RESUMO
OBJECTIVE: The purpose of this study was to gather data from paramedics practicing in the critical care transport setting to guide development of the education, training, and clinical practices for certification as a critical care paramedic. METHODS: A paper survey of 1991 randomly selected nationally registered (NREMT) paramedics was conducted. Nine paramedics with residences in small US Pacific Island territories were not included in the survey. RESULTS: We received 610 responses (30.6%). Respondents that stated that they provided critical care transport services reported using pediatric skills and equipment the most and intracranial pressure monitoring the least. Paramedics served as the primary provider for pediatric patients (72.5%), 12-lead electrocardiogram (66.3%), intravenous infusion pump (76.7%), mechanical ventilator (66.9%), central line management (63.1%), and chest tube management (63.3%). Paramedics served in a team member capacity most often with neonatal isolette (71.8%), intra-aortic balloon pump (79.2%), and ICP monitoring (64.9%). The majority provided ground critical care transport (249) compared to 44 rotor-wing and 6 fixed-wing. Sixteen respondents reported serving as primary providers on combinations of ground, rotor-, and fixed-wing services. CONCLUSIONS: Paramedics reported being the primary provider on the critical care transport team and performing skills while using equipment and administering medications that exceeded their education and training as paramedic and, at times, without the benefit of any additional education or training. National appreciation of this reality should spur development of standardized education, licensing or certification, and continuing education to prepare paramedics for their role as critical care medical providers.
Assuntos
Pessoal Técnico de Saúde/educação , Certificação , Competência Clínica , Cuidados Críticos , Transporte de Pacientes , Pessoal Técnico de Saúde/normas , Pessoal Técnico de Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/estatística & dados numéricos , Estudos Transversais , Pesquisas sobre Atenção à Saúde , Humanos , Equipe de Assistência ao Paciente/organização & administração , Sistema de Registros , Transporte de Pacientes/métodos , Transporte de Pacientes/organização & administração , Transporte de Pacientes/estatística & dados numéricos , Estados UnidosAssuntos
Serviços de Saúde Comunitária/organização & administração , Serviços Médicos de Emergência/organização & administração , Desenvolvimento de Programas , Serviços de Saúde Rural/organização & administração , Custos e Análise de Custo , Atenção à Saúde/métodos , Humanos , New Mexico , Prática Profissional , Avaliação de Programas e Projetos de SaúdeRESUMO
The prehospital electrocardiogram (ECG) is becoming the standard of care of suspected cardiac chest pain. We evaluated the evidence regarding the prehospital ECG and sought to quantify the reduction in time to reperfusion therapy attributable to the prehospital ECG. We conducted a systematic review and analyzed studies that were conducted in emergency medical systems relevant to providers in the United States. The papers were limited to studies that reported original data that compared prehospital ECG to no prehospital ECG groups. Four studies containing 99 patients met the inclusion criteria. A meta-analysis of these studies revealed a difference of 24.7 (95% confidence interval, 16.7-32.7) minutes. Providers now have a quantified value of the prehospital ECG based on the best published evidence. In addition, this search showed a relatively low quality and quantity of research on the prehospital ECG.
