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Triage
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Studies in the USA have shown that priori-tized dispatch (dividing calls into priorities by using questions about the patient’s respiratory and neurological state) improves the efficiency of the ambulance service.15, 16 A motor component of the Glasgow Coma Scale (GCS) <6 and a systolic blood pressure of <90 mmHg have been shown to be significantly associated with the need for a life-saving intervention, but patients with normal blood pressures and normal motor scores also frequently require these, so further research is needed.17 Two systems in use are the Advanced Medical Priority Dispatch System (AMPDS) and Criteria-Based Dispatch (CBD). Both use a fixed sequence of questions to determine the priority. The AMPDS sorts calls into four categories and CBD into three. As well as ranking emergency calls by urgency, prioritized dispatch allows the ambulance control to determine the type and level of response. The target of one paramedic per crew has almost been achieved throughout the UK, so the choice between the paramedic crew and the all-technician crew is less relevant. However, in many developing countries this remains an important consideration.
Communication in pre-hospital care
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
All emergency calls in ambulance control rooms are recorded on a computer aided dispatch system (CAD). The CAD has an integrated mapping system which is linked to an address database to provide a map reference for the site at which the incident has occurred. Once the location details are obtained the caller is taken through a set of questions to determine the priority of the response required. Currently in the UK two triage systems are licenced to be used for prioritising calls: Medical Priority Dispatch System (AMPDS) and NHS Pathways. Where a call is identified as immediately life threatening (Red 1 or 2) the call has a resource dispatched. In most cases as soon as the address and type of incident are established the call is automatically passed by the computer system for dispatch. The rest of the questions can then be asked without slowing the response and the responding vehicle can then be updated as required with the relevant information.
New Drugs in Myeloproliferative Disorders
Published in Richard T. Silver, Ayalew Tefferi, Myeloproliferative Disorders, 2007
Srdan Verstovsek, Ruben A. Mesa
A variable prognostic outlook for the MPDs (PMF, post ET/PV MF) complicates the design of a therapeutic plan for a particular patient. It is generally agreed, however, that PMF is associated with the worst prognosis, with its median survival rivaling that of many lethal solid malignancies. Various prognostic features can help stratify the suspected outcomes in MF patients (8), including anemia (9), karyotypic abnormalities (10), age, the presence of circulating blasts (9), and markedly increased angiogenesis in the marrow (11). Patients with ET and PV can potentially have life expectancies as long as their age matched the controls (12,13). However, such longevity among these patients is not universal as short-and long-term risks of both morbidity and mortality exist.
Effect of New 9-1-1 System on Efficiency of Initial Resource Assignment
Published in Prehospital Emergency Care, 2020
Stephen Sanko, Christianne Lane, Marc Eckstein
MPDS® was used by LAFD from January 1989 through November 2014. For the MPDS period under study (January – September 2014), all emergency calls were answered by fully qualified and accredited MPDS® telecommunicators who had 24 hours of basic training, and 24 hours of biannual continuing dispatch education. MPDS® version 12.2 was exclusively used during the MPDS comparator group time period, along with the corresponding dispatch support and quality improvement software. From October – November 2014, LAFD telecommunicators received compensated off-hours training on LA-TDS, while concurrently using MPDS on the dispatch floor. LA-TDS training included 12 hours of basic training and 12 hours of skill training. LA-TDS was implemented for all dispatchers at all dispatch consoles on December 1, 2014. No cases occurring from October-December 2014 were included in this study. LA-TDS was used exclusively during the LA-TDS study period (January – September 2015).
Availability and Use of an Automated External Defibrillator at Emergency Medical Dispatch
Published in Prehospital Emergency Care, 2019
Isabel Gardett, Meghan Broadbent, Greg Scott, Jeff J. Clawson, Christopher Olola
This retrospective descriptive study utilized a convenience sample of emergency dispatch data collected from 23 Emergency Communication Centers (ECCs) spanning 14 states across the United States (U.S.) from July 11, 2014 to August 13, 2018, using the software version of the Medical Priority Dispatch System (MPDS®) version 13.0 ©2000–2012 (Priority Dispatch Corp., Salt Lake City, Utah, USA), ProQA® software version 5.1. These ECCs received 9-1-1 and emergency medical calls primarily for medium to large EMS systems, covering mostly urban/suburban populations of between 150,000 and 2 million, including: 12 centers covering a population between 150,000 and 500,000, 7 centers covering a population over 500,000 and under 1 million, and 4 centers covering a population of over 1 million. 21 of these centers were (International Academies) accredited centers of excellence during the entire study period, reporting monthly high (MPDS) dispatch protocol compliance. The other two (non-accredited) centers reported monthly dispatch protocol compliance at accreditation levels during the study period.
Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management
Published in Prehospital Emergency Care, 2018
Emily Andrew, Ziad Nehme, Stephen Bernard, Karen Smith
The study was conducted in the state of Victoria, Australia, with a population of more than six million people across 227,000 square kilometers. Ambulance Victoria is the state-wide provider of EMS. The EMS utilizes the Medical Priority Dispatch System to triage emergency calls, and Advanced Life Support and Intensive Care paramedics are dispatched to medical emergencies in a two-tiered fashion. Clinical practice guidelines authorize all paramedics to administer intramuscular epinephrine (10 mcg/kg) for pediatric anaphylaxis, with the addition of inhaled bronchodilators and/or epinephrine according to clinical need. According to the clinical practice guideline, epinephrine in the setting of anaphylaxis may be administered to patients with a sudden onset of two or more of: respiratory distress, abdominal symptoms, skin/mucosal symptoms, or hypotension. Patients with isolated hypotension and exposure to a known allergen are also indicated to receive epinephrine. Intensive Care paramedics are also authorized to perform endotracheal intubation and administer intravenous therapy (including epinephrine, crystalloid fluid, and corticosteroids), as indicated.