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Preventing and Monitoring Work-Related Diseases in Firefighters: A Literature Review on Sensor-Based Systems and Future Perspectives in Robotic Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189723. [PMID: 34574646 PMCID: PMC8469039 DOI: 10.3390/ijerph18189723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022]
Abstract
In recent years, the necessity to prevent work-related diseases has led to the use of sensor-based systems to measure important features during working activities. This topic achieved great popularity especially in hazardous and demanding activities such as those required of firefighters. Among feasible sensor systems, wearable sensors revealed their advantages in terms of possibility to conduct measures in real conditions and without influencing the movements of workers. In addition, the advent of robotics can be also exploited in order to reduce work-related disorders. The present literature review aims at providing an overview of sensor-based systems used to monitor physiological and physical parameters in firefighters during real activities, as well as to offer ideas for understanding the potentialities of exoskeletons and assistive devices.
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Kothari K, Zuger C, Desai N, Leonard J, Alletag M, Balakas A, Binney M, Caffrey S, Kotas J, Mahar P, Roswell K, Adelgais KM. Effect of Repetitive Simulation Training on Emergency Medical Services Team Performance in Simulated Pediatric Medical Emergencies. AEM EDUCATION AND TRAINING 2021; 5:e10537. [PMID: 34099990 PMCID: PMC8166302 DOI: 10.1002/aet2.10537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Emergency medical services (EMS) professionals infrequently transport children leading to difficulty in recognition and management of pediatric critical illness. Simulation provides an opportunity to train EMS professionals on pediatric emergencies. The objective of this study was to examine the effect of serial simulation training over 6 months on EMS psychomotor and cognitive performance during team-based care. METHODS This was a longitudinal prospective study of a simulation curriculum enrolling EMS professionals over a 6-month period during which they performed three high-fidelity simulations at 3-month intervals. The simulation scenarios included a 15-month-old seizure (T0), 1-month-old with hypoglycemia (T1), and 4-year-old clonidine ingestion (T2). All scenarios were standardized and required recognition and management of respiratory failure and decompensated shock. Scenarios were videotaped and two investigators scored EMS team interventions during simulations using a standardized scoring tool. Inter-rater reliability was assessed on 30% of videos using kappa analysis. Volumes of administered intravenous fluid (IVF) and medications were measured to assess for errors in administration. The primary outcome was the change in scenario score from T0 to T2. RESULTS A total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T0, T1, and T2, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T0 to T2 (24 vs 31, p < 0.001, maximum score possible = 42). The proportion of completed tasks increased across multiple categories including improved recognition of respiratory decompensation (19% vs. 56%), management of the pediatric airway (44% vs. 88%), and timeliness of vascular access (10% vs. 38%). Correct IVF administration varied by scenario (25% vs. 52% vs. 30%, p = 0.02). CONCLUSION Serial simulation improved EMS team-based care in both recognition and management of pediatric emergencies. A standardized pediatric simulation curriculum can be used to train EMS professionals on pediatric emergencies and improve performance.
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Affiliation(s)
- Kathryn Kothari
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
- theDenver Health and Hospital AuthorityDenverCOUSA
| | - Chelsea Zuger
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Neil Desai
- theEmergency DepartmentBritish Columbia Children’s HospitalVancouverBritish ColumbiaCanada
| | - Jan Leonard
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Michelle Alletag
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Ashley Balakas
- theEmergency Medical Services Education and Outreach ProgramChildren’s Hospital ColoradoAuroraCOUSA
| | - Mike Binney
- theWest Metro Fire Protection DistrictLakewoodCOUSA
| | - Sean Caffrey
- and theEMS DivisionCrested Butte Fire Protection AuthorityCrested ButteCOUSA
| | - Jason Kotas
- theEmergency Medical Services Education and Outreach ProgramChildren’s Hospital ColoradoAuroraCOUSA
| | - Patrick Mahar
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Kelley Roswell
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Kathleen M. Adelgais
- From theDepartment of PediatricsSection of Pediatric Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
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Russo MJ, Han M, Desroches PE, Manasa CS, Dennaoui J, Quigley AF, Kapsa RMI, Moulton SE, Guijt RM, Greene GW, Silva SM. Antifouling Strategies for Electrochemical Biosensing: Mechanisms and Performance toward Point of Care Based Diagnostic Applications. ACS Sens 2021; 6:1482-1507. [PMID: 33765383 DOI: 10.1021/acssensors.1c00390] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Although there exist numerous established laboratory-based technologies for sample diagnostics and analyte detection, many medical and forensic science applications require point of care based platforms for rapid on-the-spot sample analysis. Electrochemical biosensors provide a promising avenue for such applications due to the portability and functional simplicity of the technology. However, the ability to develop such platforms with the high sensitivity and selectivity required for analysis of low analyte concentrations in complex biological samples remains a paramount issue in the field of biosensing. Nonspecific adsorption, or fouling, at the electrode interface via the innumerable biomolecules present in these sample types (i.e., serum, urine, blood/plasma, and saliva) can drastically obstruct electrochemical performance, increasing background "noise" and diminishing both the electrochemical signal magnitude and specificity of the biosensor. Consequently, this review aims to discuss strategies and concepts used throughout the literature to prevent electrode surface fouling in biosensors and to communicate the nature of the antifouling mechanisms by which they operate. Evaluation of each antifouling strategy is focused primarily on the fabrication method, experimental technique, sample composition, and electrochemical performance of each technology highlighting the overall feasibility of the platform for point of care based diagnostic/detection applications.
