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Ventrapragada A, Gumucio JA, Salcido DD, Menegazzi JJ. Revisiting the "Scanty Science" of Prehospital Emergency Care 25 Years Later. PREHOSP EMERG CARE 2024:1-4. [PMID: 39255437 DOI: 10.1080/10903127.2024.2396954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE We aimed to quantify the number of prehospital randomized controlled trials (RCTs) published in the 25 years since the Callaham editorial and review his perception of prehospital emergency care as "scanty" science. METHODS We replicated Callaham's methods to retrieve publications related to prehospital randomized controlled trials (RCTs). This study systematically searched over 35 million citations cataloged by the National Library of Medicine in the PubMed Database between January 1, 1998, and December 31, 2022. Two independent reviewers screened titles, abstracts, and full manuscripts in two rounds, and key terms that indicated RCTs, such as randomized and controlled, standard, or placebo-controlled were identified. RESULTS The final study group of prehospital RCTs published between 1998 and 2022 included 141 papers. Of the 141 RCTs, 48.2% concluded no significant difference between the intervention and control groups. The average number of RCTs per year was 5.6. Trials during the study period were conducted in 19 different countries, and multinationally. CONCLUSION In the time period reported by Callaham, the average number of prehospital RCTs was 4.5 per year. The number of prehospital RCTs published per year has increased only slightly, to 5.6 per year, in the 25 years since Callaham described prehospital emergency care as a "scanty science."
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Affiliation(s)
| | - Jorge A Gumucio
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David D Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - James J Menegazzi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Næss LE, Krüger AJ, Uleberg O, Haugland H, Dale J, Wattø JO, Nilsen SM, Asheim A. Using machine learning to assess the extent of busy ambulances and its impact on ambulance response times: A retrospective observational study. PLoS One 2024; 19:e0296308. [PMID: 38181019 PMCID: PMC10769093 DOI: 10.1371/journal.pone.0296308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Ambulance response times are considered important. Busy ambulances are common, but little is known about their effect on response times. OBJECTIVE To assess the extent of busy ambulances in Central Norway and their impact on ambulance response times. DESIGN This was a retrospective observational study. We used machine learning on data from nearby incidents to assess the probability of up to five different ambulances being candidates to respond to a medical emergency incident. For each incident, the probability of a busy ambulance was estimated by summing the probabilities of candidate ambulances being busy at the time of the incident. The difference in response time that may be attributable to busy ambulances was estimated by comparing groups of nearby incidents with different estimated busy probabilities. SETTING Medical emergency incidents with ambulance response in Central Norway from 2013 to 2022. MAIN OUTCOME MEASURES Prevalence of busy ambulances and differences in response times associated with busy ambulances. RESULTS The estimated probability of busy ambulances for all 216,787 acute incidents with ambulance response was 26.7% (95% confidence interval (CI) 26.6 to 26.9). Comparing nearby incidents, each 10-percentage point increase in the probability of a busy ambulance was associated with a delay of 0.60 minutes (95% CI 0.58 to 0.62). For incidents in rural and urban areas, the probability of a busy ambulance was 21.6% (95% CI 21.5 to 21.8) and 35.0% (95% CI 34.8 to 35.2), respectively. The delay associated with a 10-percentage point increase in busy probability was 0.81 minutes (95% CI 0.78 to 0.84) and 0.30 minutes (95% CI 0.28 to 0.32), respectively. CONCLUSION Ambulances were often busy, which was associated with delayed ambulance response times. In rural areas, the probability of busy ambulances was lower, although the potentially longer delays when ambulances were busy made these areas more vulnerable.
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Affiliation(s)
- Lars Eide Næss
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jostein Dale
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Jon-Ola Wattø
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav’s University Hospital, Trondheim, Norway
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Fladt J, Ospel JM, Singh N, Saver JL, Fisher M, Goyal M. Optimizing Patient-Centered Stroke Care and Research in the Prehospital Setting. Stroke 2023; 54:2453-2460. [PMID: 37548010 DOI: 10.1161/strokeaha.123.044169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Over the past decades, continuous technological advances and the availability of novel therapies have enabled treatment of more acute medical conditions than ever before. Many of these treatments, such as intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke, are highly time sensitive. This has raised interest in shifting advanced acute care from hospitals to the prehospital setting. Key objectives of advanced prehospital stroke care may include (1) early targeted treatments in the prehospital setting, for example, intravenous thrombolysis for acute stroke, and (2) advanced prehospital diagnostics such as prehospital large vessel occlusion and intracranial hemorrhage detection, to help inform patient triage and potentially reduce subsequent workload in emergency departments. Major challenges that may hamper a swift transition to more advanced prehospital care are related to conducting clinical trials in the prehospital setting to provide sufficient evidence for emergency interventions, as well as ambulance design, infrastructure, emergency medical service personnel training and workload, and cost barriers. Utilizing new technologies such as telemedicine, mobile stroke units and portable diagnostic devices, customized software applications, and smart storage space management may help surmount these challenges and establish efficient, targeted care strategies that are achievable in the prehospital setting. In this article, we delineate the paradigm of shifting advanced stroke care to the prehospital setting and outline future directions in providing evidence-based, patient-centered prehospital care. While we use acute stroke as an illustrative example, these principles are not limited to stroke patients and can be applied to prehospital triage for any time-critical disease.
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Affiliation(s)
- Joachim Fladt
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (J.F.)
| | - Johanna M Ospel
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
| | - Nishita Singh
- Department of Neurology, University of Manitoba, Winnipeg, Canada (N.S.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Mayank Goyal
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
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Satchell E, Carey M, Dicker B, Drake H, Gott M, Moeke-Maxwell T, Anderson N. Family & bystander experiences of emergency ambulance services care: a scoping review. BMC Emerg Med 2023; 23:68. [PMID: 37316865 DOI: 10.1186/s12873-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Emergency ambulance personnel respond to a variety of incidents in the community, including medical, trauma and obstetric emergencies. Family and bystanders present on scene may provide first aid, reassurance, background information or even act as proxy decision-makers. For most people, involvement in any event requiring an emergency ambulance response is a stressful and salient experience. The aim of this scoping review is to identify and synthesise all published, peer-reviewed research describing family and bystanders' experiences of emergency ambulance care. METHODS This scoping review included peer-reviewed studies that reported on family or bystander experiences where emergency ambulance services responded. Five databases were searched in May 2022: Medline, CINAHL, Scopus, ProQuest Dissertation & Theses and PsycINFO. After de-duplication and title and abstract screening, 72 articles were reviewed in full by two authors for inclusion. Data analysis was completed using thematic synthesis. RESULTS Thirty-five articles reporting heterogeneous research designs were included in this review (Qualitative = 21, Quantitative = 2, Mixed methods = 10, Evidence synthesis = 2). Thematic synthesis developed five key themes characterising family member and bystander experiences. In an emergency event, family members and bystanders described chaotic and unreal scenes and emotional extremes of hope and hopelessness. Communication with emergency ambulance personnel played a key role in family member and bystander experience both during and after an emergency event. It is particularly important to family members that they are present during emergencies not just as witnesses but as partners in decision-making. In the event of a death, family and bystanders want access to psychological post-event support. CONCLUSION By incorporating patient and family-centred care into practice emergency ambulance personnel can influence the experience of family members and bystanders during emergency ambulance responses. More research is needed to explore the needs of diverse populations, particularly regarding differences in cultural and family paradigms as current research reports the experiences of westernised nuclear family experiences.
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Affiliation(s)
- Eillish Satchell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Melissa Carey
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Bridget Dicker
- Paramedicine Research Unit, Auckland University of Technology, Auckland, New Zealand
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Haydn Drake
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Merryn Gott
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Tess Moeke-Maxwell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Natalie Anderson
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand.
