Characterization of non-cardiac arrest PulsePoint activations in public and private settings

BACKGROUND

Geospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated.

METHODS

We undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients.

RESULTS

Of 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68).

CONCLUSIONS

More than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped.

Acceptability and Preferences of Simulation-Based Continuing Education Among Emergency Medical Service Providers

INTRODUCTION

Simulation-based education (SBE) has been shown to be an effective and accepted teaching modality across multiple fields of medical education. Prehospital systems currently utilize simulation for initial training; however, few studies have determined the acceptability for simulation-based training for continued education among emergency medical service (EMS) providers.

METHODS

We performed a retrospective mixed method review of data from prehospital provider evaluations of high-fidelity SBE training sessions. Survey responses included questions on a Likert scale pertaining to acceptability of the training, as well as free-text comments. Providers included a mix of crews with varying levels of training.

RESULTS

We received a 96% response rate for providers who completed the training. Participants rated simulation as an educational tool and the overall value of the session highly for EMS providers across all levels of training with no difference among training level. All providers also indicated they would like similar training on a frequent basis in the future.

CONCLUSION

Simulation-based education was found to be an acceptable tool for EMS training and should be considered for use during continuing education for all levels of practicing EMS providers. In addition, EMS providers indicated a preference for participating in SBE on a frequent basis. EMS training programs should consider incorporating more frequent SBE.

Case Report of a Left-sided Superior Vena Cava Causing Unique Positioning of Central Line

Introduction

Persistent left-sided superior vena cava is a rare congenital venous malformation. While often clinically asymptomatic, these variations in normal anatomy may give rise to complications with central venous catheter placement.

Case Report

We present a case of a 71-year-old male who presented to the emergency department with sepsis of unknown etiology. A right-sided central venous catheter was placed, and due to a persistent left-sided superior vena cava the post-procedure chest radiograph showed a uniquely positioned catheter tip within the left atrium.

Conclusion

A persistent left-sided superior vena cava may lead to uniquely positioned catheter tip placement on post-procedural imaging. This case demonstrates the need to consider variants in normal venous anatomy, such as persistent left-sided superior vena cava, to aid with correct interpretation of post-procedure imaging findings.

Kinetic approach for the study of noncovalent interaction between [Ru(NH3)5pz]2+ and gold nanoparticles

Gold nanoparticles (AuNPs) capped with N-(2-mercaptopropionyl)glycine have been used to study the strength and character of the binding of a cationic metal complex, [Ru(NH3)5pz]2+ (pz = pyrazine), at pH = 8, to these nanoparticles. The strength of the binding has been studied using a kinetic approach consisting of the study of the kinetics of the oxidation of this ruthenium complex by S2O82- at different NaCl concentrations. When the ionic strength increases, the strength of the binding decreases, as a consequence of the partial neutralization of the charge on the AuNPs which, at pH = 8, has the tiopronin residue negatively charged. The increase of the ionic strength also produces a change in the character of the binding, which changes from anticooperative to noncooperative when the ionic strength increases. The nonelectrostatic and electrostatic components of the free energy of binding are determined. From the latter, we have obtained the values of the electrostatic potential differences at the AuNPs/solutions interface.