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Affiliation(s)
- Matthew J. Russo
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, Victoria 3216, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Mingyu Han
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, Victoria 3216, Australia
| | - Pauline E. Desroches
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, Victoria 3216, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Clayton S. Manasa
- ARC Centre of Excellence for Electromaterials Science, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Jessair Dennaoui
- School of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria 3000, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Anita F. Quigley
- School of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria 3000, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Robert M. I. Kapsa
- School of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria 3000, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
| | - Simon E. Moulton
- ARC Centre of Excellence for Electromaterials Science, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Victoria 3122, Australia
- Centre for Regional and Rural Futures, Deakin University, Geelong, Victoria 3220, Australia
| | - Rosanne M. Guijt
- Centre for Regional and Rural Futures, Deakin University, Geelong, Victoria 3220, Australia
| | - George W. Greene
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science, Deakin University, Melbourne, Victoria 3216, Australia
| | - Saimon Moraes Silva
- ARC Centre of Excellence for Electromaterials Science, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
- The Aikenhead Centre for Medical Discovery, St Vincent’s Hospital Melbourne, Melbourne, Victoria 3065, Australia
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Russo MJ, Quigley AF, Kapsa RMI, Moulton SE, Guijt R, Silva SM, Greene GW. A Simple Electrochemical Swab Assay for the Rapid Quantification of Clonazepam in Unprocessed Saliva Enabled by Lubricin Antifouling Coatings. ChemElectroChem 2020. [DOI: 10.1002/celc.202000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Matthew J. Russo
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science Deakin University Melbourne Victoria 3216 Australia
- BioFab3D@ACMD St Vincent's Hospital Melbourne Melbourne Victoria 3065 Australia
| | - Anita F. Quigley
- School of Electrical and Biomedical Engineering RMIT University Melbourne Victoria 3000 Australia
- BioFab3D@ACMD St Vincent's Hospital Melbourne Melbourne Victoria 3065 Australia
| | - Robert M. I. Kapsa
- School of Electrical and Biomedical Engineering RMIT University Melbourne Victoria 3000 Australia
- BioFab3D@ACMD St Vincent's Hospital Melbourne Melbourne Victoria 3065 Australia
| | - Simon E. Moulton
- ARC Centre of Excellence for Electromaterials Science Faculty of Science Engineering and Technology Swinburne University of Technology Melbourne Victoria 3122 Australia
- Iverson Health Innovation Research Institute Swinburne University of Technology Victoria 3122 Australia
| | - Rosanne Guijt
- Centre for Regional and Rural Futures Deakin University Geelong VIC 3220 Australia
| | - Saimon M. Silva
- ARC Centre of Excellence for Electromaterials Science Faculty of Science Engineering and Technology Swinburne University of Technology Melbourne Victoria 3122 Australia
- BioFab3D@ACMD St Vincent's Hospital Melbourne Melbourne Victoria 3065 Australia
| | - George W. Greene
- Institute for Frontier Materials and ARC Centre of Excellence for Electromaterials Science Deakin University Melbourne Victoria 3216 Australia
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Honno K, Kubo T, Toyokuni Y, Ishimaru T, Matsuda S, Fujino Y. Relationship between the depressive state of emergency life-saving technicians and near-misses. Acute Med Surg 2020; 7:e463. [PMID: 31988775 PMCID: PMC6971434 DOI: 10.1002/ams2.463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
Aim A depressive state is a key risk factor for medical errors made by emergency life-saving technicians (ELSTs). However, no study has examined the occurrence of near-misses in ELSTs. We investigated the association between a depressive state and near-misses among ELSTs. Methods A cross-sectional study was undertaken in 345 ELSTs using an anonymous self-administered questionnaire. The main exposure was a depressive state that was measured using the Quick Inventory of Depressive Symptomatology. For the main outcome, near-miss events, we calculated odds ratios (OR) of depressive states, adjusted for age and work-related factors by multivariable logistic regression. For exploratory purposes, we also undertook secondary analyses to determine whether work-related factors were associated with a depressive state. Results We obtained 254 responses. Compared to ELSTs without a depressive state, the adjusted OR for near-misses among ELSTs with a mild depressive state was 3.14 (95% confidence interval [CI], 1.37-7.16; P = 0.007), and that among ELSTs with a moderate or greater depressive state was 5.29 (95% CI, 1.46-19.09; P = 0.011). For a depressive state, in the exploratory analyses, the OR of nap duration while on duty for less than 2 h was 3.34 (95% CI, 1.15-9.67; P = 0.027), that for irregular mealtime while on duty was 3.71 (95% CI, 2.00-6.86; P < 0.001), and that for a duration of desk work of 4 h or longer was 2.21 (95% CI, 1.15-4.25; P = 0.017). Conclusion A depressive state was significantly associated with the occurrence of near-misses among ELSTs. That a depressive state among ELSTs was related to nap duration and excessive office work indicates that improved management of the work environment and operations of ELSTs is necessary for the provision of safe emergency medical services.