- Adult Emergency Department, Auckland City Hospital, Auckland Mail Centre, Private Bag 92024, Auckland, 1142, New Zealand.
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Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
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Affiliation(s)
- N Cavanagh
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - I E Blanchard
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
| | - D Weiss
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
| | - W Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
- York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario, Canada
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Blanchard IE, Williamson TS, Ronksley P, Hagel B, Niven D, Dean S, Shah MN, Lang ES, Doig CJ. Linkage of Emergency Medical Services and Hospital Data: A Necessary Precursor to Improve Understanding of Outcomes of Prehospital Care. PREHOSP EMERG CARE 2021; 26:801-810. [PMID: 34505811 DOI: 10.1080/10903127.2021.1977438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an existing linkage process, improved the linkage rate and reduced selection and information bias.Methods: 4,150 transported patients in a metropolitan EMS system in Alberta, Canada from 2016/17 were linked to two Emergency Department (ED) databases by a standard strategy using a unique health care number, date/time of ED arrival, and hospital name. An optimized strategy added additional linkage steps incorporating last name, year of birth, and a manual search. The strategies were compared to assess the rate of linkage, and to describe event and patient-level characteristics of unlinked records.Results: The standard strategy resulted in 3,650 out of 4,150 (88.0%) linked records (95% CI 86.9%-88.9%). Of the 500 non-linked records, an additional 381 were linked by the optimized strategy (n = 4,031/4,150 [97.1%; 95% CI: 96.6%-97.6%]). There were no false positive linkages. The highest linkage failure was in 25 to 34 year-old patients (n = 93/478, 19.5%), males (n = 236/1975, 12.0%), Echo level events (n = 15/77, 19.5%), and emergency transport (45/231, 19.5%). The optimized strategy improved linkage in these groups by 68.8% (64/93), 79.2% (187/236), 40.0% (6/15), and 51.1% (23/45) respectively. For dispatch card, the highest linkage failure occurred in Card 24-Pregnancy/Childbirth/Miscarriage (n = 30/44, 68.2%), Card 27-Stab/Gunshot/Penetrating Trauma (n = 6/17, 35.3%), and Card 9-Cardiac/Respiratory Arrest/Death (n = 12/46, 26.1%). The optimized strategy improved linkage by 10.0% (3/30), 83.3% (5/6), and 41.7% (5/12) respectively. For the 119 unlinked records, 71 (59.7%) had sufficient information for linkage, but no appropriately matching records could be found.Conclusion: An optimized sequential deterministic strategy linking EMS data to ED outcomes improved the linkage rate without increasing the number of false positive links, and reduced the potential for bias. Even with adequate information, some records were not linked to their ED visit. This study underscores the importance of understanding how data are linked to hospital outcomes in EMS research and the potential for bias.
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Affiliation(s)
- I E Blanchard
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - T S Williamson
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - P Ronksley
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - B Hagel
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - D Niven
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - S Dean
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - M N Shah
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - E S Lang
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
| | - C J Doig
- Received April 6, 2021 from Emergency Medical Services, Emergency, Critical Care, Alberta Health Services, Alberta, Canada (IEB, DN, SD, ESL, CJD); Cumming School of Medicine - Community Health Sciences, Critical Care, Emergency, and Pediatrics; Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Alberta Children's Hospital Research Institute and O'Brien Institute for Public Health, Calgary, Alberta, Canada (IEB, TSW, PR, BH, DN, SD, ESL, CJD); Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA (MNS). Revision received September 1, 2021; accepted for publication September 1, 2021
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Stemerman R, Bunning T, Grover J, Kitzmiller R, Patel MD. Identifying Patient Phenotype Cohorts Using Prehospital Electronic Health Record Data. PREHOSP EMERG CARE 2021:1-14. [PMID: 33315497 PMCID: PMC11295293 DOI: 10.1080/10903127.2020.1859658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Objective: Emergency medical services (EMS) provide critical interventions for patients with acute illness and injury and are important in implementing prehospital emergency care research. Retrospective, manual patient record review, the current reference-standard for identifying patient cohorts, requires significant time and financial investment. We developed automated classification models to identify eligible patients for prehospital clinical trials using EMS clinical notes and compared model performance to manual review.Methods: With eligibility criteria for an ongoing prehospital study of chest pain patients, we used EMS clinical notes (n = 1208) to manually classify patients as eligible, ineligible, and indeterminate. We randomly split these same records into training and test sets to develop and evaluate machine-learning (ML) algorithms using natural language processing (NLP) for feature (variable) selection. We compared models to the manual classification to calculate sensitivity, specificity, accuracy, positive predictive value, and F1 measure. We measured clinical expert time to perform review for manual and automated methods.Results: ML models' sensitivity, specificity, accuracy, positive predictive value, and F1 measure ranged from 0.93 to 0.98. Compared to manual classification (N = 363 records), the automated method excluded 90.9% of records as ineligible and leaving only 33 records for manual review.Conclusions: Our ML derived approach demonstrates the feasibility of developing a high-performing, automated classification system using EMS clinical notes to streamline the identification of a specific cardiac patient cohort. This efficient approach can be leveraged to facilitate prehospital patient-trial matching, patient phenotyping (i.e. influenza-like illness), and create prehospital patient registries.
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Affiliation(s)
- Rachel Stemerman
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Thomas Bunning
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Joseph Grover
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Rebecca Kitzmiller
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Mehul D Patel
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
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Tsur AM, Nadler R, Lipsky AM, Levi D, Bader T, Benov A, Glassberg E, Chen J. The Israel Defense Forces Trauma Registry: 22 years of point-of-injury data. J Trauma Acute Care Surg 2020; 89:S32-S38. [DOI: 10.1097/ta.0000000000002776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pap R, Lockwood C, Stephenson M, Simpson P. Indicators to measure prehospital care quality: a scoping review. ACTA ACUST UNITED AC 2019; 16:2192-2223. [PMID: 30439748 DOI: 10.11124/jbisrir-2017-003742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to locate, examine and describe the literature on indicators used to measure prehospital care quality. INTRODUCTION The performance of ambulance services and quality of prehospital care has traditionally been measured using simple indicators, such as response time intervals, based on low-level evidence. The discipline of paramedicine has evolved significantly over the last few decades. Consequently, the validity of utilizing such measures as holistic prehospital care quality indicators (QIs) has been challenged. There is growing interest in finding new and more significant ways to measure prehospital care quality. INCLUSION CRITERIA This scoping review examined the concepts of prehospital care quality and QIs developed for ambulance services. This review considered primary and secondary research in any paradigm and utilizing any methods, as well as text and opinion research. METHODS Joanna Briggs Institute methodology for conducting scoping reviews was employed. Separate searches were conducted for two review questions; review question 1 addressed the definition of prehospital care quality and review question 2 addressed characteristics of QIs in the context of prehospital care. The following databases were searched: PubMed, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. The searches were limited to publications from January 1, 2000 to the day of the search (April 16, 2017). Non-English articles were excluded. To supplement the above, searches for gray literature were performed, experts in the field of study were consulted and applicable websites were perused. RESULTS Review question 1: Nine articles were included. These originated mostly from England (n = 3, 33.3%) and the USA (n = 3, 33.3%). Only one study specifically aimed at defining prehospital care quality. Five articles (55.5%) described attributes specific to prehospital care quality and four (44.4%) articles considered generic healthcare quality attributes to be applicable to the prehospital context. A total of 17 attributes were identified. The most common attributes were Clinical effectiveness (n = 17, 100%), Efficiency (n = 7, 77.8%), Equitability (n = 7, 77.8%) and Safety (n = 6, 66.7%). Timeliness and Accessibility were referred to by four and three (44.4% and 33.3%) articles, respectively.Review question 2: Thirty articles were included. The predominant source of articles was research literature (n = 23; 76.7%) originating mostly from the USA (n = 13; 43.3%). The most frequently applied QI development method was a form of consensus process (n = 15; 50%). A total of 526 QIs were identified. Of these, 283 (53.8%) were categorized as Clinical and 243 (46.2%) as System/Organizational QIs. Within these categories respectively, QIs related to Out-of-hospital cardiac arrest (n = 57; 10.8%) and Time intervals (n = 75; 14.3%) contributed the most. The most commonly addressed prehospital care quality attributes were Appropriateness (n = 250, 47.5%), Clinical effectiveness (n = 174, 33.1%) and Accessibility (n = 124, 23.6%). Most QIs were process indicators (n = 386, 73.4%). CONCLUSION Whilst there is paucity in research aiming to specifically define prehospital care quality, the attributes of generic healthcare quality definitions appear to be accepted and applicable to the prehospital context. There is growing interest in developing prehospital care QIs. However, there is a need for validation of existing QIs and de novo development addressing broader aspects of prehospital care.
