Megan Corry - Academia.edu (original) (raw)
Papers by Megan Corry
JEMS : a journal of emergency medical services, 2013
Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence... more Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.
Frontiers in Neurology
Stroke identification is a key step in acute ischemic stroke management. Our objectives were to p... more Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes.Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS.Results: Of the 31 patients, the mean difference...
Prehospital Emergency Care, 2016
Jems Journal of Emergency Medical Services, Mar 1, 2013
Controlled Clinical Trials, 2001
Journal of Molecular and Cellular Cardiology
JEMS : a journal of emergency medical services, 2013
Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence... more Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.
Prehospital Emergency Care, 1999
The authors have previously shown that San Francisco paramedics without specific training in stro... more The authors have previously shown that San Francisco paramedics without specific training in stroke recognition identified acute stroke victims with a 61% sensitivity and a 77% positive predictive value (PPV). The authors implemented an educational program on stroke to improve paramedic accuracy in stroke recognition. Twenty-two paramedics volunteered to attend a four-hour seminar about stroke and then were followed prospectively for six months. All encounters with adult patients who were evaluated by both trained and untrained paramedics and were transported to two university hospitals were reviewed. Subjects were identified by paramedic assessment as stroke/transient ischemic attack (TIA) and/or final hospital discharge diagnosis of stroke/TIA after detailed chart review. Sensitivity and PPV for paramedic identification of stroke were calculated. During the prospective six-month phase, 84 confirmed stroke patients were transported to the target hospitals. Of the 32 who were transported by trained paramedics, all but three were identified as having stroke/TIA, resulting in a sensitivity of 91%. This is significantly higher than the 61% previously found (p=0.01). Nontrained paramedics also increased their sensitivity to 90%. Thirty-eight false-positive patients were identified, resulting in PPVs of 64% for trained paramedics and 69% for all other paramedics. Institution of an educational stroke program was associated with a significant increase in sensitivity in stroke identification by the paramedics; however, educational influences outside this training program may have contributed to the increased sensitivity. Better education for paramedics, combined with rapid response to stroke victims once identified, may result in improved care for victims of acute stroke.
Prehospital Emergency Care, 1999
Certain forms of stroke can be treated if access to medical care is expeditious. Since many strok... more Certain forms of stroke can be treated if access to medical care is expeditious. Since many stroke victims first enter medical care through emergency medical services (EMS) access, minimizing delays in the EMS system may translate to improved neurologic outcome. Because EMS dispatchers determine the response priority for these calls, dispatchers should be able to recognize the signs and symptoms of stroke based on their brief phone interviews. The authors studied the abilities of dispatchers in a major urban area to correctly identify stroke and transient ischemic attack (TIA) in victims who access 911 and describe what is communicated in the 911 call. A retrospective review was conducted of the medical records of patients treated for stroke or TIA at two urban hospitals during 1996. The tape-recorded 911 calls from patients using EMS were transcribed and analyzed. Information regarding dispatcher classification and triage of these calls was collected and described. The records of 182 patients with acute stroke or TIA were reviewed. Fifty-three percent of patients used EMS. Dispatchers coded 31% of their 911 calls as stroke. The word "stroke" was used without prompting by 51% of callers, yet fewer than half of these calls were coded as stroke by dispatchers. Many callers reported symptoms characteristic of stroke, including impaired communication (36%), weakness (30%), and decreased ability to stand or walk (25%). Only 41% of ambulances were sent at high priority. People who activate EMS for stroke frequently use the word "stroke" and/or describe symptoms compatible with stroke in their calls. EMS dispatch protocols should be sensitive for these symptoms to ensure more accurate and timely ambulance dispatch.
Prehospital Emergency Care, 1998
To determine the accuracy of acute stroke identification by paramedics in an urban emergency medi... more To determine the accuracy of acute stroke identification by paramedics in an urban emergency medical services system. Retrospective chart review of all patient encounters by paramedics resulting in transport to two university hospitals during a six-month period. Subjects were identified by paramedic coding of stroke/transient ischemic attach (TIA) or final hospital discharge ICD-9 diagnosis of acute stroke and TIA. The sensitivity and positive predictive value for paramedic identification of stroke were calculated, and the time intervals from symptom onset to various points along the patients' prehospital and hospital courses were identified. Ninety-six patients were identified, of whom 81 met the diagnosis of acute stroke or TIA. Paramedics identified 49 of these 81 patients (sensitivity 61%). Fifteen patients were identified by paramedics as having a stroke when the patient ultimately had a different diagnosis (positive predictive value 77%) Patients or their families waited on average 2.5 +/- 3.6 (SD) hours before accessing 911, and a mean of 5.1 +/- 4.0 (SD) hours elapsed from symptom onset until head imaging studies were obtained. Paramedics in San Francisco County were correct three-fourths of the time when their documentation listed patients as having stroke/TIA. However, they did not identify 39% of stroke victims, a patient population who may benefit from urgent therapy. A substantial period elapses before stroke victims access 911. This highlights the need to develop an educational program for the community at risk for stroke, and another for paramedics directed toward more accurate identification of acute stroke victims.
