Clot-busting drugs delivered by paramedics benefit patients, yet the practice isn’t widespread in the United States, a study in the August issue of JACC: Cardiovascular Interventions finds.
Researchers examined EMS programs that are part of a regional STEMI system that utilizes prehospital fibrinolysis—the administration of clot-busting drugs in the ambulance—in Sweden; France; England/Wales; Vienna, Austria; Edmonton, Alberta; Nova Scotia; and Houston. The study found that patients who received prehospital clot busters experienced a low reinfarction rate, ranging from about 2 to 5 percent, depending on the system; a low in-hospital stroke rate (under 2 percent); and an in-hospital mortality rate of only 3 to 6 percent.
Yet prehospital fibrinolysis is still rare in the United States, according to the authors. “The major challenge to successful implementation of a pre-hospital fibrinolytic strategy is the regional variations in EMS resources,” Timothy D. Henry, M.D., from the Minneapolis Heart Institute Foundation, and Bernard J. Gersh, from the Mayo Clinic College of Medicine in Rochester, Minn., write in an accompanying editorial. “The EMS system in the United States is particularly fractionated with a wide range of both funding and available services.”
The Minneapolis Heart Institute’s regional STEMI system, for example, includes 33 hospitals and 10 clinics throughout Minnesota and Wisconsin and “requires integration with nearly 50 different EMS agencies and a wide spectrum of resource availability.”
The European Society of Cardiology recommends prehospital fibrinolysis, according to the study. In England/Wales, paramedics can make the determination to administer clot-busting drugs; in the other countries, paramedics must send an ECG to the hospital and need authorization from a physician before administering the drugs. Prehospital fibrinolysis was administered by paramedics in Houston, Nova Scotia and Edmonton; by nurses in Sweden; and by physicians in France and Vienna.
Time to Dump the Glasgow Coma Scale?
The Simplified Motor Score (SMS) works as well as the Glasgow Coma Scale (GCS) for out-of-hospital assessment of the severity of traumatic brain injury, a new study concludes.
Researchers from the Denver Health Medical Center and colleagues analyzed data on more than 19,000 patients who were treated in Denver-area hospitals for head injuries between 1999 and 2008. The data included patients’ GCS; researchers used the information in the records to calculate what would have been their SMS. Using SMS, patients receive a score of 2 if they can obey commands, 1 if they localize pain or 0 if they withdraw to pain or show less response to painful stimuli.
About 18 percent of patients were intubated, 8 percent had neurosurgical procedures, 18 percent had brain injuries, and 6 percent died. Researchers found the SMS to be just as good as the GCS in predicting patient outcomes.
Prior research has also called into question the GCS, a lengthier and more complex test, as being unreliable. In an accompanying editorial, Steven M. Green, M.D., of Loma Linda University in California, who was not involved in the study, says it is time to dump the GCS. Calling the GCS “confusing, unreliable, and unnecessarily complex,” Green suggests that the SMS “would appear to amply fill the bill” as a replacement.
The study is in the July 30 online issue of Annals of Emergency Medicine.
AED Failures Connected to Deaths from Cardiac Arrest
Faulty AEDs contributed to more than 1,000 deaths from cardiac arrest over a 15-year period, according to a study published online in August in Annals of Emergency Medicine.
Researchers analyzed reports to the U.S. Food and Drug Administration’s Manufacturer and User Device Experience database about all adverse events connected to use of an AED between January 1993 and October 2008. Of the nearly 41,000 adverse events, 1,150 were connected to fatalities. Almost half (45 percent) of the failures occurred during the attempt to charge and deliver a recommended shock, and many of those failures involved unanticipated device shutdowns. That includes AEDs that never powered on, that failed to complete rhythm analysis or that failed to deliver the recommended shock.
Problems with pads and connectors, and battery or power problems, each accounted for about 23 percent of the failures. Another 14 percent were attributed to “rhythm analysis discrepancy.” Many of the other reports did not include enough details for researchers to determine a precise cause.
In many cases, a backup device was able to deliver shocks.
“AEDs can truly be lifesavers but only if they are in good working order and people are willing to use them,” lead study author Lawrence DeLuca, M.D., of the University of Arizona Department of Emergency Medicine in Tucson, said in a news release.
Hospital Workers’ Uniforms Teeming with Hazardous Bacteria
More than 60 percent of coats, uniforms and medical scrubs worn in a major Israeli hospital tested positive for disease-causing bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Researchers swabbed the sleeve ends, pockets and abdominal area of 75 registered nurses and 60 doctors at the Shaare Zedek Medical Center in Jerusalem. Eight samples were contaminated by MRSA, while another 21 were contaminated by other antibiotic-resistant bacteria.
Steps to improve clothing hygiene include daily uniform changes, proper laundering, plastic or disposable covers for situations in which workers may contact body fluids, and strict hand hygiene. The study is in the September issue of the American Journal of Infection Control.
