title: An observational study of the utility of continuous positive airway pressure ventilation for appropriate candidates in prehospital care in the Midwest region.
abstract: BACKGROUND
  Emergency medical services (EMS) practitioners in Ireland have been recently licensed to use continuous positive airway pressure (CPAP) ventilation for patients with pulmonary oedema. Both the British Thoracic Society and the Canadian Medical Association advocate the use of CPAP in hospital for patients with severe exacerbations of pulmonary oedema.
  
  
  OBJECTIVE
  The aim of this study was to identify prehospital patients in the Midwest, over a 6-month period, which could potentially benefit from CPAP if it were available in the National Ambulance Service.
  
  
  METHODS
  Potential CPAP patients were identified in the Advanced Paramedic Clinical Activity Study (APCAS) database and then followed up in the receiving hospital emergency department (ED) and medical records. Prior to this study, Irish guidance for prehospital use of CPAP did not exist and therefore the database was interrogated using a Toronto EMS Medical Directive. Descriptive analysis was conducted in Microsoft Excel and SPSS.
  
  
  RESULTS
  Emergency AS1 calls (999/112) were assessed (n = 1369) and 141 patients (10.3, 95 % confidence interval 8.9-12.1 %) were identified as potential candidates for prehospital CPAP. Further investigation of ED records for 63 potential candidates found 36.5 % (95 % confidence interval 26-49 %) met the Toronto EMS criteria for CPAP.
  
  
  CONCLUSIONS
  This study suggests that a suitable patient cohort for CPAP exists in the prehospital environment and highlights the need for a prospective study of CPAP use on these patients.
authors.affiliation: Department of Anaesthesia, Galway University Hospital, Galway, Ireland. cathal.macdonncha@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Mac Donncha
authors.affiliation: Centre for Prehospital Research, Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Cummins
authors.affiliation: National Ambulance Service, Health Service Executive, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Hennelly
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Hannigan
authors.affiliation: Centre for Prehospital Research, Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland.|Retrieval, Emergency and Disaster Medicine Research and Development (REDSPOT), Emergency Department, University Hospital Limerick, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Ryan
mesh_terms: D000552:Ambulances; D002170:Canada; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D011654:Pulmonary Edema / Q000628:therapy*
keywords: Advanced paramedics; Continuous positive airway pressure; Emergency medical services; Prehospital; Pulmonary oedema; Respiratory failure