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JEMS: AMS in Pediatric Patients Requires Unique Assessment PDF Print E-mail
Thursday, 05 January 2012 11:10

This article was produced by JEMS and features Mark Meridith.

Learning Objectives

>> List the five causes of altered mental status in pediatric patients.
>> Recognize the signs and symptoms of a pediatric patient with altered mental status.
>> Review the proper assessment techniques for pediatric patients with altered mental status.

Key Terms
Diabetic ketoacidosis (DKA): Altered level of consciousness due to an inability of the body to use glucose for metabolism.
Differential diagnosis: Any condition having similar signs and symptoms that must be considered during patient evaluation.
Encephalitis: An inflammation of the brain, primarily from infection that results from the bite of an infected mosquito.
Hematoma: A collection of blood in a localized area within an organ, space or tissue.
Hyperglycemia: Increased glucose in the blood, most often linked to diabetes mellitus; diabetic ketoacidoisis may result.
Hypoglycemia: Decreased glucose in the blood, usually called by excessive insulin or low food intake.
Intussusception: The telescoping of intestines causing a decreased blood supply to the affected segment.
Meningitis: Any infection or inflammation of the membranes covering the brain and spinal cord.
Primary survey: The initial, rapid examination of a patient or scene for life-threatening conditions.

EMS is dispatched to a residence for an “unresponsive child.” On arrival, a frantic mother is waiting at the door and directs the crew to the living room. EMS providers find an 8-year-old male who’s only responsive to deep pain. While one paramedic assesses the patient, their partner obtains a history from the mother. The mother states her child was complaining of a headache for the past week, and says it worsened earlier today. He’s an otherwise healthy child. 

A full primary survey reveals that airway breathing and circulation (ABCs) are intact. The patient’s vital signs are a heart rate of 60, respiratory rate of 8, blood pressure of 160/120 and oxygen saturation of 90%. An IV is established, and a glucose check is administered, revealing a blood sugar of 95. The patient will only respond to deep, sternal rub. 


Patients with altered mental status (AMS) are some of the most challenging EMS calls. AMS in pediatric patients adds another level of complexity to the scenario. The younger the patient is, the less that they can tell us about what happened and what they’re feeling. EMS providers must remember that AMS isn’t the primary diagnosis. It’s always secondary to a cause, such as trauma, poisoning or a disease process.

The primary survey for any patient should consist of the ABCs, with the addition of disability and exposure (ABCDEs). This assessment should be performed in a systematic approach. It’s vital to address the key findings that cause life-threatening challenges during the primary survey, but it can be difficult when caring for the patient with AMS because they may not appear critical. All providers, whether assessing a scene in the field or walking into a room in the emergency department (ED), get a first impression and can usually tell “sick” or “not sick.” This is easier said than done sometimes, so the primary survey must be performed on every patient, every time.

Often dispatch information isn’t clear, leaving the prehospital provider wondering what they’re going to walk into. Create an algorithm that can be reviewed briefly when you’re dispatched to any medical or trauma case involving a pediatric patient. This algorithm is crucial because the stress of knowing you’re about to care for a pediatric patient is enough to cause any provider to overlook key assessment findings. 

Several tools can be used as guides to assist the provider. One of these tools is the American Heart Association’s (AHA) Handbook of Emergency Cardiovascular Care for Healthcare Providers. This excellent resource can provide critical information for the providers to use during their care. For example, how many of the 11 reversible causes can the provider recall when caring for a critical pediatric patient?1 If the providers are caring for their own child, you’d expect them to recall all 11, but that’s unlikely. So healthcare providers should use these tools to feel more confident in conducting assessments because they’re doing so.

When assessing the patient with AMS, the healthcare provider should never assume that they know the cause because your tunnel vision will lead you down a wrong path. One example is a case in which the EMS providers responded to a scene with mother who was altered with evidence of ethanol and drug use. She was breast-feeding an infant who was also altered and “sleepy” with no evidence of trauma. The crew assumed it was due to the mother’s intoxication; however, the cause of the infant’s AMS was actually due to head trauma after the child was dropped numerous times throughout the day.

