effects , Bariatric Surgery/instrumentation , Equipment Design , Humans , Obesity, Morbid/psychology , Obesity, Morbid/surgery , Postoperative Complications/etiology , Transportation of Patients/methodsSubject(s)
Emergency Medical Services/methods , Multiple Trauma/therapy , Trauma Severity Indices , Acidosis/diagnosis , Acidosis/etiology , Acidosis/therapy , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Critical Illness/therapy , Emergency Medical Services/standards , Humans , Hypothermia/diagnosis , Hypothermia/etiology , Hypothermia/therapy , Multiple Trauma/complications , Multiple Trauma/diagnosis , Pain Management/methods , Time Factors , Trauma CentersABSTRACT
OBJECTIVES: The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between fire-based basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system. METHODS: This was a retrospective cohort study using standardized abstraction methodology. A two-tiered hospital-based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2. RESULTS: During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52-78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome. CONCLUSIONS: Out-of-hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out-of-hospital and ED settings in our community.
Subject(s)
Cause of Death , Emergency Medical Services/standards , Heart Arrest/mortality , Heart Arrest/therapy , Age Distribution , Aged , Cardiopulmonary Resuscitation/methods , Cohort Studies , Colorado/epidemiology , Confidence Intervals , Emergency Medical Services/methods , Female , Follow-Up Studies , Heart Arrest/diagnosis , Humans , Incidence , Male , Middle Aged , Neurologic Examination , Odds Ratio , Patient Discharge/statistics & numerical data , Probability , Registries , Retrospective Studies , Risk Assessment , Sex Distribution , Survival Analysis , Urban PopulationSubject(s)
Burns/pathology , Emergency Medical Services/methods , Burns/classification , Burns/therapy , HumansSubject(s)
Dyspnea/etiology , Emergency Medical Services , Heart Diseases/diagnosis , Lung Diseases/diagnosis , Bronchodilator Agents/therapeutic use , Diagnosis, Differential , Dyspnea/therapy , Female , Heart/anatomy & histology , Heart Diseases/complications , Humans , Lung Diseases/complications , Male , Physical Examination , Respiratory System/anatomy & histologySubject(s)
Amputation, Surgical , Emergency Medical Services/methods , Wounds and Injuries , Humans , United StatesABSTRACT
OBJECTIVE: To determine the level of standardization in performance of the semen analysis among clinical laboratories in the United States. DESIGN: A survey was mailed to laboratories requesting information about the laboratory and performance of the semen analysis. Responses were received from 536 laboratories. SETTING: Clinical laboratories enrolled in the American Association of Bioanalysts Andrology Proficiency Testing Program. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Agreement among laboratories. RESULT(S): Sixty-one percent of respondent laboratories were part of an assisted reproductive technology program. The laboratories perform less than 50 (53%), less than 10 (25%), or less than 5 (16%) andrology laboratory procedures per month. The laboratories routinely report sperm count (94% of laboratories), motility (95%), morphology (85%) and forward progression (69%), and semen volume (96%) as part of the semen analysis. Only 64% of laboratories routinely report abstinence, and 60% of laboratories indicate the criteria used for sperm morphology on the report form. The most common lower limits of normality for sperm count and motility were >20 x 10(6)/mL (77% of laboratories) and >50% (59% of laboratories), respectively. Few laboratories performed quality control for sperm counts (29%), motility (41%), and morphology (41%). CONCLUSION(S): These data indicate a significant lack of standardization in the performance and reporting of semen analyses among laboratories in the United States.
