EMS Controversies

Question 1

Pre-hospital intubation

Answer 1

-Effectiveness questioned vs BMV due to rates of esophageal intubation in some systems and poor outcomes with RSI in head-injured patients

Question 2

Prehospital RX

Answer 2

-No studies have demonstrated a benefit in the pre-hospital administration of medications for COPD, bronchospasm, or anaphylaxis (however, most systems feel these medications do not cause harm, may be helpful, and provide comfort/perceived clinical improvement for most patients)

Question 3

Pre-hospital amiodarone

Answer 3

-To terminate refractory VF has been found to result in higher survival rates to hospital arrival but not significantly effect survival to discharge

Question 4

Pre-hospital fibrinolytic agents

Answer 4

-For acute STEMI; not gained wide acceptance and may be useful only if prolonged transport times exist or if hospitals do not have catheterization/intervention facilities available

Question 5

Trauma: on scene time

Answer 5

-Widely accepted that in trauma all effort should be made to reduce on-scene time

Question 6

Trauma: IVF

Answer 6

-Paradigm shift to restrictive or hypotensive resuscitation for penetrating truncal injuries (vs high volume IVF for hemodynamic instability which may lead to hemodilution or disruption of a fragile clot or further hemorrhage by increasing MAP)

Question 7

Pneumatic anti-shock garments

Answer 7

-Shown to ↑ mortality in penetrating torso injuries; no longer recommended in urban EMS systems with short transport times