The two parts of the assessment that are easily overlooked in pediatric patients with AMS are disability and exposure. The goal in the disability assessment is to check the neurological status. This starts by checking the alert, verbal stimuli, painful stimuli and unresponsiveness scale and pupils. For the patient with chronic medical problems, this may be difficult to define; the provider may find it useful to ask a reliable caregiver to advise what’s different. 

When assessing exposure, the emergency provider must look at the patient’s entire body, including the posterior surfaces. Failing to properly expose a patient with AMS can cause the EMS provider to miss the source. 

Everyone wants to be an expert when it comes to the basics; properly exposing a patient to complete the primary survey is a big part of that. Remember that the only way to get proficient at pediatric patient assessment is to do an assessment the same way every time, regardless of whether you’re examining an adult or pediatric patient.

The last part of the assessment of the pediatric patient with AMS is obtaining a complete set of vital signs. These patients should be placed on a full monitor to obtain heart rate, respiratory rate, blood pressure and pulse oximeter reading. The use of capnography is recommended to assess air exchange and work of breathing.

Although not all EMS providers carry thermometers, a basic assessment of whether the patient feels hot or cold should be done. Glucose isn’t a vital sign, but it’s vital that patients with AMS have a glucose obtained. Correcting hypoglycemia early in the field can decrease morbidity and mortality.

Chairman of Emergency Medicine at Vanderbilt University Medical Center and JEMS Editorial Board member Corey Slovis, MD, FACEP, is notorious for teaching that there are five causes for everything. Well, for patients with AMS, there are five main causes to examine.2 Although the specific causes for pediatric patients may differ from those for adults, the general categories hold true.

1. Vital Sign Abnormalities
Hyperthermia/hypothermia: As previously stated, obtaining a full set of vital signs should be a priority in these patients because vital-sign abnormalities are one of the top causes of AMS. Many kids become altered when they have a fever. They can become lethargic or irritable, making examining them difficult. For the patient who’s severely altered and febrile, the concern for overwhelming sepsis or meningitis is higher. 

Your concern should be whether the patient is suffering from a heat stroke if the patient has been outside in a hot environment and presents with hyperthermia and AMS. If this patient is suffering from heat stroke, the EMS provider should immediately cool the patient by undressing them and using ice packs to the axillae and groin.

Hypothermia is also a cause of AMS. For patients who are found outside during the winter months or who have suffered trauma and been undressed, care should be taken to ensure that the patient is kept as warm as possible. A patient begins to be coagulopathic and their blood begins to not clot well when their temperature drops below 96° F.3

Hypoxia: Who knew that the pulse oximeter (SpO2) would change how we practice as much as it has? You could argue that there are patients who don’t need an SpO2 reading, but every patient with AMS needs to be monitored continuously with one. 

Patients with increased work of breathing, wheezing, trauma to the chest or hypoxemia should be addressed quickly and placed on 100% oxygen via a non-rebreather mask. Placing a child with AMS on 100% oxygen is always the right thing to do—except in rare cases, such as the child with cyanotic congenital heart disease.

Hypovolemia: The most common cause of hypovolemia causing AMS is acute blood loss. EMS providers should realize, however, that hypotension is a late sign in pediatric patients. Once the child is hypotensive, they’re in decompensated shock and are at an increased risk for morbidity and mortality. Also, hypovolemia should be considered in patients with a resting heart rate above baseline for their age. Normal pediatric systolic blood pressure = (age x 2) + 90.1

Tachycardia/bradycardia: Although not common causes, tachydysrhythmias and bradycardia can both cause AMS in pediatric patients. Infants can present with fussiness or unresponsiveness secondary to supraventricular tachycardia. If the patient has a heart rate above 220 and it isn’t variable, a 12-lead ECG should be performed to look for this; if found, it should be treated appropriately with vagal maneuvers and/or adenosine.

