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Kumpula EK, Todd VF, O'Byrne D, Dicker BL, Pomerleau AC. Naloxone use by Aotearoa New Zealand emergency medical services, 2017-2021. Emerg Med Australas 2024; 36:356-362. [PMID: 38037538 DOI: 10.1111/1742-6723.14358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/30/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Emergency medical services (EMS) use of naloxone in the prehospital setting is indicated in patients who have significantly impaired breathing or level of consciousness when opioid intoxication is suspected. The present study characterised naloxone use in a nationwide sample of Aotearoa New Zealand road EMS patients to establish a baseline for surveillance of any changes in the future. METHODS A retrospective analysis of rates of patients with naloxone administrations was conducted using Hato Hone St John (2017-2021) and Wellington Free Ambulance (2018-2021) electronic patient report form datasets. Patient demographics, presenting complaints, naloxone dosing, and initial and last vital sign clinical observations were described. RESULTS There were 2018 patients with an equal proportion of males and females, and patient median age was 47 years. There were between 8.0 (in 2018) and 9.0 (in 2020) naloxone administrations per 100 000 population-years, or approximately one administration per day for the whole country of 5 million people. Poisoning by unknown agent(s) was the most common presenting complaint (61%). The median dose of naloxone per patient was 0.4 mg; 85% was administered intravenously. The median observed change in Glasgow Coma Scale score was +1, and respiratory rate increased by +2 breaths/min. CONCLUSIONS A national rate of EMS naloxone patients was established; measured clinical effects of naloxone were modest, suggesting many patients had reasons other than opioid toxicity contributing to their symptoms. Naloxone administration rates provide indirect surveillance information about suspected harmful opioid exposures but need to be interpreted with care.
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Affiliation(s)
| | - Verity F Todd
- Hato Hone St John, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - David O'Byrne
- Te Whatu Ora Hutt Hospital, Lower Hutt, New Zealand
- Wellington Free Ambulance, Wellington, New Zealand
| | - Bridget L Dicker
- Hato Hone St John, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Adam C Pomerleau
- National Poisons Centre, University of Otago, Dunedin, New Zealand
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2
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Wenstrup J, Hestoy BH, Sagar MV, Blomberg SNF, Christensen H, Christensen HC, Kruuse C. Emergency Medical Services dispatcher recognition of stroke: A systematic review. Eur Stroke J 2024; 9:283-294. [PMID: 38174575 DOI: 10.1177/23969873231223339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke. METHODS The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument. FINDINGS Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low. DISCUSSION Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented. CONCLUSION While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.
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Affiliation(s)
- Jonathan Wenstrup
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Emergency Medical Services, Copenhagen, Denmark
- Emergency Medical Services, Region Zealand, Denmark
| | - Bartal Hofgaard Hestoy
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Malini Vendela Sagar
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Emergency Medical Services, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Brain- and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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3
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Johnsen AM, Wagman P, Broström A, Fransson EI. Work-, lifestyle-, and health-related factors among women and men working in the emergency medical services. Int J Occup Saf Ergon 2024; 30:651-661. [PMID: 38632949 DOI: 10.1080/10803548.2024.2332115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.
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Affiliation(s)
- Anna M Johnsen
- School of Health and Welfare, Jönköping University, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Sweden
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Sweden
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4
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Cheetham A, Babcock L, Hartwell V, Schwartz H, Bensman R, Lee SH, Riney L, Semenova O, Zhang Y, Pomerantz WJ. Emergency department pediatric mental and behavioral health patients transported by EMS and police: Trends and interventions. Acad Pediatr 2024:S1876-2859(24)00157-8. [PMID: 38754700 DOI: 10.1016/j.acap.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE We aimed to understand transport utilization trends, demographics, Emergency Department (ED) interventions, and outcomes of pediatric mental and behavioral health (MBH) patients transported by emergency medical services (EMS), police, or self-transported. METHODS This retrospective cohort study utilized electronic health record data from patients aged 5-18 years presenting with acute MBH conditions at two affiliated pediatric EDs from January 2012 to December 2020. Data included demographics, ED interventions for aggression/agitation, Brief Rating of Aggression by Children and Adolescents (BRACHA) scores, and ED dispositions. Descriptive statistics and comparative analyses were conducted using Chi-square, Wilcoxon rank sum tests, and multivariable logistic regression. Linear regression analyzed trends. RESULTS Of 440,302 ED encounters, 70,557 (16%) were for acute MBH concerns, with 14.6% transported by EMS and 5.9% by police. The proportion of MBH visits increased from 9.9% in 2012 to 19.8% in 2020 (95% CI [0.7, 1.7], p = 0.0009), with a concurrent 0.4% annual increase in those transported by EMS (95% CI [0.2, 0.6], p = 0.006). MBH patients transported by EMS and police had significantly higher odds of requiring restraint in the ED and were more likely to have higher BRACHA scores, and to be admitted compared to self-transported patients (all comparisons p < 0.001). CONCLUSIONS Pediatric MBH ED visits and EMS utilization are increasing. MBH patients transported by EMS and police may represent a more aggressive ED population. Given the rising encounters within this high-risk population, our EDs, EMS, and police need support and resources for safe pediatric MBH patient management. WHAT'S NEW With higher numbers of pediatric mental and behavioral health (MBH) patients transported by EMS or police requiring ED interventions for agitation/aggression, this study reveals insights into their high-acuity. Notably unique, it includes pediatric MBH patients transported by police.
