Improved paramedic sensitivity in identifying stroke victims in the prehospital setting.

OBJECTIVE: The authors have previously shown that San Francisco paramedics without specific training in stroke recognition identified acute stroke victims with a 61% sensitivity and a 77% positive predictive value (PPV). The authors implemented an educational program on stroke to improve paramedic accuracy in stroke recognition. METHODS: Twenty-two paramedics volunteered to attend a four-hour seminar about stroke and then were followed prospectively for six months. All encounters with adult patients who were evaluated by both trained and untrained paramedics and were transported to two university hospitals were reviewed. Subjects were identified by paramedic assessment as stroke/transient ischemic attack (TIA) and/or final hospital discharge diagnosis of stroke/TIA after detailed chart review. Sensitivity and PPV for paramedic identification of stroke were calculated. RESULTS: During the prospective six-month phase, 84 confirmed stroke patients were transported to the target hospitals. Of the 32 who were transported by trained paramedics, all but three were identified as having stroke/TIA, resulting in a sensitivity of 91%. This is significantly higher than the 61% previously found (p=0.01). Nontrained paramedics also increased their sensitivity to 90%. Thirty-eight false-positive patients were identified, resulting in PPVs of 64% for trained paramedics and 69% for all other paramedics. CONCLUSIONS: Institution of an educational stroke program was associated with a significant increase in sensitivity in stroke identification by the paramedics; however, educational influences outside this training program may have contributed to the increased sensitivity. Better education for paramedics, combined with rapid response to stroke victims once identified, may result in improved care for victims of acute stroke.

Burning the EMS candle. EMS shifts and worker fatigue.

Has coffee become your best friend? Do you sleep only in your dreams? Is your bed merely an illusion? If so, you are not alone; sleep deprivation is a fact of life for many EMS personnel. Though widely accepted, isn't it time that we question the effects of those long days and nights?

Characteristics of midsized urban EMS systems.

Emergency medical services (EMS) systems in 25 midsized cities (population, 400,000 to 900,000) are described. Information describing EMS system configuration and performance was collected by written and telephone surveys with follow-ups. Responding cities provide either one- or two-tier systems. In a one-tier system, an advanced life support (ALS) unit responds to and transports all patients who use 911 to activate the system. Three types of two-tier systems are identified. In system A, ALS units respond to all calls. Once on scene, an ALS unit can turn a patient over to a basic life support (BLS) unit for transport. In system B, ALS units do not respond to all calls; BLS units may be sent for noncritical calls. In system C, a nontransport ALS unit is dispatched with a transporting BLS unit. For ALS calls, ALS personnel join BLS personnel for transport. Overall, cities staff an average of one ambulance per 51,223 population. One-tier systems average one ambulance per 53,291 compared with two-tier systems, which average one ambulance per 47,546. In the two-tiered system B, the average ALS unit serves 118,956 population. In the 60% of cities that use a one-tier system, one ALS unit serves 58,336 (P less than .0005). Overall, the code 3 response time for all cities is an average of 6.6 minutes. The average response time of two-tier systems is 5.9 minutes versus 7.0 minutes for one-tier systems (.05 less than P less than .1). These data suggest that the two-tiered system B allows for a given number of ALS units to serve a much larger population while maintaining a rapid code 3 response time.

Stimulant action of pethidine on the pregnant rat uterus in-vitro.

Pethidine's stimulant action on the 22-day pregnant rat isolated uterus does not involve receptors sensitive to methysergide and is unlikely to involve the synthesis and release of endogenous prostaglandins. The sensitivity of pethidine-induced contractions to verapamil suggests that mobilization of extracellular calcium is necessary for pethidine's action.

The effect of cyproterone acetate on the plasma gonadotrophin response to gonadotrophin releasing hormone.

Cyporterone acetate (100-150 mg daily) was administered to 8 male patients with excessive libido. Within 3 months a significant fall (P less than 0.02) in plasma testosterone was demonstrated. The plasma luteinising hormone (LH) and follicle stimulatin hormone (FSH) responses to gonadotrophin releasing hormone (LH/FSH-RH) were also significantly impaired (P less than 0.05). A direct correlation between the resting plasma testosterone level and the LH response to LH/FSH-RH was demonstrated (r = 0.743). It is concluded that the fall inplasma testosterone levels in patients receiving cyproterone acetate may be attributed to suppression of LH release, rather than an antiandrogen effect on the testis or hypothalamus.