2. Toxic/Metabolic
Hypo/hyperglycemia: Every patient with AMS, whether an adult or child, should have their glucose checked. Too often EMS providers make excuses for not sticking for a glucose because the patient is a child. That excuse isn’t valid and can’t be tolerated. If a patient is hypoglycemic, then the brain is also hypoglycemic and is at risk of permanent damage. Hypoglycemia should be corrected rapidly in the prehospital setting, either through oral glucose if the patient is awake or through IV dextrose if the patient is altered.
>> Infants: Administer 5 cc/kg of D10W;
>> Children: Administer 2–4 cc/kg of D25; and
>> Adolescents: Administer 1 cc/kg of D50.

Hydrogen ion excess (acidosis): This can be a cause for AMS, but unless your service carries a blood gas machine, you won’t be able to know whether the patient is acidotic. The most common condition leading to acidosis and AMS is diabetic ketoacidosis (DKA); this is treated with fluids and an insulin drip in the hospital setting.

Toxic (overdose): All too often children find medicine that isn’t theirs and ingest it. In the toddler age group, this is often because they find pills (that look like candy to them) on the floor, left on a table or night stand or get into the unlocked medicine cabinet. In the adolescent population, they’re usually ingesting medicines in an attempt to get high. Knowing what medicines are in the house, even if it means putting them all in a bag and bringing them to the ED, can be invaluable. 

Caregivers often forget about medicines that are in their cabinet and deny that the patient could ever have ingested anything. For patients with AMS and vital-sign changes, such as apnea or bradycardia, administering naloxone 0.1mg/kg is appropriate and will not present untoward side effects. If the patient doesn’t respond to this, increase the dose to 0.2mg/kg up to a total of 10mg to look for patient effect. 

Another toxic source that can cause AMS, especially in the winter months, is carbon monoxide (CO). Every patient with suspected CO poisoning should receive 100% oxygen en route to the hospital.

3. Structural
Trauma: Trauma is the number one cause of death in children and is always something to consider in a patient with AMS. Head injuries due to non-accidental trauma (child abuse) should always be in your differential diagnosis, especially for infants and toddlers.4

Healthcare providers are now doing a better job of recognizing head injuries causing concussions in older children and adolescents.5 These injuries aren’t apparent on a computerrized axial tomography (CT) scan like a subdural or epidural hematoma, but they should still be considered. 

Seizure: Pediatric seizures are a common reason for EMS to transport a patient. Whether the patient has epilepsy or is having just a simple febrile seizure, these patients can present with AMS. No matter the cause, all seizure patients should have a glucose checked by EMS (see hypoglycemia above). Not all seizure patients present with generalized tonic clonic activity. Patients with partial seizures may present with AMS and automatisms, such as eye blinking, tongue thrusting or rhythmic movements of just one extremity. This is why it’s imperative for the healthcare provider to fully assess all patients with AMS.

Stroke: The proper recognition of pediatric stroke patients is on the rise. Although it’s much less common than in the adult population, patients with such predisposing risk factors as sickle cell disease or clotting disorders are at risk. Just as in adults, timely recognition of a stroke is the key to minimizing morbidity and mortality. Crews must also consider the possibility of a child involved in a fall having sustained a concussion or multiple concussions over a short time period, which can result in significant damage. 

Intussusception: In toddlers who have been vomiting or had diarrhea, intussusception can also cause AMS. Intussusception is the telescoping of intestines causing a decreased blood supply to the affected segment. This is usually manifested as intermittent, severe, crampy abdominal pain. 

Often the child will be seen drawing their legs up to their abdomen in pain. The patient may pass a bloody stool, but this is usually a late finding. In some patients, this condition can cause AMS. Intussusception is treated with an air reduction enema and sometimes requires surgery.

4. Infectious
Many infectious causes can lead to AMS in the pediatric patient. The three most common causes are meningitisencephalitis and overwhelming sepsis. Providing these patients with high-flow oxygen and monitoring vital signs are the key to a successful transport. As with any patient with infectious signs and symptoms, the healthcare provider must protect themselves through the use of gloves and a mask when the situation dictates.

5. Psychiatric
Although uncommon in most pediatric patients, this is a diagnosis of exclusion and one that shouldn’t be routinely entertained in the prehospital environment.

