Procedural Sedation and Analgesia Facilitator – Expanded Scope Role for Paramedics in the Emergency Department
Bibliographic record
Abstract
Introduction Procedural sedation and analgesia (PSA) is accepted as a standard of care in emergency departments (ED). PSA requires careful monitoring of a patient‟s cardio-respiratory status, and an ability to act immediately and appropriately in the event of any untoward event. The knowledge and skills necessary for this are a natural extension of the expertise of Advanced Care Paramedics (ACP). We report a series of PSA‟s conducted by ACPs over a 19 month period at a busy teaching hospital. Methods This is a retrospective descriptive study presenting data from a registry recording details of all cases of ACP-facilitated PSA conducted in our ED between August 1, 2004 and February 28, 2006. Baseline characteristics, indication for the procedure, medications used and adverse events are reported. Results 1334 ACP-facilitated PSAs were conducted during the period. According to definitions used by this study, „desaturation‟- a SaO2 of < 90% at any time during the procedure in patients with an initial SaO2 of > 95% occurred in only 11 (0.9%) patients, and „hypotension‟ – systolic blood pressure (SBP) < 85 mm Hg in patients with an initial SBP > 100 mm Hg occurred in 0.6% of patients. One significant adverse event was recorded, that of pulmonary aspiration. Medications used for PSA included fentanyl (94.1%of cases), propofol (65.5%), midazolam (36.7%) and ketamine (2.2%). Conclusion PSA conducted in the ED by specifically trained ACPs is not associated with a significant number of adverse effects. This role should be recognized and subjected to further study.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".