New England Journal of Medicine, 2001
It is uncertain whether the administration of benzodiazepines by paramedics is an effective and s... more It is uncertain whether the administration of benzodiazepines by paramedics is an effective and safe treatment for out-of-hospital status epilepticus. We conducted a randomized, double-blind trial to evaluate intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus. Adults with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures received intravenous diazepam (5 mg), lorazepam (2 mg), or placebo. An identical second injection was given if needed. Of the 205 patients enrolled, 66 received lorazepam, 68 received diazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepam (59.1 percent) or diazepam (42.6 percent) than patients given placebo (21.1 percent) (P=0.001). After adjustment for covariates, the odds ratio for termination of status epilepticus by the time of arrival in the lorazepam group as compared with the placebo group was 4.8 (95 percent confidence interval, 1.9 to 13.0). The odds ratio was 1.9 (95 percent confidence interval, 0.8 to 4.4) in the lorazepam group as compared with the diazepam group and 2.3 (95 percent confidence interval, 1.0 to 5.9) in the diazepam group as compared with the placebo group. The rates of respiratory or circulatory complications (indicated by bag valve-mask ventilation or an attempt at intubation, hypotension, or cardiac dysrhythmia) after the study treatment was administered were 10.6 percent for the lorazepam group, 10.3 percent for the diazepam group, and 22.5 percent for the placebo group (P=0.08). Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.
Journal of Molecular and Cellular Cardiology, 1992
Although the stimulatory action of catecholamines on the heart has been presumed to result exclus... more Although the stimulatory action of catecholamines on the heart has been presumed to result exclusively from their direct effects on the cardiac myocytes, little work has been done addressing the effects of catecholamines on the supporting non-myocytes of the heart. We have recently identified medium conditioned by neonatal rat cardiac non-myocytes (NMC-CM) as the source of a growth-promoting factor which leads to cardiac myocyte hypertrophy in culture, suggesting that these non-myocytes may play an active role in myocardial growth. Since cardiac non-myocytes also contain adrenergic receptors (both alpha and beta) on their cell surface, we asked whether adrenergic stimulation of these non-myocytes could supplement the growth-promoting effect of NMC-CM. While isoproterenol (ISO, 0.2 microM) caused no increase in the per cell content of total protein in the non-myocytes, inclusion of ISO in the medium used in the production of NMC-CM augmented the growth promoting effects of this "ISOCM" over control CM. This increase was not seen with the alpha 1 adrenergic agonist phenylephrine suggesting that the stimulatory effect was specific to the beta-adrenergic receptor. Because TGF beta 3 contains an upstream cAMP Response Element, we wonder whether its expression could respond to the increase in cAMP induced by ISO. Non-myocytes treated over 72 h with ISO expressed increased steady state mRNA levels for TGF beta 3 but not that for the closely related TGF beta 1 over this time period. We believe that this is the first report indicating that a potential mechanism for the observed effects of beta-adrenergic stimulation on myocardial cells in culture and possibly relevant in vivo is the contribution of beta-stimulated factor(s) produced by non-myocytes which act in a paracrine fashion on myocardial cells.