The 8-year-old boy from our opening case is transported from home with AMS after his worsening headache. His physical exam is notable only for a response to deep sternal rub. The patient’s mom reports that he hasn’t suffered any trauma and has never had a headache like this before. He’s placed on 100% oxygen via a non-rebreather mask and is immediately transported to the closest hospital. 

On arrival, the patient is intubated for airway protection and healthcare providers obtain a CT scan. The CT revealed a mid-brain hemorrhage leading to a stroke. It was later discovered that this was secondary to an arteriovenous malformation.

As with every patient, a systematic approach to the pediatric patient with AMS is the key to success and will help the prehospital provider ensure the patient gets the best care possible. JEMS

1. American Heart Association. Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association: Dallas. 2010.
2. Corey Slovis, MDFive Causes of Altered Mental Status. Emergency Medicine Lecture Series. Vanderbilt University School of Medicine.
3. Tsudei B, Kearney PA. Hypothermia in the trauma patient. Injury. 2004;35(1):7–15.
4. Limmer D, O’Keefe M, Grant H, et al. Emergency Care, 10th Edition. Brady: 775, 2005.
5. Donofrio C, Campbell R. (2011) Recognizing Concussion and Treating Postconcussion Syndrome. In Rehab Management. Retrieved Nov. 30, 2011, from

Read “EMS Providers Can Identify Child Abuse” from October JEMS on to learn more about signs and symptoms of child abuse.

This article originally appeared in January 2012 JEMS as “Clear the Fog: The challenges of patient who can’t explain their condition.”

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Last Updated ( Thursday, 05 January 2012 15:18 )
JEMS: EMS Experts Discuss Views on Resuscitation PDF Print E-mail
The following article was produced by JEMS and features our department Chairman, Corey Slovis. Click Here to View this article on

David Lehrfeld, MD,Ray Fowler, MD, FACEP | From the December 2011 Issue | Thursday, December 1, 2011

This is the greatest era in the history of EMS, the newest subspecialty in the house of medicine. It may be said that EMS can do more now for critically ill or injured patients in the field than ever before. Field treatments are now focused more than ever on directly approaching the now-scientifically understood pathophysiology of the conditions threatening our patients.

At this important juncture in the history of EMS, it’s a useful time to reach into the minds of some of the great resuscitation researchers in the world to find out what they’re thinking about regarding the care of critically ill patients in the prehospital arena. 

Our approach to crafting a paper as a “grand rounds” on resuscitation has been to ask five prominent thinkers in EMS science to respond to three questions. We first wanted to know what they felt—in the area of greatest interest to each physician—was the greatest accomplishment in the past decade in resuscitating critically ill patients in the field. Next, we asked them what they felt is the most difficult challenge in the care of critically ill patients in the field. 

Finally, we asked the panelists to look into the future and predict the best place to look to improve the outcomes from resuscitation in the field. In doing so, we wanted to tap each expert’s vision to help guide an industry that’s eager to continue its growth and improve the quality of care as a subspecialty of medicine.

These interviews pose a few questions and provide each panelists’ thoughts on that subject, moving from the past to the present and into the future.

What has been the greatest accomplishment in the past decade for EMS in the area of resuscitation science?

Ahamed Idris, MD, FACEP: We must examine every basic and fundamental thing that we do in interventions in EMS. I lump many things under this need for careful evaluation. For CPR, that includes when do we need to ventilate, and what rate of chest compressions is optimal? 

One thing we discovered is that BLS is the most important thing for improving survival from cardiac arrest. Advanced cardiac life support (ACLS) doesn’t have a lot to offer. The one key thing ACLS offers is hypothermia, but most of the other interventions are not very useful. We’re in the process of examining antiarrhythmics, and it may be that placebo is the “ideal antiarrhythmic drug” because it has the best survival advantage. We may even need to examine the use of epinephrine.

