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Emergency Adult Medical Care
While much of initial Emergency Medical
Services care centered on cardiac and traumatic emergencies, interest has
evolved in the management of other emergencies by Emergency Medical Services
providers as they have broadened their scope of practice. The management of
airway obstruction and respiratory arrest is an important function of the
Emergency Medical Services system.
Paramedics can achieve airway control
by endotracheal and nasotracheal intubation with a high success rate and an
acceptable complication rate. Early advanced airway measures for upper airway
obstruction from burns, trauma, foreign bodies, or allergic causes may be
lifesaving. Neuromuscular paralytic agents, such as succinylcholine, may be used
safely by paramedics in the field with appropriate instruction and close medical
oversight.
Respiratory distress in patients with chronic obstructive
pulmonary disease (COPD) and asthma is a common clinical entity treated in
Emergency Medical Services systems. Beta-2 agonists and ipratropium have been
shown to be safe and effective bronchodilators for field use. Pulse oximetric
studies for the evaluation of occult hypoxemia have become widely
used.
Devices capable of delivering continuous positive airway pressure
(CPAP) have become available for use on ambulances. There are initial
observations indicating that this treatment may add benefit to the care of
patients with acute exacerbations of COPD and perhaps also for other disorders
such as asthma.
Paramedics are commonly called to evaluate patients with
altered mental status. Glucose is given routinely to hypoglycemic patients and
naloxone to patients with suspected opioid overdose. Similarly, control of
seizures with diazepam or lorazepam and airway support for status epilepticus
are important Emergency Medical Services functions.
Pediatric
Care
With the development of pediatric emergency care as an area of interest,
experts and organizations have started to review the care of children in
Emergency Medical Services systems. It is estimated that 5 to 10 percent of an
Emergency Medical Services system's volume consists of pediatric cases, and the
most common pediatric emergencies are trauma, respiratory emergencies, and
seizures.
Cardiac arrest in children is rare (approximately 1 per 10,000
children per year in the United States), usually with a dismal outcome. The
ability of paramedics to perform procedures to treat pediatric cardiac arrest,
respiratory emergencies, and trauma is extremely variable and age-dependent. For
most age groups, endotracheal intubation success rates are comparable with those
for adults.
As would be expected, endotracheal intubation and intravenous
access have poorer success in infants and small children. Conversely, the
benefit of these procedures in the field for pediatric patients remains
unproven. For example, a study of pediatric prehospital intubation in Los
Angeles County found no increase in patient survival compared with bag-mask
ventilation.
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