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Affiliation(s)
- Robin Pap
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,School of Science and Health, Western Sydney University, Sydney, Australia
| | - Craig Lockwood
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Paul Simpson
- School of Science and Health, Western Sydney University, Sydney, Australia
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Multiple shocks or early transfer for shock refractory ventricular fibrillation? CAN J EMERG MED 2019; 21:315-317. [PMID: 31115289 DOI: 10.1017/cem.2019.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Carter AJE, Jensen JL, Petrie DA, Greene J, Travers A, Goldstein JP, Cook J, Fidgen D, Swain J, Richardson L, Cain E. State of the Evidence for Emergency Medical Services (EMS) Care: The Evolution and Current Methodology of the Prehospital Evidence-Based Practice (PEP) Program. ACTA ACUST UNITED AC 2019; 14:57-70. [PMID: 30129435 PMCID: PMC6147365 DOI: 10.12927/hcpol.2018.25548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Emergency medical services (EMS) leaders and clinicians need to incorporate evidence into safe and effective clinical practice. Access to high-quality evidence, and the time to synthesize it, can be barriers to evidence-based practice. The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, repository of critically appraised evidence specific to EMS. This paper describes the evolution and current methodology of the PEP program. Methods/design: The purpose of PEP is to identify, catalog and critically appraise relevant studies. Following regular systematic searches, two trained appraisers critically appraise included studies and assign a score on three-point level of evidence (LOE) and direction of evidence (DOE) scales. Each clinical intervention is plotted on a 3 × 3 (LOE × DOE) evidence matrix, which provides a summary recommendation. Discussion: The PEP program is a unique knowledge translation tool, specific to EMS. End-users can easily identify which clinical interventions are, or are not, supported by evidence.
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Affiliation(s)
- Alix J E Carter
- Medical Director, Research, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jan L Jensen
- Performance Manager, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - David A Petrie
- Medical Director, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jennifer Greene
- Paramedic Knowledge Translation Coordinator, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Andrew Travers
- Provincial Medical Director, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Judah P Goldstein
- Research Coordinator, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jolene Cook
- Medical Oversight Physician, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Dana Fidgen
- Manager, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Janel Swain
- Provincial Ground Clinical Supervisor, Emergency Health Services, Halifax, NS
| | - Luke Richardson
- Medical Resident, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Ed Cain
- Emergency Medicine Physician, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
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VanderKooy T, Spaur K, Brou L, Caffrey S, Adelgais KM. Utilization of Intravenous Catheters by Prehospital Providers during Pediatric Transports. PREHOSP EMERG CARE 2017; 22:50-57. [PMID: 28792258 DOI: 10.1080/10903127.2017.1347225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prehospital intravenous (IV) access in children may be difficult and time-consuming. Emergency Medical Service (EMS) protocols often dictate IV placement; however, some IV catheters may not be needed. The scene and transport time associated with attempting IV access in children is unknown. The objective of this study is to examine differences in scene and transport times associated with prehospital IV catheter attempt and utilization patterns of these catheters during pediatric prehospital encounters. METHODS Three non-blinded investigators abstracted EMS and hospital records of children 0-18 years of age transported by EMS to a pediatric emergency department (ED). We compared patients in which prehospital IV access was attempted to those with no documented attempt. Our primary outcome was scene time. Secondary outcomes include utilization of the IV catheter in the prehospital and ED settings and a determination of whether the catheter was indicated based on a priori established criteria (prehospital IV medication administration, hypotension, GCS < 13, and ICU admission). RESULTS We reviewed 1,138 records, 545 meeting inclusion criteria. IV catheter placement was attempted in 27% (n = 149) with success in 77% (n = 111). There was no difference in the presence of hypotension or median GCS between groups. Mean scene time (12.5 vs. 11.8 minutes) and transport time (16.9 vs. 14.6 minutes) were similar. Prehospital IV medications were given in 38.7% (43/111). One patient received a prehospital IV medication with no alternative route of administration. Among patients with a prehospital IV attempt, 31% (46/149) received IV medications in the ED and 23% (34/396) received IV fluids in the ED. Mean time to use of the IV in the ED was 70 minutes after arrival. Patients with prehospital IV attempt were more likely to receive IV medication within 30 minutes of ED arrival (39.1% vs. 19.0%, p = 0.04). Overall, 34.2% of IV attempts were indicated. CONCLUSIONS Prehospital IV catheter placement in children is not associated with an increase in scene or transport time. Prehospital IV catheters were used in approximately one-third of patients. Further study is needed to determine which children may benefit most from IV access in the prehospital setting.
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Abstract
Noting that a variety of pre-hospital interventions can now be applied to treat traumatic injury, David J Lockey calls for research to determine which of these actually improve survival and reduce morbidity.
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Feasibility of Use of ROTEM to Manage the Coagulopathy of Military Trauma in a Deployed Setting. Prehosp Disaster Med 2017. [DOI: 10.1017/s1049023x00024328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. Prehosp Disaster Med 2017; 32:148-155. [PMID: 28122657 DOI: 10.1017/s1049023x16001424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment. METHODS Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison. RESULTS Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building. CONCLUSIONS Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to engaging Emergency Medical Service providers in substance use research: a qualitative study. Prehosp Disaster Med. 2017;32(2):148-155.
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16
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Paul AO, Poloczek S, Güthoff C, Richter M, Ekkernkamp A, Matthes G. [Interface between preclinical and clinical trauma care: Analysis of the processes in a trauma network]. Unfallchirurg 2016; 118:657-65. [PMID: 26084753 DOI: 10.1007/s00113-015-0024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In the initial treatment of severely injured patients a good cooperation of the emergency medical service (EMS) with the hospital team is mandatory. The aim of this investigation was to evaluate the quality of cooperation between hospitals working within a trauma network and the rescue service and to develop a tool allowing assessment of the preclinical and clinical interface. METHODS Specific surveys concerning preclinical management and transfer to the target hospital were developed within a modified Delphi process. Injured trauma patients were included if the EMS involved was participating in the network and they were transferred to one of the participating hospitals. RESULTS Over an 11-month period a total of 360 patients were included in the study. The notification of transferring injured patients to the target hospital was carried out in a regular manner. Transport accompanied by an emergency physician occurred in 97% of the cases and no emergency physician was available although needed in only 1% of cases. Correct choice of target hospital was documented in 98.2%. The average waiting time for transferring the patient to the hospital team was 0.15 min. In 95.7% of cases a hospital physician was available to directly receive the patient in the emergency room. On a scale ranging from 1 (poor) to 10 (very good) clinical personnel as well as rescue teams rated the cooperation between both with a median of 10 points (IQR 8;10). From the clinicians point of view airway and circulation problems and external bleeding were correctly treated in the preclinical setting (airway 93.9%, circulation 97.3% and external bleeding 95.3%); however, for extremity injuries only in 78.5% of the cases. CONCLUSION This survey presents an adequate tool to identify weak spots within the primary management and to point out elements for improvement.