Another important discovery in the past decade has been the rediscovery of whole blood as the ideal resuscitation fluid for traumatic shock. Up until 1974, whole blood was the resuscitation fluid of choice for traumatic shock. Experience in the military has revealed that whole blood is the best resuscitation fluid of anything that can be given.

Paul E. Pepe, MD, MPH, FCCM, FACEP: There are four areas that come to mind right away. One is the public recognition of the importance of AEDs. Two is the development and validation of courses that have made CPR education simpler, faster to learn, and in turn, better because we’ve simplified the training process.1–3 The third issue is the recognition by the medical community that we haven’t been doing quality CPR and that when we do focus on quality CPR, we improve survival rates. The fourth concern is now that “ventilation should match perfusion,” meaning you don’t need as many breaths in a low-flow state, particularly in the first few minutes after sudden cardiac arrest.

J. Brent Myers, MD, MPH: I think the greatest accomplishment is the recognition that the resuscitation of the out-of-hospital cardiac arrest patient is owned by EMS. It’s become a form of a philosophical thing. The notion that we’re going to do something, then take the patient to a hospital, and the in-hospital providers are going to do something else, has been totally debunked. I refer to Art Kellerman’s editorial in the October 2010Annals of Emergency Medicine, where he said that, based on his editorial analysis of the literature, the patient who suffers out-of-hospital cardiac arrest is 35-fold more likely to survive if there is return of spontaneous circulation (ROSC) in the field rather than ROSC later in the ED. 

So, to me, we can talk about sequences of defibrillation and continuous compression and therapeutic hypothermia, but none of these works if EMS considers the cardiac arrest patient in a manner similar to the penetrating trauma patient. EMS is the definitive treatment for medical cardiac arrest patients in the field.

Corey Slovis, MD, FACEP, FACP:
I’m delighted that I can’t pick just one. There are three. Therapeutic hypothermia; the decreased emphasis on immediate hyperventilation and intubation with the advent and increased popularity of continuous chest compressions; and the really strong focus—although not yet completely disseminated through the community—on the use of AEDs.

John Freese, MD, FACEP: I believe the greatest accomplishment is the ability to analyze the quality of CPR being delivered to the patient. The world has spent 50-plus years trying to build a model of ideal resuscitation. Now that we can look at the variables of that quality, we realize that we have been building on a variable platform.

One example would be CPR prior to defibrillation. Some research has said that it made no difference, but now that we’re controlling the variables, we may have to go back and look at that research again. 

Intubation is another example. I have been wary of continuing intubation for the cardiac arrest patient. If we could control the interruptions to less than 10 seconds and ensure the quality of CPR being delivered during the intubation, what, then, is the effect of intubation on outcomes?

What is the greatest current challenge in the resuscitation of critical EMS patients in the field?

Dr. Idris: I think one of the biggest challenges is identifying who the critically ill patient is. With people who are really sick, it’s pretty obvious. People who are in traumatic shock may have a normal blood pressure, but they’re still in shock. Identification of critically ill patients is a challenge in EMS. 

For example, we know that at least 20% of patients in traumatic shock have a normal blood pressure. These patients are even misidentified in the ED, and it probably does result in a delay of care for patients who look too good to be sick.

Dr. Pepe: Airway management choices: Although endotracheal intubation (ETI) has been considered the “gold standard” for airway control and is immediately used in the hospital, concerns exist in the way EMS systems are organized today. Paramedics may not be as skilled as would be preferred in ETI. Because of infrequent opportunities for individual paramedics to perform ETI, it is less likely to be performed in as facile a manner as one would like. 

However, in systems that maintain a smaller cadre of medics through tiered dispatch systems and an intensive focus on controlling respiratory rates in low-flow states, outcomes can be improved. Nevertheless, the majority of EMS systems are not set up that way, and this has made ETI a less reliable tool and one that can actually be harmful without all the right factors in place.

Dr. Meyers: I think the biggest challenge now is probably the one that has been there all along: I know that this may be politically insensitive, but my biggest concern is changing the paradigm of bystander education. This notion that we need cards and four-hour courses as opposed to a 20-minute YouTube video to teach somebody how to do CPR. We’ve got to cross that threshold. It’s OK for a bystander to pull out his iPhone and use an app to learn CPR on the spot. All of the card courses are equally guilty; it’s everybody.