Controlled Clinical Trials, 2001
Status epilepticus is a neurological emergency that is typically first encountered and managed in... more Status epilepticus is a neurological emergency that is typically first encountered and managed in the prehospital environment. Although aggressive pharmacological treatment of status epilepticus is well established in the emergency department and hospital settings, the relative risks and benefits of active therapy for status epilepticus in the prehospital setting are not known. The Prehospital Treatment of Status Epilepticus (PHTSE) study is a prospective, randomized, double-blind, placebo-controlled study designed to address the following aims: (1) to determine whether administration of benzodiazepines by paramedics is an effective and safe means of treating status epilepticus in the prehospital setting and whether this therapy influences longer-term patient outcome, (2) to determine whether lorazepam is superior to diazepam for the treatment of status epilepticus in the prehospital setting, and (3) to determine whether control of status epilepticus prior to arrival to the emergency department influences patient disposition. The initial phase of the PHTSE study began in January 1994 and was completed in February 1999 after the successful enrollment of 205 patients into the three treatment arms. In this paper, we describe the rationale for the conceptualization of the study and details of the study design and methodology, and emphasize some aspects of study implementation that are unique to research involving the emergency medical system. Control Clin Trials 2001;22:290-309
The American Journal of Emergency Medicine, 1999
Injectable benzodiazepines are commonly stocked on ambulances for use by paramedics. We evaluated... more Injectable benzodiazepines are commonly stocked on ambulances for use by paramedics. We evaluated the stability of lorazepam and diazepam as a function of storage temperature. Diazepam (5 mg/mL) and lorazepam (2 mg/mL) injectable solutions were stored for up to 210 days in clear glass syringes at three conditions: 4 degrees C to 10 degrees C (refrigerated); 15 degrees C to 30 degrees C (on-ambulance ambient temperature); and 37 degrees C (oven-heated). High-performance liquid chromatography (HPLC) analyses of syringe contents were performed at 30-day intervals. After 210 days, the reduction in diazepam concentration was 7% refrigerated, 15% at ambient temperature, and 25% at 37 degrees C. The reduction in lorazepam concentration was 0% refrigerated, 10% at ambient temperature, and 75% at 37 degrees C. Whereas diazepam retained 90% of its original concentration for 30 days of on-ambulance storage, lorazepam retained 90% of its original concentration for 150 days. The decrease in lorazepam concentration correlated with an increase in the maximum ambient temperature in San Francisco. These results suggest that diazepam and lorazepam can be stored on ambulances. When ambient storage temperatures are 30 degrees C or less, ambulances carrying lorazepam and diazepam should be restocked every 30 to 60 days. When drug storage temperatures exceed 30 degrees C, more frequent stocking or refrigeration is required.
Neurocritical care, Jan 5, 2015
Emergency neurological life support (ENLS) is an educational program designed to provide users ad... more Emergency neurological life support (ENLS) is an educational program designed to provide users advisory instruction regarding management for the first few hours of a neurological emergency. The content of the course is divided into 14 modules, each addressing a distinct category of neurological injury. The course is appropriate for practitioners and providers from various backgrounds who work in environments of variable medical complexity. The focus of ENLS is centered on a standardized treatment algorithm, checklists to guide early patient care, and a structured format for communication of findings and concerns to other healthcare professionals. Certification and training in ENLS is hosted by the Neurocritical Care Society. This document introduces the concept of ENLS and describes the revisions that constitute this second version.
JEMS : a journal of emergency medical services, 2013
Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence... more Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.
Frontiers in Neurology
Stroke identification is a key step in acute ischemic stroke management. Our objectives were to p... more Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes.Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS.Results: Of the 31 patients, the mean difference...
Prehospital Emergency Care, 2016
Jems Journal of Emergency Medical Services, Mar 1, 2013
Controlled Clinical Trials, 2001
Journal of Molecular and Cellular Cardiology
JEMS : a journal of emergency medical services, 2013
Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence... more Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.
Prehospital Emergency Care, 1999
The authors have previously shown that San Francisco paramedics without specific training in stro... more The authors have previously shown that San Francisco paramedics without specific training in stroke recognition identified acute stroke victims with a 61% sensitivity and a 77% positive predictive value (PPV). The authors implemented an educational program on stroke to improve paramedic accuracy in stroke recognition. Twenty-two paramedics volunteered to attend a four-hour seminar about stroke and then were followed prospectively for six months. All encounters with adult patients who were evaluated by both trained and untrained paramedics and were transported to two university hospitals were reviewed. Subjects were identified by paramedic assessment as stroke/transient ischemic attack (TIA) and/or final hospital discharge diagnosis of stroke/TIA after detailed chart review. Sensitivity and PPV for paramedic identification of stroke were calculated. During the prospective six-month phase, 84 confirmed stroke patients were transported to the target hospitals. Of the 32 who were transported by trained paramedics, all but three were identified as having stroke/TIA, resulting in a sensitivity of 91%. This is significantly higher than the 61% previously found (p=0.01). Nontrained paramedics also increased their sensitivity to 90%. Thirty-eight false-positive patients were identified, resulting in PPVs of 64% for trained paramedics and 69% for all other paramedics. Institution of an educational stroke program was associated with a significant increase in sensitivity in stroke identification by the paramedics; however, educational influences outside this training program may have contributed to the increased sensitivity. Better education for paramedics, combined with rapid response to stroke victims once identified, may result in improved care for victims of acute stroke.