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Affiliation(s)
- A O Paul
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
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17
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Frischknecht Christensen E, Berlac PA, Nielsen H, Christiansen CF. The Danish quality database for prehospital emergency medical services. Clin Epidemiol 2016; 8:667-671. [PMID: 27843347 PMCID: PMC5098515 DOI: 10.2147/clep.s100919] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM OF DATABASE The aim of the Danish quality database for prehospital emergency medical services (QEMS) is to assess, monitor, and improve the quality of prehospital emergency medical service care in the entire prehospital patient pathway. The aim of this review is to describe the design and the implementation of QEMS. STUDY POPULATION The study population consists of all "112 patient contacts" defined as emergency patients, where the entrance to health care is a 112 call forwarded to one of the five regional emergency medical coordination centers in Denmark since January 1, 2014. Estimated annual number of included "112 patients" is 300,000-350,000. MAIN VARIABLES We defined nine quality indicators and the following variables: time stamps for emergency calls received at one of the five regional emergency medical coordination centers, dispatch of prehospital unit(s), arrival of first prehospital unit, arrival of first supplemental prehospital unit, and mission completion. Finally, professional level and type of the prehospital resource dispatched to an incident and end-of-mission status (mission completed by phone, on scene, or admission to hospital) are registered. DESCRIPTIVE DATA Descriptive data included age, region, and Danish Index for Emergency Care including urgency level. CONCLUSION QEMS is a new database under establishment and is expected to provide the basis for quality improvement in the prehospital setting and in the entire patient care pathway, for example, by providing prehospital data for research and other quality databases.
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Affiliation(s)
- Erika Frischknecht Christensen
- Clinical Institute, Aalborg University; Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg; Prehospital Emergency Medical Services, North Denmark Region
| | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Lecky F, Russell W, Fuller G, McClelland G, Pennington E, Goodacre S, Han K, Curran A, Holliman D, Freeman J, Chapman N, Stevenson M, Byers S, Mason S, Potter H, Coats T, Mackway-Jones K, Peters M, Shewan J, Strong M. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study. Health Technol Assess 2016; 20:1-198. [PMID: 26753808 DOI: 10.3310/hta20010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. METHODS Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). PRIMARY OUTCOMES recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. RESULTS Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%; p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury. CONCLUSIONS Current NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating 'early neurosurgery through bypass' and address the challenge of reliable TBI diagnosis at the scene of injury. TRIAL REGISTRATION Current Controlled Trials ISRCTN68087745. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Lecky
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Wanda Russell
- Trauma Audit and Research Network, Center of Occupational and Environmental Health, Institute of Population, University of Manchester, Manchester, UK
| | - Gordon Fuller
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Graham McClelland
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elspeth Pennington
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Steve Goodacre
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Kyee Han
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Curran
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Damien Holliman
- Department of Neurosurgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer Freeman
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Nathan Chapman
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Sonia Byers
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Suzanne Mason
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Hugh Potter
- Potter Rees Serious Injury Solicitors LLP, Manchester, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester/University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kevin Mackway-Jones
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Mary Peters
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Jane Shewan
- Research and Development Department, Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - Mark Strong
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
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Anest T, Stewart de Ramirez S, Balhara KS, Hodkinson P, Wallis L, Hansoti B. Defining and improving the role of emergency medical services in Cape Town, South Africa. Emerg Med J 2016; 33:557-61. [PMID: 26848162 DOI: 10.1136/emermed-2015-205177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 01/20/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses. METHODS This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script. RESULTS 33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a κ coefficient of 0.69. CONCLUSIONS The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training.
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Affiliation(s)
- Trisha Anest
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kamna S Balhara
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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van de Glind I, Berben S, Zeegers F, Poppen H, Hoogeveen M, Bolt I, van Grunsven P, Vloet L. A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study. Scand J Trauma Resusc Emerg Med 2016; 24:2. [PMID: 26746873 PMCID: PMC4706720 DOI: 10.1186/s13049-015-0195-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In pre-hospital Emergency Medical Services (EMS) more research is needed to direct and underpin care delivery and inform policy. To target future research efforts, this study aimed to determine future research priorities with representatives of the EMS field. METHODS A four-round online Delphi survey was used to discuss different viewpoints and reach consensus on research priorities. A multidisciplinary panel of experts was recruited in the field of pre-hospital EMS and adjoining (scientific) professional organisations (n = 62). 48 research topics were presented in Delphi I, and the panel was asked to rate their importance on a 5-point scale. In Delphi II and III the panel selected their priority research topics, and arguments why and suggestions for research questions were collected and reported back. In Delphi IV appropriateness of the remaining topics and agreement within the expert panel was taken into account to make up the final list of research priorities. RESULTS The response on the Delphi-survey was high: 95% (n = 59; Delphi I); 97% (n = 60, Delphi II); 94% (n = 58, Delphi III); 97% (n = 60, Delphi IV). The panel reduced the number of research topics from 48 topics in Delphi I to 12 topics in Delphi III. A variety of arguments and suggestions for research questions were collected, giving insight in reasons why research on these topics in the near future is needed. Delphi IV showed an adequate level of agreement with respect to the 12 presented research topics. The following 9 topics were rated as appropriate for the national pre-hospital EMS research agenda: Non-conveyance to the hospital (ranked highest); Performance measures for quality of care; Hand over/registration/exchange of patient data; Care and task substitution; Triage; Assessment of acute neurologic signs & symptoms; Protocols and protocol adherence; Immobilisation; and Open/secure airway. DISCUSSIONS The research priorities identified in our study resemble those in other studies. However, the topic 'non-conveyance to the hospital' was determined as a priority in this study but not in other studies. CONCLUSIONS The national pre-hospital EMS research agenda can focus future research efforts to improve the evidence base and clinical practice of pre-hospital emergency medical services. Dissemination and implementation of the research agenda deserves careful attention.
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Affiliation(s)
- Irene van de Glind
- HAN University of Applied Sciences, Department of Emergency and Critical Care, PO Box 6960, 6503 GL, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101 (114), 6500 HB, Nijmegen, The Netherlands.
| | - Sivera Berben
- HAN University of Applied Sciences, Department of Emergency and Critical Care, PO Box 6960, 6503 GL, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101 (114), 6500 HB, Nijmegen, The Netherlands. .,Radboud university medical center, Regional Emergency Healthcare Network Nijmegen, PO BOX 9101 (911), 6500 HB, Nijmegen, The Netherlands.
| | - Fon Zeegers
- HAN University of Applied Sciences, Department of Emergency and Critical Care, PO Box 6960, 6503 GL, Nijmegen, The Netherlands. .,HAN University of Applied Sciences, Institute of Nursing Studies, PO BOX 6960, 6503 GL, Nijmegen, The Netherlands.
| | - Henk Poppen
- HAN University of Applied Sciences, Institute of Nursing Studies, PO BOX 6960, 6503 GL, Nijmegen, The Netherlands.
| | - Margreet Hoogeveen
- Dutch National Sector Organisation for Ambulance Care (Ambulancezorg Nederland, AZN), PO BOX 489, 8000 AL, Zwolle, The Netherlands.
| | - Ina Bolt
- Dutch Nurses Association, department of Ambulance Care (V&VN, ambulance care), PO Box 8212, 3503 RE, Utrecht, The Netherlands.
| | - Pierre van Grunsven
- Regional Emergency Medical Service Veiligheidsregio Gelderland-Zuid, PO BOX 1120, 6501 BC, Nijmegen, The Netherlands.
| | - Lilian Vloet
- HAN University of Applied Sciences, Department of Emergency and Critical Care, PO Box 6960, 6503 GL, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101 (114), 6500 HB, Nijmegen, The Netherlands. .,Nursing Advisory Board and scientific office, Canisius Wilhelmina Hospital, PO BOX 9015, 6500 GS, Nijmegen, The Netherlands.