Dr. Slovis: The great variability of bystander response and EMS response, where some communities have many of their citizens trained in CPR and others have few; where some communities have a tiered response and other communities have response times that don’t allow for survival.

Dr. Freese: I believe it’s the coordination of the care—both in the field and with the transfer to hospital care. We put an enormous pressure on our providers to do a great number of things in a short amount of time, and I think that leads to some degree of frustration that we expect them to accomplish “A to Z” in such a short amount a time; yet, they may not have providers who have sufficient skill and knowledge in the importance of what they’re doing and why they’re doing it to assist them.

Where is the best place to look for the next few years to improve resuscitation outcomes for EMS?

Dr. Idris: The challenge, which goes to my second point, is that we can’t very well measure the effect of what we’re doing, the effect of our interventions. For the patient in cardiac arrest, we can’t measure blood flow during CPR. So we don’t know what we need to do to improve the patient’s condition or what we need to change to improve the way we are doing it. Outcome is our only guide right now. 

There’s no intermediate measurement that can give us feedback on blood flow while we are doing CPR. The same thing applies to trauma. Blood pressure is a crude measurement of traumatic shock: It’s a metabolic derangement. If we could measure what is happening at the tissue level, we could resuscitate patients more effectively. My whole thinking about improving outcomes from cardiac arrest is “saving life through metrics.” We could save many more lives by better measuring what we are doing.

Dr. Pepe: The best place to look is having the political clout to make our cities safer by ensuring that every man, woman and child—at least of age 12 or above—knows how to perform CPR and is ready to do so in a timely manner. This includes the use of AEDs and perhaps, with cheaper AEDs, they might even be sold as an automobile accessory to be sure one is always available. (JEMS then asked Dr. Pepe if he ever imagines a smartphone app that will somehow serve as an AED, and he replied, “Yes, or something similar.”)

Dr. Meyers: Hmmm … that’s the most challenging of the questions. For the first time in EMS, we’re generating our own data in a robust fashion. Thanks to the Resuscitation Outcomes Consortium, EMS as a subspecialty, and Prehospital Emergency Care as a world-class journal, we can now objectively look at each other. I think we look to each other to do this. We have to give kudos to the AHA for the past set of Guidelines, the 2010 AHA Guidelines for CPR and ECC; they were truly multidisciplinary, a really practical document. 

Previously, when we had to look at someone’s ejection fraction before we gave certain drugs, clearly this did not have prehospital resuscitation in mind. We are at such a different place. For the first time, we have quality data from EMS systems and national bodies acknowledging that data, and we are seeing a measureable and quantifiable change in outcome.

Dr. Slovis: EMS has to become one of the leaders in preventive medicine in regard to blood pressure control, smoking cessation and lipids management. Who better to lead our nation in preventive healthcare practices than the very people who save lives on a daily basis? Our fire halls have to become community outreach health centers for specific diseases as they relate to stroke and heart attack: BP checks and referrals for treatment, smoking cessation and referrals to places to get care for this, easy lipid profile testing and firefighter- and EMS-led exercise classes offered free to the public.

Dr. Freese: I think the next big leap is going to come with the further integration of technology into our resuscitation technology that’s able to communicate from one device to another. I think proprietary technology is a hurdle. 

An applied mechanical CPR device, which easily improves resuscitation outcomes, is necessary. But if it’s not talking to the monitor and isn’t able to analyze underlying rhythms appropriately, then time defibrillation efforts at the proper time in the upstroke, and the appropriate time with respect to ventricular fibrillation quality—if all that doesn’t happen, we’ve missed the boat. 

I think what you end up with today with some technology is like we have with people—they don’t understand what each other is doing. We also need to be able to transfer the information to medical oversight. Dr. Myers tells his crews “if you don’t have a pulse after 10 minutes, give him a call.” And he includes the receiving facility, so they can see the progress of the patient prior to resuscitation. Then, they can see what has happened in real time rather than having someone explain to them what has been going on for the past 30 minutes. 