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Affiliation(s)
- Katsumi Honno
- Department of Public Health School of Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Yoshiki Toyokuni
- Department of Public Health School of Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Tomohiro Ishimaru
- Department of Health Management Nishinihon Occupational Health Service Center Kitakyushu Japan.,Department of Occupational Health Practice and Management Institute of Industrial Ecological Sciences University of Occupational and Environmental Health Kitakyushu Japan
| | - Shinya Matsuda
- Department of Public Health School of Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology Institute of Industrial Ecological Sciences University of Occupational and Environmental Health Kitakyushu Japan
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Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf 2019; 10:2042098618821916. [PMID: 30728945 PMCID: PMC6351968 DOI: 10.1177/2042098618821916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022] Open
Abstract
Lack of verification is often cited as a root cause of medication errors; however, medication errors occur in spite of conventional verification practices and it appears that human factors engineering (HFE) can inform the design of a more effective method. To this end, an HFE-driven process was designed and implemented in an urban, Midwestern emergency medical service agency. Medication error data were collected over a 54-month period, 27 months before and after implementation. A decrease in the average monthly error rate was realized for all medications administered (49.0%) during the post-intervention time period. The average monthly error rate for fentanyl, a commonly administered analgesic, demonstrated a 71.1% error rate decrease. This study is the first to evaluate the effectiveness of a team-based cross-check process for medication verification to prevent errors in the prehospital setting.
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Affiliation(s)
- Paul Misasi
- Wichita State University, 1845 N. Fairmount, Wichita, KS, 67260, USA
| | - Joseph R Keebler
- Associate Professor, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
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Sinclair JE, Austin MA, Bourque C, Kortko J, Maloney J, Dionne R, Reed A, Price P, Calder LA. Barriers to Self-Reporting Patient Safety Incidents by Paramedics: A Mixed Methods Study. PREHOSP EMERG CARE 2018; 22:762-772. [PMID: 29787325 DOI: 10.1080/10903127.2018.1469703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND A minimal amount of research exists examining the extent to which patient safety events occur within paramedicine and even fewer studies investigating patient safety systems for self-reporting by paramedics. The purpose of this study was to identify barriers to paramedic self-reporting of patient safety incidents (PSIs). METHODS We randomly distributed paper-based surveys among 1,153 paramedics in an Ontario region in Canada. The survey described one of 5 different PSI clinical scenarios (near miss, adverse event, and minor, major or critical patient care variances) and listed 18 potential barriers to self-reporting PSIs as statements presented for rating on a 5-point Likert scale (very significant = 1 - very insignificant = 5). We invited comments on PSI self-reporting with 2 open-ended questions. We analyzed data with descriptive statistics, chi-square tests and Kruskal-Wallis H test. We used an inductive approach to qualitatively analyze emerging themes. RESULTS We received responses from 1,133 paramedics (98.3%). Almost one third (28.4%) were Advanced Care Paramedics and 45.1% had >10 years' experience. The top 5 barriers to PSI self-reporting (very significant or significant, %) were the fear of being: punished (81.4%), suspended (79.6%), terminated (79.1%), investigated by Ministry of Health and Long-Term Care (78.4%), and decertified (78.0%). Overall, 64.1% responded they would self-report a given PSI. Intention to self-report a PSI varied according to scenario (22.8% near miss, 46.6% adverse event, 74.4% minor, 92.6% major, 95.6% critical). No association was found between level of training (p = 0.55) or years of experience (p = 0.10) and intention to self-report a PSI. Seven themes to improve PSI self-reporting by paramedics emerged from the qualitative data. CONCLUSIONS A high proportion of fear-based barriers to self-reporting of PSIs exist among this study population. This suggests that a culture change is needed to facilitate the identification of future patient safety threats.