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Abstract
ABSTRACTInformed consent to participation in research is an important protector of potential subjects’ rights and autonomy. Ethical research involving critically ill people is challenging because their medical condition often makes obtaining informed consent impossible. This is especially true in the prehospital setting, where additional barriers to obtaining informed consent exist. A recently published Canadian policy (Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans) specifies circumstances under which an exception to the requirement for informed consent may be granted so that vulnerable individuals are not denied the potential benefits of participating in research. This article reviews the rationale for theTri-Council Policy Statementand illustrates some problems with its application in the context of a Canadian prehospital study on continuous positive airway pressure. A new risk analysis model and a national research ethics board are discussed as possible ways to facilitate interpretation and application of the current exception of informed consent policy.
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Affiliation(s)
- James Thompson
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
RÉSUMÉ:
L’encombrement des salles d’urgence a atteint un niveau de crise et les retombées s’étendent au-delà des murs des hôpitaux. De plus en plus, le personnel des urgences surchargées utilise la tactique du «détournement des ambulances», obligeant les préposés aux SMU à se diriger vers le prochain établissement adéquat. Comme de plus en plus d’hôpitaux ont recours au détournement, les patients s’accumulent dans les établissements qui les acceptent jusqu’à ce que ceux-ci débordent également. Finalement, plus personne n’accepte de patients et les préposés aux SMU doivent attendre avec leurs patients dans les corridors de l’urgence qu’une civière se libère. En raison de cette situation, il y a moins d’ambulances disponibles pour répondre aux appels 911. Le principal mandat d’un service pré-hospitalier est de prodiguer des soins sur les lieux de l’incident et non dans les corridors d’une urgence et il est inacceptable qu’une pénurie de lits à l’urgence entraîne des retards de réponse au 911.
La plupart des gens sont d’accord pour dire qu’il est inacceptable que des patients malades aient à attendre dans les corridors de l’urgence pour des civières inexistantes; cependant, même si cette situation est dangereuse, elle l’est moins que le fait d’obliger ces mêmes patients à attendre indûment à la maison l’arrivée des SMU. Les hôpitaux devraient peut-être prendre un engagement moral d’accepter les patients peu importe la situation d’encombrement, puis d’assigner les ressources nécessaires pour les soigner; ou les services ambulanciers devraient peut-être embaucher et former du personnel pour traiter les patients dans les corridors des urgences. Quelle que soit l’approche adoptée, les hôpitaux et les préposés aux SMU doivent cesser de s’imputer mutuellement la responsabilité du problème et travailler à trouver des solutions.
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Affiliation(s)
- K Wanger
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Berringer R, Christenson J, Blitz M, Spinelli J, Freeman J, Maddess G, Rae S. Medical role of first responders in an urban prehospital setting. CAN J EMERG MED 2015; 1:93-8. [PMID: 17659111 DOI: 10.1017/s1481803500003742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT:
Background:
Almost all North American cities have first responder programs. To date there is no published documentation of the roles first responders play, nor of the frequency and type of interventions they perform. Many urban stakeholders question the utility and safety of routinely dispatching large vehicles emergently to calls that may not require their services. Real world data on first responder interventions will help emergency medical services (EMS) directors and planners determine manpower requirements, assess training needs, and optimize dispatch protocols to reduce the rate of inappropriate “code 3” (lights and siren) responses.
Objective:
Our objectives were to determine how often first responders arrive first on scene, to estimate the time interval between first response and EMS response, and to examine the frequency and type of interventions performed by first responders.
Methods:
In a prospective observational study, trained observers were assigned to fire department first responder (FDFR) units. These observers recorded on-scene times for FDFR and EMS units, and documented the performance of first responder interventions.
Results:
FDFRs arrived first on scene in 49% of code 3 calls. They performed critical interventions in 18% of calls attended and 36% of calls where they arrived first. Oxygen administration was the most frequent critical intervention, yet occult hypoxemia was common and compliance with oxygen administration protocols was poor.
Conclusions:
First responders perform critical interventions during a minority of code 3 calls, even when “critical” is defined generously. Many “lights and siren” dispatches are unnecessary. Future research should attempt to identify dispatch criteria that more accurately predict the need for first responder intervention. First responder training and continuous quality improvement (CQI) should focus on interventions that are performed with some regularity, particularly oxygen administration.
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Affiliation(s)
- R Berringer
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Pak SC, Micalos PS, Maria SJ, Lord B. Nonpharmacological interventions for pain management in paramedicine and the emergency setting: a review of the literature. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:873039. [PMID: 25918548 PMCID: PMC4396997 DOI: 10.1155/2015/873039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/13/2015] [Indexed: 11/30/2022]
Abstract
Paramedicine and the emergency medical services have been moving in the direction of advancing pharmaceutical intervention for the management of pain in both acute and chronic situations. This coincides with other areas of advanced life support and patient management strategies that have been well researched and continue to benefit from the increasing evidence. Even though paramedic practice is firmly focused on pharmacological interventions to alleviate pain, there is emerging evidence proposing a range of nonpharmacological options that can have an important role in pain management. This review highlights literature that suggests that paramedicine and emergency medical services should be considering the application of complementary and alternative therapies which can enhance current practice and reduce the use of pharmacological interventions.
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Affiliation(s)
- Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Peter S. Micalos
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Sonja J. Maria
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Bill Lord
- University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
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Jensen JL, Bigham BL, Blanchard IE, Dainty KN, Socha D, Carter A, Brown LH, Travers AH, Craig AM, Brown R, Morrison LJ. The Canadian National EMS Research Agenda: a mixed methods consensus study. CAN J EMERG MED 2015; 15:73-82. [DOI: 10.2310/8000.2013.130894] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction:
Research is essential for the development of evidence-based emergency medical services (EMS) systems of care. When resources are scarce and gaps in evidence are large, a national agenda may inform the growth of EMS research in Canada. This mixed methods consensus study explores current barriers and existing strengths within Canadian EMS research, provides recommendations, and suggests EMS topics for future study.
Methods:
Purposeful sampling was employed to invite EMS research stakeholders from various roles across the country. Study phases consisted of 1) baseline interviews of a subsample, 2) roundtable discussion, and 3) an online Delphi survey, in which participants scored each statement for importance. Consensus was defined a priori and met if 80% scored a statement as “important” or “very important.”
Results:
Fifty-three stakeholders participated, representing researchers (37.7%), EMS administrators (24.6%), clinicians/ providers (20.7%), and educators (17.0%). Participation rates were as follows: interviews, 13 of 13 (100%); roundtable, 47 of 53 (89%); survey round 1, 50 of 53 (94%); survey round 2, 47 of 53 (89%); and survey round 3, 40 of 53 (75%). A total of 141 statements were identified as important: 20 barriers, 54 strengths/opportunities, 31 recommendations, and 36 suggested topics for future research. Like statements were synthesized, resulting in barriers (n 5 10), strengths/opportunities (n 5 24), and recommendations (n 5 19), which were categorized as time, opportunities, and funding; education and mentorship; culture of research and collaboration; structure, process, and outcome of research; EMS and paramedic practice; and the future of the EMS Research Agenda.
Conclusions:
Consensus-based key messages from this agenda should be considered when designing, funding, and publishing EMS research and will advance EMS research locally, regionally, and nationally.