Prehospital Emergency Care, 1999
Certain forms of stroke can be treated if access to medical care is expeditious. Since many strok... more Certain forms of stroke can be treated if access to medical care is expeditious. Since many stroke victims first enter medical care through emergency medical services (EMS) access, minimizing delays in the EMS system may translate to improved neurologic outcome. Because EMS dispatchers determine the response priority for these calls, dispatchers should be able to recognize the signs and symptoms of stroke based on their brief phone interviews. The authors studied the abilities of dispatchers in a major urban area to correctly identify stroke and transient ischemic attack (TIA) in victims who access 911 and describe what is communicated in the 911 call. A retrospective review was conducted of the medical records of patients treated for stroke or TIA at two urban hospitals during 1996. The tape-recorded 911 calls from patients using EMS were transcribed and analyzed. Information regarding dispatcher classification and triage of these calls was collected and described. The records of 182 patients with acute stroke or TIA were reviewed. Fifty-three percent of patients used EMS. Dispatchers coded 31% of their 911 calls as stroke. The word "stroke" was used without prompting by 51% of callers, yet fewer than half of these calls were coded as stroke by dispatchers. Many callers reported symptoms characteristic of stroke, including impaired communication (36%), weakness (30%), and decreased ability to stand or walk (25%). Only 41% of ambulances were sent at high priority. People who activate EMS for stroke frequently use the word "stroke" and/or describe symptoms compatible with stroke in their calls. EMS dispatch protocols should be sensitive for these symptoms to ensure more accurate and timely ambulance dispatch.
Prehospital Emergency Care, 1998
To determine the accuracy of acute stroke identification by paramedics in an urban emergency medi... more To determine the accuracy of acute stroke identification by paramedics in an urban emergency medical services system. Retrospective chart review of all patient encounters by paramedics resulting in transport to two university hospitals during a six-month period. Subjects were identified by paramedic coding of stroke/transient ischemic attach (TIA) or final hospital discharge ICD-9 diagnosis of acute stroke and TIA. The sensitivity and positive predictive value for paramedic identification of stroke were calculated, and the time intervals from symptom onset to various points along the patients' prehospital and hospital courses were identified. Ninety-six patients were identified, of whom 81 met the diagnosis of acute stroke or TIA. Paramedics identified 49 of these 81 patients (sensitivity 61%). Fifteen patients were identified by paramedics as having a stroke when the patient ultimately had a different diagnosis (positive predictive value 77%) Patients or their families waited on average 2.5 +/- 3.6 (SD) hours before accessing 911, and a mean of 5.1 +/- 4.0 (SD) hours elapsed from symptom onset until head imaging studies were obtained. Paramedics in San Francisco County were correct three-fourths of the time when their documentation listed patients as having stroke/TIA. However, they did not identify 39% of stroke victims, a patient population who may benefit from urgent therapy. A substantial period elapses before stroke victims access 911. This highlights the need to develop an educational program for the community at risk for stroke, and another for paramedics directed toward more accurate identification of acute stroke victims.
New England Journal of Medicine, 2001
It is uncertain whether the administration of benzodiazepines by paramedics is an effective and s... more It is uncertain whether the administration of benzodiazepines by paramedics is an effective and safe treatment for out-of-hospital status epilepticus. We conducted a randomized, double-blind trial to evaluate intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus. Adults with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures received intravenous diazepam (5 mg), lorazepam (2 mg), or placebo. An identical second injection was given if needed. Of the 205 patients enrolled, 66 received lorazepam, 68 received diazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepam (59.1 percent) or diazepam (42.6 percent) than patients given placebo (21.1 percent) (P=0.001). After adjustment for covariates, the odds ratio for termination of status epilepticus by the time of arrival in the lorazepam group as compared with the placebo group was 4.8 (95 percent confidence interval, 1.9 to 13.0). The odds ratio was 1.9 (95 percent confidence interval, 0.8 to 4.4) in the lorazepam group as compared with the diazepam group and 2.3 (95 percent confidence interval, 1.0 to 5.9) in the diazepam group as compared with the placebo group. The rates of respiratory or circulatory complications (indicated by bag valve-mask ventilation or an attempt at intubation, hypotension, or cardiac dysrhythmia) after the study treatment was administered were 10.6 percent for the lorazepam group, 10.3 percent for the diazepam group, and 22.5 percent for the placebo group (P=0.08). Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.
