EMS World

JUN 2015

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Therapeutic Hypothermia and the Limits of Hospital Research The implementation of therapeutic hypothermia for patients who have suffered car- diac arrest provides a recent and potentially cautionary example of the limitations of using hospital-based research as the basis for EMS interventions. Studies conducted in the hospital setting have shown that post-resuscitation therapeutic hypothermia is associated with improved survival and neurologic outcome. 22,23 Studies conducted in the prehospital setting, however, have failed to demonstrate any added benefit from commencing patient cooling prior to arrival at the hospital. In other words, delaying the initiation of hypothermia until a patient arrives at the hospital may not have an impact on clinical outcome. 24 More worrisome is the potential for harm from prehospital cooling (often achieved through rapid administration of chilled IV fluids), which has been associated with an increased incidence of pulmonary edema and greater administration of diuretics during the first 12 hours of hospitalization. 25 EMS RESEARCH isolated, the severity of each patient's condi - tion may also vary greatly. This is particu- larly problematic when studying the relative efficacy of interventions that are generally reserved for more critical patients, e.g., endo- tracheal intubation. Similarly, the diversity of EMS systems is also an issue for EMS research. To obtain a representative sample, it may be necessary to employ multiple study sites in differ- ent jurisdictions, each of which is likely to be served by different EMS systems, each with its own particular system design and deployment model. Even within the same EMS system, patients may receive different levels of first response and transport care (first responder, BLS or ALS). Response times are also likely to vary, especially between urban and rural communities. Finally, the prehospital setting is any- thing but a controlled environment. On- scene interventions can take place anywhere from a tiny hall bathroom to the middle of a busy highway. Several factors, including patient presentation and scene safety issues, can influence whether patient care is pro- vided on the scene or for how long. Inter- ventions in the back of a moving ambulance are necessarily constrained in terms of both space and available resources, especially compared to the hospital setting. Conducting a retrospective trial—using existing data collected from previous inci- dents—can sidestep some of these research challenges while still providing a wealth of 34 JUNE 2015 | EMSWORLD.com *For terms and conditions please visit www.buyemp.com/customer-service.html BuyEMP.com You order. We ship (free). * It's that simple. Power up and down stairs with the FERNO ® EZ-Glide ® with PowerTraxx ™ • Strong – 500lb weight capacity • Maneuverable – 1" track-to-ground clearance • Durable – All metal frame construction • Comfortable – Large patient seating surface EZ-Glide ® with PowerTraxx ™ Contact EMP for more details 800.558.6270 For More Information Circle 25 on Reader Service Card

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