While much of the initial research in EMS has centered on cardiac and traumatic emergencies, interest has evolved in management of other emergencies by EMS providers as they have broadened their scope of practice. There is evidence that prehospital ALS care improves a patient's condition during transport. 13 However, it is not known whether the ultimate outcome is improved by such care.
The management of airway obstruction and respiratory arrest is an important function of the EMS system. Airway control by endotracheal and nasotracheal intubation is readily achieved by paramedics with a high success rate and an acceptable complication rate. Early advanced airway measures for upper airway obstruction from burns, trauma, foreign body, or allergic causes may be lifesaving. Some EMS systems have shown that neuromuscular paralytic agents, such as succinylcholine, may be safely used by paramedics in the field with appropriate instruction and close medical oversight.
Respiratory distress in patients with chronic obstructive pulmonary disease and asthma is a common clinical entity treated in EMS systems. b 2 agonists have been shown to be safe and effective bronchodilators for field use. Pulse oximetric studies for the evaluation of occult hypoxemia have become widely utilized.
Paramedics are commonly called to evaluate patients with altered mental status. Glucose is frequently given to hypoglycemic patients and naloxone to patients with suspected narcotic overdose. Similarly, control of seizures with diazepam and airway support for status epilepticus are important EMS functions.
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