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Hoyle JD, Crowe RP, Bentley MA, Beltran G, Fales W. Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics. PREHOSP EMERG CARE 2017; 21:185-191. [DOI: 10.1080/10903127.2016.1227001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hoyle JD, Sleight D, Henry R, Chassee T, Fales B, Mavis B. Pediatric Prehospital Medication Dosing Errors: A Mixed-Methods Study. PREHOSP EMERG CARE 2015; 20:117-24. [DOI: 10.3109/10903127.2015.1061625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stevens AD, Hernandez C, Jones S, Moreira ME, Blumen JR, Hopkins E, Sande M, Bakes K, Haukoos JS. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial. Resuscitation 2015; 96:85-91. [PMID: 26247145 DOI: 10.1016/j.resuscitation.2015.07.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/09/2015] [Accepted: 07/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. METHODS We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. RESULTS Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28-39) seconds and 42 (95% CI: 36-51) seconds, respectively (difference=9 [95% CI: 4-14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference=39%, 95% CI: 13-61%). CONCLUSIONS A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations.
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Affiliation(s)
- Allen D Stevens
- Department of Medicine, National Jewish Health, Denver, CO, USA; Division of Emergency Medical Services, Platte Valley Medical Center, Brighton, CO, USA
| | - Caleb Hernandez
- Department of Emergency Medicine, University of Northern Colorado Medical Center, Greeley, CO, USA
| | - Seth Jones
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Maria E Moreira
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason R Blumen
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Margaret Sande
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Bakes
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Understanding Multiteam Systems in Emergency Care: One Case at a Time. ACTA ACUST UNITED AC 2014. [DOI: 10.1108/s1534-085620140000016007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Cottrell EK, O'Brien K, Curry M, Meckler GD, Engle PP, Jui J, Summers C, Lambert W, Guise JM. Understanding safety in prehospital emergency medical services for children. PREHOSP EMERG CARE 2014; 18:350-8. [PMID: 24669906 DOI: 10.3109/10903127.2013.869640] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services (EMS), particularly in regard to children. Roughly 27.7 million (or 27%) of the annual emergency department visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. METHODS We conducted four 8- to 12-person focus groups among paid and volunteer EMS providers to understand 1) patient safety issues that occur in the prehospital care of children, and 2) factors that contribute to these safety issues (e.g., patient, family, systems, environmental, or individual provider factors). Focus groups were conducted in rural and urban settings. Interview transcripts were coded for overarching themes. RESULTS Key factors and themes identified in the analysis were grouped into categories using an ecological approach that distinguishes between systems, team, child and family, and individual provider level contributors. At the systems level, focus group participants cited challenges such as lack of appropriately sized equipment or standardized pediatric medication dosages, insufficient human resources, limited pediatric training and experience, and aspects of emergency medical services culture. EMS team level factors centered on communication with other EMS providers (both prehospital and hospital). Family and child factors included communication barriers and challenging clinical situations or scene characteristics. Finally, focus group participants highlighted a range of provider level factors, including heightened levels of anxiety, insufficient experience and training with children, and errors in assessment and decision making. CONCLUSIONS The findings of our study suggest that, just as in hospital medicine, factors at the systems, team, child/family, and individual provider level system contribute to errors in prehospital emergency care. These factors may be modifiable through interventions and systems improvements. Future studies are needed to ascertain the generalizability of these findings and further refine the underlying mechanisms.