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Ankolekar S, Parry R, Sprigg N, Siriwardena AN, Bath PMW. Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: qualitative data from the Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT). Ann Emerg Med 2014; 64:640-8. [PMID: 24746844 DOI: 10.1016/j.annemergmed.2014.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE Optimal practices for recruiting, consenting, and randomizing patients, and delivering treatment in out-of-hospital ultra-acute stroke trials, remain unclear. We aim to identify key barriers and facilitators relevant to the design and conduct of ambulance-based stroke trials and to formulate preliminary recommendations for the design of future trials. METHODS Using semistructured interviews, we investigated the experiences and challenges faced by paramedics who took part in a randomized controlled trial in suspected ultra-acute stroke, the Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT), in which recruitment, consent, randomization, assessment, and treatment were delivered by paramedics before hospitalization. RESULTS We purposively selected a diversity sample of 14 of the 78 paramedics who participated in RIGHT. We identified 13 themes (7 facilitators and 6 barriers to out-of-hospital stroke research). A simple stroke diagnostic tool, use of proxy consent on behalf of patients, and straightforward trial processes were identified as the main facilitators. Recruitment became easier with each new randomization attempt. Key barriers reported were informed consent in the emergency setting, lack of institutional support for research, learning curve and rarity (each paramedic treats only a few eligible patients), and difficulty in attending training sessions. Interviewed paramedics were motivated to participate in research. CONCLUSION Ultra-acute stroke research in the out-of-hospital environment is feasible, but important barriers need to be addressed. Proxy consent by paramedics addresses some of the difficulties with the consent process in the out-of-hospital setting.
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Affiliation(s)
- Sandeep Ankolekar
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Stroke Service, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - Ruth Parry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Stroke Service, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | | | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Stroke Service, Nottingham University Hospitals National Health Service Trust, Nottingham, UK.
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27
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Affiliation(s)
- James Thompson
- at Flinders University, Adelaide and Dr Claire Drummond is associate head of faculty (teaching and learning) at Flinders University, Adelaide
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28
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Hargreaves K, Goodacre S, Mortimer P. Paramedic perceptions of the feasibility and practicalities of prehospital clinical trials: a questionnaire survey. Emerg Med J 2013; 31:499-504. [DOI: 10.1136/emermed-2013-202346] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simpson PM, Bendall JC, Patterson J, Middleton PM. Beliefs and expectations of paramedics towards evidence-based practice and research. INT J EVID-BASED HEA 2013; 10:197-203. [PMID: 22925616 DOI: 10.1111/j.1744-1609.2012.00273.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this cross-sectional online survey was to better understand the beliefs of paramedics towards research and evidence-based practice and their expectations regarding its impact on their ability to provide patient care. METHODS An online survey of frontline paramedical staff in New South Wales, Australia, was conducted in March, 2010. Paramedics were asked to respond to five questions relating to their beliefs and expectations relating to prehospital research and evidence-based practice, using a four-point Likert scale for each. Descriptive statistics are used to describe responses to survey questions. Tests for trend between nominal and ordinal explanatory variables and ordinal survey responses were performed using χ(2) statistics. RESULTS There were 892 responses to the survey throughout the 1-month study period. The vast majority of paramedics believed prehospital research and paramedic participation in research were very important. Ninety per cent believed prehospital research would improve patient care, while 92% reported being likely to change clinical practice as a result of prehospital evidence. Paramedics with shorter lengths of service and those with tertiary education were significantly more supportive of, and had higher expectations of, research and evidence-based practice. CONCLUSIONS Paramedics who responded to this online survey appear to have generally positive expectations of and perceptions towards evidence-based practice and research and their impact on prehospital care. Tertiary education and shorter length of service were associated with more positive expectations of, and higher level of support for, evidence-based practice.
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Affiliation(s)
- Paul M Simpson
- Ambulance Service of New South Wales Biostatistical Training Program, New South Wales Department of Health, Sydney, New South Wales, Australia.
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30
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Togher FJ, Davy Z, Siriwardena AN. Patients’ and ambulance service clinicians’ experiences of prehospital care for acute myocardial infarction and stroke: a qualitative study: Table 1. Emerg Med J 2012; 30:942-8. [DOI: 10.1136/emermed-2012-201507] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Walsh B, Cone DC, Meyer EM, Larkin GL. Paramedic attitudes regarding prehospital analgesia. PREHOSP EMERG CARE 2012; 17:78-87. [PMID: 22971168 DOI: 10.3109/10903127.2012.717167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although pain is a major reason why patients summon emergency medical services (EMS), prehospital medical providers administer analgesic agents at inappropriately low rates. One possible reason is the role of EMS provider attitudes. OBJECTIVE This study was conducted to elicit attitudes that may act as impediments or deterrents to administering analgesia in the prehospital environment. METHODS A qualitative methodology was employed. We recruited experienced paramedics, with at least one year of full-time fieldwork, from a variety of agencies in New England. We sought to include a balance of rural and urban as well as both private and hospital-based agencies. Participants at each site were selected through purposive sampling. A semistructured discussion guide was designed to elicit the paramedics' past experiences with administering analgesia, as well as reflections on their role in the care of patients in pain. Both interviews and focus groups were conducted. These sessions were recorded and transcribed verbatim. The transcripts were topic-analyzed and iteratively coded by two independent investigators utilizing the constant comparative method of Glaser and Strauss' Grounded Theory; coding ambiguities were resolved by consensus. Through a series of conceptual mapping and iterative code refinement, themes and domains were generated. RESULTS Fifteen paramedics from five EMS agencies in three New England states were recruited. Major themes were: 1) a reluctance to administer opioids to patients without significant objective signs (e.g., deformity, hypertension); 2) a preoccupation with potential malingering; 3) ambivalence about the degree of pain control to target or to expect (e.g., aiming to "take the edge off"); 4) a fear of masking diagnostic symptoms; and 5) an aversion to aggressive dosing of opioids (e.g., initial doses of morphine did not exceed 5 mg). CONCLUSIONS A number of potentially modifiable attitudinal barriers to appropriate pain management were revealed.
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Affiliation(s)
- Brooks Walsh
- Yale-New Haven Medical Center Emergency Medicine Residency Program, Yale University School of Medicine, New Haven, CT 06519,
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Ripley E, Ramsey C, Prorock-Ernest A, Foco R, Luckett S, Ornato JP. EMS providers and exception from informed consent research: benefits, ethics, and community consultation. PREHOSP EMERG CARE 2012; 16:425-33. [PMID: 22823963 DOI: 10.3109/10903127.2012.702189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND As attention to, and motivation for, emergency medical services (EMS)-related research continues to grow, particularly exception from informed consent (EFIC) research, it is important to understand the thoughts, beliefs, and experiences of EMS providers who are actively engaged in the research. OBJECTIVE We explored the attitudes, beliefs, and experiences of EMS providers regarding their involvement in prehospital emergency research, particularly EFIC research. METHODS Using a qualitative design, 24 participants were interviewed including nationally registered paramedics and Virginia-certified emergency medical technicians employed at Richmond Ambulance Authority, the participating EMS agency. At the time of our interviews, the EMS agency was involved in an EFIC trial. Transcribed interview data were coded and analyzed for themes. Findings were presented back to the EMS agency for validation. RESULTS Overall, there appeared to be support for prehospital emergency research. Participants viewed research as necessary for the advancement of the field of EMS. Improvement in patient care was identified as one of the most important benefits. A number of ethical considerations were identified: individual risk versus public good and consent. The EMS providers in our study were open to working with EMS researchers throughout the community consultation and public disclosure process. CONCLUSION The EMS providers in our study valued research and were willing to participate in studies. Support for research was balanced with concerns and challenges regarding the role of providers in the research process.
