I need some studies

[marcus2011]

Long story short me and my operations supervisor got into a knock down drag out on some things most importantly strokes, stemi's, and the running of emergency traffic to the hospital.

So here is what i need from my friends here at EMTLIFE.

I have researched all three topics and can not find any research on most. I need some studies on the time saved running emergency traffic to and from a scene, How long it takes permanent damage to occur in a stroke without TPA or Fibro, The time it takes most hospitals to determine what type of stroke has occurred and the time it takes for heart tissue to have necrosis set in.

I would like to say thank you in advance.

 

[NomadicMedic]

I suggest you hop on over to PubMed and put your searching hat on. Google Scholar will also give you hits on peer reviewed journals.

But... We encourage self reliance and the investigative spirit. That means we're certainly not going to do your research for you.

But I will say that every study I've seen shows NO significant time savings when running lights and sirens.

 

[Medic Tim]

Long story short me and my operations supervisor got into a knock down drag out on some things most importantly strokes, stemi's, and the running of emergency traffic to the hospital.

So here is what i need from my friends here at EMTLIFE.

I have researched all three topics and can not find any research on most. I need some studies on the time saved running emergency traffic to and from a scene, How long it takes permanent damage to occur in a stroke without TPA or Fibro, The time it takes most hospitals to determine what type of stroke has occurred and the time it takes for heart tissue to have necrosis set in.

I would like to say thank you in advance.

Most studies I have read show running code does not save time or improve pt outcomes. It is more dangerous for the crew, pt and general public to run code. I don't have anything to cite as I am at work on my cell but I am sure someone will post something. In my experience running code for everything is done to make the crew feel better because you did something. I have also found that people not comfortable with their assessment/skills run code much more than others.
Driving fast does not help your pt. A smooth transport is the best transport.

I will get off my soapbox now

 

[Melclin]

Hoping you were arguing against L/S

But... We encourage self reliance and the investigative spirit. That means we're certainly not going to do your research for you.

If you can't do a simple google search for a topic without finding the first three references bellow, I don't hold out a great deal of hope of an actual lit search taking place. Hand holding may be required.


OP:
Lights and sirens use saves very little time (1,2,3) and is associated with high incidence of serious MVAs (4). On a side note, these took literally under 5 mins to find. Where did you learn to lit search?

I doubt anyone will be able to put exact times on MI and stroke. Arguments about windows of opportunity for thrombolysis take place using hours, not the seconds or (few) mins saved by L/S transport.

The role of ambulance is swift identification, transport without delay(that doesn't mean fast & dangerous) and early notification to allow for time saving preparations in hospital (5). This is where the significant time is saved, not in L/S transports. Same for MI. Check out the AHA guidelines on STEMI.

Aggressive limitation of L/S transport made no difference to pt outcomes (6) in most cases.

1) http://www.sciencedirect.com/science/article/pii/S019606449870037X
2) http://www.sciencedirect.com/science/article/pii/S0196064495702679
3) http://www.ncbi.nlm.nih.gov/pubmed/10634288
4) http://informahealthcare.com/doi/abs/10.1080/10903120190939751
5) http://stroke.ahajournals.org/content/38/10/2765.short
6) http://www.ncbi.nlm.nih.gov/pubmed/10155532

I'm not aware of any other data linking outcomes to L/S transport vs non emerg transport.

The time saved issue is pretty clear though. It really doesn't save much time at all. Sure if I have a haemorrhagic shock pt and I'm looking at travelling 50kms through peak hour traffic, then its reasonable, but you've gotta be smart about these things.

If there are conditions that will cause significant harm to the pt in that kind of time window, we really should be treating them on scene (ABC type stuff). For most other things, the time saved won't matter. Better of putting your effort into streamlining systems and procedures to save time that way eg, reducing door to needle times etc.

 

[marcus2011]

Thank all of you for your replies to this subject matter I was attempting to obtain research that I already have not found using google search you know research that some members here may have that kind of stuff. The sarcasm and feeling of lack of knowledge or education from asking a simple favor was not warranted or needed so think you and moderators please close this forum and my account on this forum if need be. This community needs to learn the difference between helping a fellow individual and attempting to belittle them . Thank you

 

[Tigger]

Thank all of you for your replies to this subject matter I was attempting to obtain research that I already have not found using google search you know research that some members here may have that kind of stuff. The sarcasm and feeling of lack of knowledge or education from asking a simple favor was not warranted or needed so think you and moderators please close this forum and my account on this forum if need be. This community needs to learn the difference between helping a fellow individual and attempting to belittle them . Thank you

Yes, we are belittling you by providing suggestions on how to best go about finding the information you need. :blink: We have no idea how much you researched before asking the question. Generally, if you're going to ask someone to find you studies, you should mention what you have already found. If you found stuff on google, tell us that!

For what it's worth, google is really only a starting point for finding peer reviewed literature. I personally seek out footnotes from those search results and then use a database search to find the actual study or article. You might try going to your local library, who likely has free access to a collection of online databases filled with scholarly research.

It is not asking a favor for others do your research, it's asking for others to do your work. You will learn quite a bit more about the topic by doing the research yourself instead of being spoon-fed it. You can find information on this topic, you just need to spend the time doing so.

And lest you say that I am belittling you talking down to you, here's this in regards to lights and sirens saving time (they don't, but you'll want actual studies to back that up).

http://www.emsworld.com/article/103...ficant-amount-of-travel-time-and-lives?page=2

EMSworld is kind of a rag. It is not a source of research, though the author of this article is quite well respected. What this article does offer is a crap ton of citations to studies regarding the topic. Find the studies cited, read them, and see if you agree with their conclusion.

Most of all, have an open mind. Realize that sometimes the research just does not back up your opinion, which may be the case here. Learn from it and move on.

 

[Medic Tim]

When you ask for advice and input you need to be able to take the good and the bad. There is good information posted in this thread. Instead of throwing an internet temper tantrum because it didn't go how you wanted, look at the info that has been given to you. A few minutes in google can produce several results. Don't expect people here jump on your side of the argument when evidence and experience tells us the opposite. If you aren't going to put the time into a basic search why should we.


I also noticed in another thread you are 20 min from a level 1 hospital or a cath lab or whatever. How much time are you really going to save being that close to begin with?

 

[NomadicMedic]

OP, rather than getting all tender over my reply to your post, note that I gave you TWO very valid sources... PubMed and Google Scholar.

Both of these will provide you with peer reviewed articles to support your argument.

 

[SDog]

Thank all of you for your replies to this subject matter I was attempting to obtain research that I already have not found using google search you know research that some members here may have that kind of stuff. The sarcasm and feeling of lack of knowledge or education from asking a simple favor was not warranted or needed so think you and moderators please close this forum and my account on this forum if need be. This community needs to learn the difference between helping a fellow individual and attempting to belittle them . Thank you

People are blunt and sometimes come of rude but in all actaullity I think they have given you what you asked for. Take what you need from them and leave what you don't. And honestly I dont believe any one was trying to belittle you. Good luck with your research.

 

[ffemt8978]

Thank all of you for your replies to this subject matter I was attempting to obtain research that I already have not found using google search you know research that some members here may have that kind of stuff. The sarcasm and feeling of lack of knowledge or education from asking a simple favor was not warranted or needed so think you and moderators please close this forum and my account on this forum if need be. This community needs to learn the difference between helping a fellow individual and attempting to belittle them . Thank you

No.