The technology piece has to come along for us to be able to improve outcome. We are transfixed on the depth of compression: We need technology to assess the efficacy of our compressions, to guide us as to how we make compressions effective for this patient.

The diversity of the responses from these great leaders in our field demonstrates the breadth of both the responsibility and the opportunity that we have in EMS. The science is clear: Good BLS works; it’s an essential partner in the successes that we’ve had to date and lies at the heart of the potential for the greatest decrease in morbidity and mortality in our work. 

From these great leaders we hear that simple, quick training programs in performing citizen CPR, for example, might improve survival from out-of-hospital cardiac arrest of thousands of people each year, a public health imperative that cries out for prompt attention. 

It is clear, then, that we must use all our experience to optimize training, because lives truly hang in the balance. Concepts as simple as immediate citizen response, de-emphasized early ventilation, appropriate rate of compressions and seeking out EMS response are key factors that will save thousands in our country alone. 

The opportunity to tease out of the minds of great thinkers the essence of their experiences can help us set our sights on the future. Such leadership will allow us to optimize our care and simultaneously guide an industry to partner with medical providers. Thus, we may together set our paths for developing technologies and maximizing patient outcomes. JEMS

1. Roppolo LP, Heymann R, Pepe P, et al. A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: The two-person CPR study. Resuscitation. 2011;82(3):319–325. 
2. Roppolo LP, Saunders T, Pepe PE, et al. Layperson training for cardiopulmonary resuscitation: When less is better. Curr Opin Crit Care. 2007; 13(3):256–260. 
3. Roppolo LP, Pepe PE, Campbell L, et al. Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study. Resuscitation. 2007;74(2):276–285. 

Ahamed Idris, MD, FACEP, is professor of emergency medicine and chief of the section on resuscitation research. He’s the principal investigator for the National Institutes of Health Dallas Resuscitation Outcomes Consortium, University of Texas Southwestern Medical Center. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Paul E. Pepe, MD, MPH, FCCM, FACEP, is a professor of surgery, medicine, pediatrics and public health and is Chairman of emergency medicine at the UT Southwestern Medical Center in Dallas. He’s also the director of the City of Dallas Medical Emergency Services for Public Safety, Public Health and Homeland Security. He can be reached through his administrative assistant at 
This e-mail address is being protected from spambots. You need JavaScript enabled to view it

J. Brent Myers, MD, MPH, is director of the Raleigh/Wake County EMS System in Raleigh N.C., and is an adjunct assistant professor of emergency medicine at the University of North Carolina, Chapel Hill, N.C. He can be reached at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Corey Slovis, MD, FACEP, FACP, is professor and Chairman of emergency medicine at Vanderbilt University School of Medicine, and he’s the medical director of the Nashville, Tenn. Fire Department and Nashville International Airport. He can be contacted at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

John Freese, MD, FACEP, is the medical director and director of prehospital research at the Fire Department of New York, and he’s the principal investigator for NYC Project Hypothermia.

This article originally appeared in December 2011 JEMS as “Resuscitation Round Table: Five EMS experts offer views on key topic.”

Friday, 09 December 2011 12:02

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Last Updated ( Friday, 16 December 2011 09:34 )
Team Triage Reduces Emergency Department Walkouts, Improves Patient Care PDF Print E-mail
Tuesday, 10 August 2010 11:43

"The emergency department at Vanderbilt University Medical Center established a program in which patients are quickly assessed in a triage area by a team consisting of a physician, a nurse, and a paramedic. Patients with urgent problems are promptly moved to a treatment room. Patients with nonurgent problems are tested and/or treated in the team triage area. They are then released or return to the waiting area until test results and a treatment room are available. As a result of the program, most patients see the triage doctor within 10 minutes of arriving, the percentage of patients who leave without treatment has decreased from 5 percent to under 1 percent, and patient satisfaction has increased markedly."


The Trauma Level 1 Patient PDF Print E-mail
Monday, 08 February 2010 16:13
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