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Affiliation(s)
- Elizabeth Ripley
- Department of Internal Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Where There Are No Emergency Medical Services—Prehospital Care for the Injured in Mumbai, India. Prehosp Disaster Med 2012; 25:145-51. [DOI: 10.1017/s1049023x00007883] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:In a populous city like Mumbai, which lacks an organized pre-hospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai.Methods:A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July–August 2005) at a Level-I, urban, trauma center.Results:The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0 .41) and those who came by taxi (OR = 0.54).Conclusions:Currently, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries and the insufficient evidence that prehospital field interventions by the EMS actually have improved outcomes, Mumbai must proceed with caution when implementing advanced EMS systems into its congested urban traffic. Similar cities, such as Mexico City and Jakarta, have had limited success with implementing EMS systems. Perhaps reinforcing the existing network of informal providers of taxi drivers and police and with training, funding quick transport with taxes on roads and automobile fuels and regulating the private ambulance providers, could be more cost-effective in a culture in which sharing and helping others is not just desirable, but is necessary for overall economic survival.
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Krüger AJ, Lockey D, Kurola J, Di Bartolomeo S, Castrén M, Mikkelsen S, Lossius HM. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services. Scand J Trauma Resusc Emerg Med 2011; 19:71. [PMID: 22107787 PMCID: PMC3282653 DOI: 10.1186/1757-7241-19-71] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Physician-staffed pre-hospital units are employed in many Western emergency medical services (EMS) systems. Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver a higher quality of care to pre-hospital patients. There is no common data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician-staffed pre-hospital services in Europe. Methods Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary meeting in Stavanger, Norway. Results The core data set was divided into 5 sections: "fixed system variables", "event operational descriptors", " patient descriptors", "process mapping", and "outcome measures and quality indicators". After the initial round, a total of 361 variables were proposed by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. Conclusions Using a modified nominal group technique, we have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care.
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Affiliation(s)
- Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.
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El Sayed MJ. Measuring quality in emergency medical services: a review of clinical performance indicators. Emerg Med Int 2011; 2012:161630. [PMID: 22046554 PMCID: PMC3196253 DOI: 10.1155/2012/161630] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/15/2011] [Indexed: 11/17/2022] Open
Abstract
Measuring quality in Emergency Medical Services (EMSs) systems is challenging. This paper reviews the current approaches to measuring quality in health care and EMS with a focus on currently used clinical performance indicators in EMS systems (US and international systems). The different types of performance indicators, the advantages and limitations of each type, and the evidence-based prehospital clinical bundles are discussed. This paper aims at introducing emergency physicians and health care providers to quality initiatives in EMS and serves as a reference for tools that EMS medical directors can use to launch new or modify existing quality control programs in their systems.
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Affiliation(s)
- Mazen J. El Sayed
- EMS and Prehospital Care Program, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 110 72020, Lebanon
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Jensen JL, Blanchard IE, Bigham BL, Dainty KN, Socha D, Carter A, Brown LH, Craig AM, Travers AH, Brown R, Cain E, Morrison LJ. Methodology for the development of a Canadian national EMS research agenda. BMC Emerg Med 2011; 11:15. [PMID: 21961624 PMCID: PMC3203066 DOI: 10.1186/1471-227x-11-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 09/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many health care disciplines use evidence-based decision making to improve patient care and system performance. While the amount and quality of emergency medical services (EMS) research in Canada has increased over the past two decades, there has not been a unified national plan to enable research, ensure efficient use of research resources, guide funding decisions and build capacity in EMS research. Other countries have used research agendas to identify barriers and opportunities in EMS research and define national research priorities. The objective of this project is to develop a national EMS research agenda for Canada that will: 1) explore what barriers to EMS research currently exist, 2) identify current strengths and opportunities that may be of benefit to advancing EMS research, 3) make recommendations to overcome barriers and capitalize on opportunities, and 4) identify national EMS research priorities. METHODS/DESIGN Paramedics, educators, EMS managers, medical directors, researchers and other key stakeholders from across Canada will be purposefully recruited to participate in this mixed methods study, which consists of three phases: 1) qualitative interviews with a selection of the study participants, who will be asked about their experience and opinions about the four study objectives, 2) a facilitated roundtable discussion, in which all participants will explore and discuss the study objectives, and 3) an online Delphi consensus survey, in which all participants will be asked to score the importance of each topic discovered during the interviews and roundtable as they relate to the study objectives. Results will be analyzed to determine the level of consensus achieved for each topic. DISCUSSION A mixed methods approach will be used to address the four study objectives. We anticipate that the keys to success will be: 1) ensuring a representative sample of EMS stakeholders, 2) fostering an open and collaborative roundtable discussion, and 3) adhering to a predefined approach to measure consensus on each topic. Steps have been taken in the methodology to address each of these a priori concerns.
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Affiliation(s)
- Jan L Jensen
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B2B2, Canada
- Dalhousie University Division of EMS, Halifax, NS, Canada
| | - Ian E Blanchard
- Alberta Health Services, Emergency Medical Services, Calgary, AB, Canada
| | - Blair L Bigham
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Katie N Dainty
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Doug Socha
- Hastings-Quinte EMS, Hastings County, ON, Canada
| | - Alix Carter
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B2B2, Canada
- Dalhousie University Division of EMS, Halifax, NS, Canada
| | | | - Alan M Craig
- Toronto Emergency Medical Services, Toronto, ON, Canada
| | - Andrew H Travers
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B2B2, Canada
- Dalhousie University Division of EMS, Halifax, NS, Canada
| | - Ryan Brown
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B2B2, Canada
- Dalhousie University Division of EMS, Halifax, NS, Canada
| | - Ed Cain
- Dalhousie University Division of EMS, Halifax, NS, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Out-of-Hospital Clinical Trials: Challenges in Advancing the Evidence Base. Ann Emerg Med 2011; 57:232-3. [DOI: 10.1016/j.annemergmed.2010.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 11/23/2010] [Accepted: 11/30/2010] [Indexed: 11/19/2022]
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Schmidt TA, Nelson M, Daya M, DeIorio NM, Griffiths D, Rosteck P. Emergency medical service providers' attitudes and experiences regarding enrolling patients in clinical research trials. PREHOSP EMERG CARE 2010; 13:160-8. [PMID: 19291551 DOI: 10.1080/10903120802708852] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate Emergency Medical Services (EMS) providers' attitudes and experiences about enrolling patients in clinical research trials utilizing the federal rules for exception from informed consent. We hypothesized that Emergency Medical Technicians (EMTs) would have varied attitudes about research using an exception from informed consent which could have an impact on the research. METHODS AND SETTING Since January 2007, the EMS system has been participating in a randomized, multi-center interventional trial in which out-of-hospital providers enroll critically injured trauma patients using exception from informed consent.A voluntary, anonymous, written survey was administered to EMS providers during an in-service. The survey included demographics and Likert-type questions about their experiences with and attitudes towards research in general, and research using an exception from informed consent for an out-of-hospital clinical trial. RESULTS The response rate was 79.3% (844/1067). Most respondents, 93.3%, agreed that "research in EMS care is important." However, 38.5% also agreed that individual EMTs/paramedics should maintain the personal right of refusal to enroll patients in EMS trials. Fifty-four percent of respondents agreed with the statement that "the right of research subjects to make their own choices is more important than the interests of the general community." In response to statements about the current study, 11.3% agreed that "the study is unethical because the patient cannot consent" and 69.2% responded that they would personally be willing to be enrolled in the study before they were able to give consent if they were seriously injured. Those who had not enrolled a patient into the study (681 respondents) were asked their reasons: 76.8% had not encountered an eligible patient or did not work for an agency that carried the fluid; 4.3% did not have time; 4.1% forgot and 1.1% stated that they were opposed to enrolling patients in studies without their consent. CONCLUSION The majority of EMS personnel in one community support EMS research and this specific out-of-hospital clinical trial being conducted under an exception from informed consent. Potential barriers to enrollment were identified. Further study in other systems is warranted to better understand EMS provider perspectives about exception from informed consent research.