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Lammers R, Willoughby-Byrwa M, Fales W. Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis. PREHOSP EMERG CARE 2014; 18:295-304. [DOI: 10.3109/10903127.2013.856501] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Disclosure of Harmful Medical Errors in Out-of-Hospital Care. Ann Emerg Med 2013; 61:215-21. [DOI: 10.1016/j.annemergmed.2012.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 12/24/2022]
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Hoyle JD, Davis AT, Putman KK, Trytko JA, Fales WD. Medication dosing errors in pediatric patients treated by emergency medical services. PREHOSP EMERG CARE 2011; 16:59-66. [PMID: 21999707 DOI: 10.3109/10903127.2011.614043] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medication dosing errors occur in up to 17.8% of hospitalized children. There are limited data to describe pediatric medication errors by emergency medical services (EMS) paramedics. It has been shown that paramedics have infrequent encounters with pediatric patients. OBJECTIVE To characterize medication dosing errors in children treated by EMS. METHODS We studied patients aged ≤11 years who were treated by paramedics from eight Michigan EMS agencies from January 2004 through March 2006. We defined a medication dosing error as ≥20% deviation from the weight-appropriate dose, as determined by the patient's reported weight in the prehospital medical record or by use of the Broselow-Luten tape (BLT). We studied errors in administering six EMS medications commonly given to children: albuterol, atropine, dextrose, diphenhydramine, epinephrine, and naloxone. RESULTS There were 5,547 children aged ≤11 years who were treated during the study period, of whom 230 (4.1%) received drugs and had a documented weight. These patients received a total of 360 medication administrations. Multiple drug administrations occurred in 73 cases. Medication dosing errors occurred in 125 of the 360 drug administrations (34.7%; 95% confidence interval [CI] 30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows: albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine 53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine overdoses was 808% ± 428%. The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% ± 27.4%. CONCLUSIONS Medications delivered in the prehospital care of children were frequently administered outside of the proper dose range when compared with patient weights recorded in the prehospital medical record. EMS systems should develop strategies to reduce pediatric medication dosing errors.
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Affiliation(s)
- John D Hoyle
- Emergency Department, Helen DeVos Children's Hospital/Michigan State University College of Human Medicine, Grand Rapids, Michigan 49503, USA.
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Handly N, Bass RR, New JP, Chang DC. Effect of patient age on airway response by paramedics: frailty or futility? PREHOSP EMERG CARE 2011; 15:351-8. [PMID: 21612387 DOI: 10.3109/10903127.2011.561402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We studied patterns related to patient age and indication for airway interventions delivered by paramedics from 2000 through 2004. METHODS The study population included patients ≥ 15 years old managed by paramedics. Outcomes were the frequencies of definitive airway, ventilatory techniques, and oxygenation techniques. Independent variables were patient age, gender, race, hospital drive time, do-not-resuscitate status, and two trauma indicators of the American College of Surgeons Committee on Trauma (anatomic injury and mechanism of injury). Subset analysis was performed with the presence or absence of a set of recorded conditions. RESULTS A total of 827,772 paramedic transports were studied; 233,470 were identified with at least one indication for airway intervention. Patients older than 65 years were, when compared with patients 65 years old or younger, 1) less likely to receive ventilatory interventions with any indication; 2) more likely to receive ventilatory intervention without an indication; and 3) more likely to receive oxygenation interventions whether indications were present or not. We considered age in five-year intervals and noted a consistent biphasic pattern for all interventions, regardless of indications. The odds ratios for interventions for patients in each block compared with those for 15- to 29-year-old patients increased with age until about 70 years of age, then gradually declined. CONCLUSIONS Patterns of age-related variations in airway interventions cannot be explained by the application of protocols. The reason for the peak rate of interventions at age 70 years is unknown. Explanations need to consider the influence on paramedic behavior of a number of factors, including frailty and futility. Additional paramedic training may be needed to change these patterns.
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Affiliation(s)
- Neal Handly
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
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Fairbanks RJ, Crittenden CN, O'Gara KG, Wilson MA, Pennington EC, Chin NP, Shah MN. Emergency medical services provider perceptions of the nature of adverse events and near-misses in out-of-hospital care: an ethnographic view. Acad Emerg Med 2008; 15:633-40. [PMID: 19086213 DOI: 10.1111/j.1553-2712.2008.00147.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near-misses and adverse events in out-of-hospital care. METHODS This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near-misses and adverse events in out-of-hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated. RESULTS Fifteen in-depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near-misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (< 19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a "blame-and-shame" culture. CONCLUSIONS Adverse events and near-misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis-generating themes are generalizable to the EMS community as a whole.
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Affiliation(s)
- Rollin J Fairbanks
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
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