Blog Archives

The Specter of Diversion

It seems that diversion is dead in Massachusetts, and even if it isn’t yet everywhere else in the country, it’s probably fair to say that it is fading away: diversion is falling out of favor with many in EMS and emergency medicine fields.

While the data on direct patient harm caused by diversion are inconclusive1, it is likely an ineffective strategy, at least in its “classic” form, when viewed from a system’s perspective. Diversion does nothing to increase ED throughput locally, and may in fact cause EMS offload delays2.

AED use on commercial flights

In-flight automated external defibrillator use and consultation patterns. AM Brown, et al.  Prehosp Emerg Care, 2010. This 2010 article speaks to the issue of in-flight emergencies on commercial aircrafts, but also raises two broader themes:   AED use and availability in

Kids and Young Adults with SCA

Warning Symptoms and Family History in Children and Young Adults with Sudden Cardiac Arrest Jonathan A. Drezner, MD, Jessie Fudge, MD, Kimberly G. Harmon, MD, Stuart Berger, MD, Robert M. Campbell, MD, and Victoria L. Vetter, MD JABFM July–August 2012

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HEMS in patients with major trauma

It would be hard if not impossible to conduct a randomized prospective study of HEMS vs. ground EMS for poly-trauma.  Thus, past studies have typically relied on retrospective database review, or have used the “before and after” approach (HEMS being the intervention added or taken away in a region).

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Prehospital Diagnosis and Triage of STEMI

Studies examining accuracy of ER physicians also report variable numbers – 5.2% unnecessary cath activation; 9-14%, depending on false positive definition.  What should be the correct reference standard for EMS (without tele-ECG capability)?

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