Journal of Molecular and Cellular Cardiology, 1992
Although the stimulatory action of catecholamines on the heart has been presumed to result exclus... more Although the stimulatory action of catecholamines on the heart has been presumed to result exclusively from their direct effects on the cardiac myocytes, little work has been done addressing the effects of catecholamines on the supporting non-myocytes of the heart. We have recently identified medium conditioned by neonatal rat cardiac non-myocytes (NMC-CM) as the source of a growth-promoting factor which leads to cardiac myocyte hypertrophy in culture, suggesting that these non-myocytes may play an active role in myocardial growth. Since cardiac non-myocytes also contain adrenergic receptors (both alpha and beta) on their cell surface, we asked whether adrenergic stimulation of these non-myocytes could supplement the growth-promoting effect of NMC-CM. While isoproterenol (ISO, 0.2 microM) caused no increase in the per cell content of total protein in the non-myocytes, inclusion of ISO in the medium used in the production of NMC-CM augmented the growth promoting effects of this "ISOCM" over control CM. This increase was not seen with the alpha 1 adrenergic agonist phenylephrine suggesting that the stimulatory effect was specific to the beta-adrenergic receptor. Because TGF beta 3 contains an upstream cAMP Response Element, we wonder whether its expression could respond to the increase in cAMP induced by ISO. Non-myocytes treated over 72 h with ISO expressed increased steady state mRNA levels for TGF beta 3 but not that for the closely related TGF beta 1 over this time period. We believe that this is the first report indicating that a potential mechanism for the observed effects of beta-adrenergic stimulation on myocardial cells in culture and possibly relevant in vivo is the contribution of beta-stimulated factor(s) produced by non-myocytes which act in a paracrine fashion on myocardial cells.
Controlled Clinical Trials, 2001
Status epilepticus is a neurological emergency that is typically first encountered and managed in... more Status epilepticus is a neurological emergency that is typically first encountered and managed in the prehospital environment. Although aggressive pharmacological treatment of status epilepticus is well established in the emergency department and hospital settings, the relative risks and benefits of active therapy for status epilepticus in the prehospital setting are not known. The Prehospital Treatment of Status Epilepticus (PHTSE) study is a prospective, randomized, double-blind, placebo-controlled study designed to address the following aims: (1) to determine whether administration of benzodiazepines by paramedics is an effective and safe means of treating status epilepticus in the prehospital setting and whether this therapy influences longer-term patient outcome, (2) to determine whether lorazepam is superior to diazepam for the treatment of status epilepticus in the prehospital setting, and (3) to determine whether control of status epilepticus prior to arrival to the emergency department influences patient disposition. The initial phase of the PHTSE study began in January 1994 and was completed in February 1999 after the successful enrollment of 205 patients into the three treatment arms. In this paper, we describe the rationale for the conceptualization of the study and details of the study design and methodology, and emphasize some aspects of study implementation that are unique to research involving the emergency medical system. Control Clin Trials 2001;22:290-309
The American Journal of Emergency Medicine, 1999
Injectable benzodiazepines are commonly stocked on ambulances for use by paramedics. We evaluated... more Injectable benzodiazepines are commonly stocked on ambulances for use by paramedics. We evaluated the stability of lorazepam and diazepam as a function of storage temperature. Diazepam (5 mg/mL) and lorazepam (2 mg/mL) injectable solutions were stored for up to 210 days in clear glass syringes at three conditions: 4 degrees C to 10 degrees C (refrigerated); 15 degrees C to 30 degrees C (on-ambulance ambient temperature); and 37 degrees C (oven-heated). High-performance liquid chromatography (HPLC) analyses of syringe contents were performed at 30-day intervals. After 210 days, the reduction in diazepam concentration was 7% refrigerated, 15% at ambient temperature, and 25% at 37 degrees C. The reduction in lorazepam concentration was 0% refrigerated, 10% at ambient temperature, and 75% at 37 degrees C. Whereas diazepam retained 90% of its original concentration for 30 days of on-ambulance storage, lorazepam retained 90% of its original concentration for 150 days. The decrease in lorazepam concentration correlated with an increase in the maximum ambient temperature in San Francisco. These results suggest that diazepam and lorazepam can be stored on ambulances. When ambient storage temperatures are 30 degrees C or less, ambulances carrying lorazepam and diazepam should be restocked every 30 to 60 days. When drug storage temperatures exceed 30 degrees C, more frequent stocking or refrigeration is required.
Neurocritical care, Jan 5, 2015
Emergency neurological life support (ENLS) is an educational program designed to provide users ad... more Emergency neurological life support (ENLS) is an educational program designed to provide users advisory instruction regarding management for the first few hours of a neurological emergency. The content of the course is divided into 14 modules, each addressing a distinct category of neurological injury. The course is appropriate for practitioners and providers from various backgrounds who work in environments of variable medical complexity. The focus of ENLS is centered on a standardized treatment algorithm, checklists to guide early patient care, and a structured format for communication of findings and concerns to other healthcare professionals. Certification and training in ENLS is hosted by the Neurocritical Care Society. This document introduces the concept of ENLS and describes the revisions that constitute this second version.