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Affiliation(s)
- Terri A Schmidt
- Department of Emergency Medicine, Oregon Health & Science University, Portland OR 97239, USA.
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Wang HE, Davis DP, Wayne MA, Delbridge T. PREHOSPITALRAPID-SEQUENCEINTUBATION-WHATDOES THEEVIDENCESHOW? PREHOSP EMERG CARE 2009. [DOI: 10.1080/312704000917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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LIBERMAN MOISHE, C BRANAS CHARLES, MULDER DAVIDS, LAVOIE ANDRÉ, SAMPALIS JOHNS. Advanced Versus Basic Life Support in the Pre‐Hospital Setting – The Controversy between the ‘Scoop and Run’ and the ‘Stay and Play’ Approach to the Care of the Injured Patient. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/15031430410025515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brice JH, Friend KD, Delbridge TR. Accuracy of EMS-Recorded Patient Demographic Data. PREHOSP EMERG CARE 2009; 12:187-91. [DOI: 10.1080/10903120801907687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pointer JE, Harlan K. Impact of Liberalization of Protocols for the Use of Morphine Sulfate in an Urban Emergency Medical Services System. PREHOSP EMERG CARE 2009; 9:377-81. [PMID: 16263668 DOI: 10.1080/10903120500253805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the impact of liberalization of paramedic management protocols for the use of morphine sulfate (MS). METHODS A retrospective database analysis tallied and categorized MS use into seven conditions during two intervals--six months before (control) and six months after (study) the protocol change. RESULTS In the control interval, 760 of 34,020 (2.2%) patients received MS. In the study interval, 999 of 30,320 (3.3%) received the drug, a 50% relative increase in MS use. MS use dramatically increased in two assessment categories: other painful medical conditions (19.0% vs. 2.8% of transports, relative risk [RR] 6.8, 95% confidence interval [CI] 5.2-8.9) and nontraumatic abdominal pain (9.2% vs. 1.9% of transports, RR 4.8, 95% CI 3.3-6.9). CONCLUSION Liberalization of pain management protocols resulted in an appreciable increase in the use of MS only in medical categories, predominantly abdominal pain, with no apparent safety or misuse issues.
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Jensen JL, Petrie DA, Travers AH. The Canadian prehospital evidence-based protocols project: knowledge translation in emergency medical services care. Acad Emerg Med 2009; 16:668-73. [PMID: 19691810 DOI: 10.1111/j.1553-2712.2009.00440.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The principles of evidence-based medicine are applicable to all areas and professionals in health care. The care provided by paramedics in the prehospital setting is no exception. The Prehospital Evidence-based Protocols Project Online (PEP) is a repository of appraised research evidence that is applicable to interventions performed in the prehospital setting and is openly available online. This article describes the history, current status, and potential future of the project. METHODS The primary objective of the PEP is to catalog and grade emergency medical services (EMS) studies with a level of evidence (LOE). Subsequently, each prehospital intervention is assigned a class of recommendation (COR) based on all the appraised articles on that intervention, in an effort to organize the evidence so it may be put into practice efficiently. An LOE is assigned to each article by the section editor, based on the study rigor and applicability to EMS. The section editor committee consists of EMS physicians and paramedics from across Canada, and two from Ireland and a paramedic coordinator. The evidence evaluation cycle is continuous; as the section editors send back appraisals, the coordinator updates the database and sends out another article for review. RESULTS The database currently has 182 individual interventions organized under 103 protocols, with 933 citations. CONCLUSIONS This project directly meets recent recommendations to improve EMS by using evidence to support interventions and incorporating it into protocols. Organizing and grading the evidence allows medical directors and paramedics to incorporate research findings into their daily practice. As such, this project demonstrates how knowledge translation can be conducted in EMS.
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Affiliation(s)
- Jan L Jensen
- Division of Emergency Medical Services, Dalhousie University, Emergency Health Services, Halifax, Nova Scotia, Canada.
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Bøtker MT, Bakke SA, Christensen EF. A systematic review of controlled studies: do physicians increase survival with prehospital treatment? Scand J Trauma Resusc Emerg Med 2009; 17:12. [PMID: 19265550 PMCID: PMC2657098 DOI: 10.1186/1757-7241-17-12] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 03/05/2009] [Indexed: 11/21/2022] Open
Abstract
Background The scientific evidence of a beneficial effect of physicians in prehospital treatment is scarce. The objective of this systematic review of controlled studies was to examine whether physicians, as opposed to paramedical personnel, increase patient survival in prehospital treatment and if so, to identify the patient groups that gain benefit. Methods A systematic review of studies published in the databases PubMed, EMBASE and Cochrane from January 1, 1990 to November 24, 2008. Controlled studies comparing patient survival with prehospital physician treatment vs. treatment by paramedical personnel in trauma patients or patients with any acute illness were included. Results We identified 1.359 studies of which 26 met our inclusion criteria. In nine of 19 studies including between 25 and 14.702 trauma patients in the intervention group, physician treatment increased survival compared to paramedical treatment. In four of five studies including between nine and 85 patients with out of hospital cardiac arrest, physician treatment increased survival. Only two studies including 211 and 2.869 patients examined unselected, broader patient groups. Overall, they demonstrated no survival difference between physician and paramedical treatment but one found increased survival with physician treatment in subgroups of patients with acute myocardial infarction and respiratory diseases. Conclusion Our systematic review revealed only few controlled studies of variable quality and strength examining survival with prehospital physician treatment. Increased survival with physician treatment was found in trauma and, based on more limited evidence, cardiac arrest. Indications of increased survival were found in respiratory diseases and acute myocardial infarction. Many conditions seen in the prehospital setting remain unexamined.
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Affiliation(s)
- Morten T Bøtker
- Department of Anesthesiology and Intensive Care, Aarhus Hospital Nørrebrogade, University Hospital of Aarhus, Aarhus, Denmark.
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Davis PR, Rickards AC, Ollerton JE. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting. J ROY ARMY MED CORPS 2008; 153:269-73. [PMID: 18619161 DOI: 10.1136/jramc-153-04-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To determine the optimal composition o f the pre-hospital medical response team (MERT) and the value of pre-hospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care. METHOD A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals. RESULTS There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting. CONCLUSIONS A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.
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Affiliation(s)
- P R Davis
- Consultant Emergency Medicine, 16 Close Support Medical Regiment, Southern General Hospital, Glasgow G51 4TF.
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Smith E, Boyle M, MacPherson J. The development of a quality assessment tool for ambulance patient care records. Health Inf Manag 2008; 33:112-20. [PMID: 18239230 DOI: 10.1177/183335830403300403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective cohort study of the 2002 Victorian prehospital emergency care documentation completed by ambulance paramedics had the objectives: (i) to design and implement a quality assessment tool to determine the quality of the ambulance patient care record (PCR)information; and (ii) to identify critical demographic and clinical items on the ambulance PCR that needed improvement. The study outcomes included a functioning quality assessment tool and associated user guide for prehospital use, and the identification of three critical PCR components requiring improvement. Ninety percent of PCRs passed the quality assessment; 10% (approximately 5 300) contained measurably poor or incomplete documentation.
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Affiliation(s)
- Erin Smith
- Centre for Ambulance and Paramedic Studies, Monash University, Peninsula Campus, McMahons Rd, Frankston VIC 3199, Australia.
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Ummenhofer W, Zürcher M. Ausbildung von Rettungspersonal. Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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