When are Prehospital Intravenous Catheters Used for Treatment?

Kuzma, Kristin; Sporer, Karl A.; Michael, Glen E.; Youngblood, Glen M.

doi:10.1016/j.jemermed.2007.11.054

Cited by 22 publications

(18 citation statements)

References 12 publications

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“…Our findings are similar to those of Kuzma et al, [5] who concluded that only 17% of prehospitalinitiated IVs were utilised and that 83% were considered prophylactic management. Their findings also suggested that IV utilisation rates were higher in patients with abnormal vital signs.…”

Section: Discussionsupporting

confidence: 91%

Utilisation of prehospital intravenous access

Bester

Sobuwa

2014

S Afr Med J

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Section: Discussionsupporting

confidence: 91%

Utilisation of prehospital intravenous access

Bester

Sobuwa

2014

S Afr Med J

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“…9 Typically placed in higher acuity patients, the proportion of non-injured patients in whom intravenous access is initiated may reach 60% in some EMS systems. 10, 11 EMS personnel use pre-hospital intravenous catheters to deliver medications, administer intravenous fluid, or obtain samples of blood. Yet, over half of catheters may be unused by EMS personnel or deemed as over-treatment during post-hoc review.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, over half of catheters may be unused by EMS personnel or deemed as over-treatment during post-hoc review. 10, 11 Unnecessary initiation of pre-hospital intravenous catheters increases scene time, 3 and may impact EMS system supply costs. 9 More importantly, there is little evidence that indicates pre-hospital placement of intravenous access improves patient-centered outcomes for non-injured, non-arrest patients.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Access During Out-of-Hospital Emergency Care of Noninjured Patients: A Population-Based Outcome Study

Seymour

Cooke

Hebert

et al. 2012

Annals of Emergency Medicine

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Study objective Advanced, pre-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among non-injured patients. We evaluated the association between pre-hospital, intravenous access and mortality among non-injured, non-arrest patients. Methods We analyzed a population-based cohort of adult (aged ≥18 years) non-injured, non-arrest patients transported by four advanced life support agencies to one of 16 hospitals from January 1, 2002 until December 31, 2006. We linked eligible EMS records to hospital administrative data, and used multivariable logistic regression to determine the risk-adjusted association between pre-hospital, intravenous access and hospital mortality. We also tested whether this association differed by patient acuity using a previously published, out-of-hospital triage score. Results Among 56,332 eligible patients, one half (N=28,978, 50%) received pre-hospital intravenous access from EMS personnel. Overall hospital mortality in patients who did and did not receive intravenous access was 3%. However, in multivariable analyses, the placement of pre-hospital, intravenous access was associated with an overall reduction in odds of hospital mortality (OR=0.68, 95%CI: 0.56, 0.81). The beneficial association of intravenous access appeared to depend on patient acuity (p=0.13 for interaction). For example, the OR of mortality associated with intravenous access was 1.38 (95%CI: 0.28, 7.0) among those with lowest acuity (score = 0). In contrast, the OR of mortality associated with intravenous access was 0.38 (95%CI: 0.17, 0.9) among patients with highest acuity (score ≥ 6). Conclusions In this population-based cohort, pre-hospital, intravenous access was associated with a reduction in hospital mortality among non-injured, non-arrest patients with the highest acuity.

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“…Only a small proportion of patients who received analgesia had their heart rate, blood pressure, or oxygen saturation monitored, which contrasts with some pre-hospital recommendations [28]. Care in the wilderness is often limited to the essential procedures [1,2].…”

Section: Monitoring Equipment and Oxygen Therapymentioning

confidence: 99%

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

Pasquier¹,

Eidenbenz²,

Dami³

et al. 2017

Emerg Med

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Objective: The delivery of a safe an effective analgesia is a core principle and a priority of prehospital care. Analgesia in hostile environments (mountain settings, etc.) presents various challenges, and the benefit-risk ratio of the procedure should be evaluated. The objective of this study was to examine pain management strategies and the time spent on scene for analgesia provisions in an alpine environment. Methods:We undertook a retrospective study from a single physician-staffed helicopter emergency medical service in the Swiss Alps. Patients with isolated limb injuries were included. We examined the choice and route of analgesic medication, patient monitoring, medical co-treatments and time delays during the rescue mission.Results: Analgesia was provided to 657 (57%) of the 1156 included patients. Fentanyl was most commonly administered followed by ketamine, with or without fentanyl. Heart rhythm monitoring, oxygen administration, and saline infusion were used infrequently, but were used significantly more often in patients treated with ketamine. The median time on site was 6 minutes longer for patients receiving intravenous analgesia compared with those not receiving it.Conclusion: Analgesia in hostile environments seems to be limited to essential procedures. The safety of this approach must be confirmed.

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When are Prehospital Intravenous Catheters Used for Treatment?

Cited by 22 publications

References 12 publications

Utilisation of prehospital intravenous access

Utilisation of prehospital intravenous access

Intravenous Access During Out-of-Hospital Emergency Care of Noninjured Patients: A Population-Based Outcome Study

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

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