Original ArticlesAn evaluation of the use of guidelines in prehospital management of brain injury☆
Section snippets
Setting
The study was conducted in a large northeastern county adjoining a major metropolitan area. The county has a population of 1 million and consists of nearly 400 square miles of suburban area, with a few urban and rural areas at the edges of the catchment. The participating agency was a paid fire and rescue department with over 1,500 uniformed personnel. Paramedics were available in medic units and engine companies; the average scene response time for an advanced life support (ALS) provider was
ALS provider education results
Of the 381 ALS providers attending the educational component, 331 (86.9%) returned a pretest, 272 (71.4%) returned a posttest, and 168 (44.1%) returned a three-month follow-up test. Overall, 103 (27.0%) complete sets were available for analysis. All results are reported as the percentage correct.
There was a fairly large discrepancy between the number of complete sets available for analysis (n = 103) and the total number of pretests (n = 331), posttests (n = 272), and three-month follow-ups (n = 168)
Discussion
The focus of attention toward evidence-based management of TBI patients is not a new concept. The first consensus guidelines developed by the BTF were published in 1995,11 and were chiefly aimed at the surgical and intensive care specialists responsible for the hospital-based care of such patients. With the publication of similar guidelines for the prehospital care community, extension of this evidence-based approach backward to the first point of patient care interaction and medical
Limitations
This study has several limitations. First, the education section had a very small sample size. Future studies will need to incorporate larger samples to make more definitive statements about education and learning retention of the guidelines. In addition, although the scores on the GCS calculation section met the 65% criteria, the argument may be made that this is still an unacceptably low knowledge level, and that this section of the program needs to be strengthened. Patients were followed up
Conclusions
Proper patient evaluation and medical response in targeted areas are absolutely critical to achieving improved outcomes in patients with traumatic brain injury. The successful implementation of the BTF prehospital guidelines is manifested by the reductions in patient mortality and improvements in patient functional outcomes (i.e., improvement in GOS and RLAS). Whereas this study focused solely on the implementation of these protocols for ALS providers in this EMS system, future work ought to be
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Patients with head trauma: A study on initial prehospital assessment and care
2018, International Emergency NursingCitation Excerpt :However, current guidelines on pre-hospital management of TBI patients do not take account of the possible gender differences [10,12] As, at this point, it is unclear whether these difference in outcome result from physiological differences, symptom presentation, or the assessment [15]. Some studies have evaluated pre-hospital assessment and management of TBI patients [9,16,17], but there is still a knowledge gap concerning how the assessment and care by the pre-hospital personnel correlates with the elements in the guidelines when they handle patients with TBI. Only one study investigated possible gender differences in the management of patients with severe TBI in the prehospital setting and [17].
Neurotrauma
2017, Essentials of NeuroanesthesiaControversies in the Management of Traumatic Brain Injury
2016, Anesthesiology ClinicsCitation Excerpt :The first was published in 1995, revised in 2000, and the most recent in 2007. There are only a few studies that examine the impact of application of these guidelines on TBI outcomes, and data show that compliance reduces mortality and improves outcomes.81 Gerber and colleagues82 calculated that TBI mortality between 2001 and 2009 in New York State experienced significant reduction from 22% to 13%, whereas there was a significant increase in guideline adherence, from 56% to 75%.
Using an evidence-based care bundle to improve Thai emergency nurses' knowledge of care for patients with severe traumatic brain injury
2015, Nurse Education in PracticeCitation Excerpt :The term ‘care bundle’ is defined as a small number of evidence-based practice elements; generally limited to three to five key elements, which, when executed together, result in better outcomes than when implemented individually (Resar et al., 2012). Care bundles are being used in emergency care in Australia, United Kingdom, Ireland, the Netherlands, and Singapore to improve the care of patients with stroke and transient ischemic attack (NICS, 2009; Weeraratne et al., 2010), sepsis (Kuan et al., 2013; Nguyen et al., 2011; Tromp et al., 2010), cardiac arrest (Nolan and Soar, 2008), chronic obstructive pulmonary disease (McCarthy et al., 2013), and acute asthma (McCreanor et al., 2012). Implementation of care bundles in emergency care has been shown to improve clinical outcomes (McCarthy et al., 2013; Tromp et al., 2010; Weeraratne et al., 2010).
Clinical Research in Prehospital Care: Current and Future Challenges
2023, Clinics and Practice
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Presented in part at the Emergency Medical Services Today Conference and Exposition, March 2003, Philadelphia, Pennsylvania; the Prehospital Research Forum Scientific Assembly, September 2002, Portland, Oregon; and the American College of Emergency Physicians 2001 Research Forum, October 2001, Chicago, Illinois.
Supported by a grant from the Brain Trauma Foundation, New York, New York.