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Affiliation(s)
- Alexandra Cheetham
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Lynn Babcock
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Victoria Hartwell
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Hamilton Schwartz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Rachel Bensman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Sang Hoon Lee
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Lauren Riney
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Olga Semenova
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | - Wendy J Pomerantz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center. 3333 Burnet Ave, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine. 3230 Eden Ave, Cincinnati, OH 45267, USA.
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Gottula AL, Qi M, Lane BH, Shaw CR, Gorder K, Powell E, Danielson K, Ciullo A, Johnson NJ, Tonna JE, Hinckley WR, Koshoffer A, Al-Araji R, Bartos J, Benoit J, Hsu CH. Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model. PREHOSP EMERG CARE 2024:1-27. [PMID: 38739864 DOI: 10.1080/10903127.2024.2355652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Evidence suggests that Extracorporeal Cardiopulmonary Resuscitation (ECPR) can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, when ECPR is indicated over 50% of potential candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the United States in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR Helicopter Emergency Medical Services (HEMS)-based system. METHODS We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. Emergency Medical Services (EMS) response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial. The combined model was used to estimate the total ECPR eligibility in each system. RESULTS The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical criteria, 24,661 (3.4%) ECPR-indicated OHCA were identified. When considering overall ECPR eligibility within 45 minutes from OHCA to initiation, only 11.76% of OHCA where ECPR was indicated were eligible in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%). CONCLUSIONS The study demonstrates a two-fold increase in ECPR eligibility for a field-deployable ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based OHCA system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine, University of Michigan
- Department of Anesthesiology, University of Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation
| | - Man Qi
- Department of Geography and Geographic Information System, The University of Cincinnati
| | - Bennett H Lane
- Department of Emergency Medicine, University of Cincinnati
| | - Christopher R Shaw
- Department of Emergency Medicine, Division of Critical Care, Oregon Health and Science University
| | - Kari Gorder
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital
| | | | | | - Anna Ciullo
- Department of Emergency Medicine, University of Utah
| | - Nicholas J Johnson
- Department of Emergency Medicine & Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington
| | | | - William R Hinckley
- Department of Emergency Medicine, University of Cincinnati
- UC Health, Air Care and Mobile Care
| | - Amy Koshoffer
- University of Cincinnati Libraries, The University of Cincinnati
| | | | - Jason Bartos
- Center for Resuscitation Medicine, The University of Minnesota
| | - Justin Benoit
- Department of Emergency Medicine, University of Cincinnati
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation
- Department of Surgery, University of Michigan
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6
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Law G, Cooper R, Pirrie M, Ferron R, McLeod B, Spaight R, Siriwardena AN, Agarwal G. Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study. JMIR Public Health Surveill 2024; 10:e46029. [PMID: 38728683 PMCID: PMC11090162 DOI: 10.2196/46029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/24/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic impacted mental health and health care systems worldwide. OBJECTIVE This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. METHODS An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. RESULTS Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. CONCLUSIONS The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences.
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Affiliation(s)
- Graham Law
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincolnshire, United Kingdom
| | - Rhiannon Cooper
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Ferron
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Niagara Emergency Medical Services, Niagara, ON, Canada
| | - Brent McLeod
- Hamilton Paramedic Service, Hamilton, ON, Canada
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, Nottingham, United Kingdom
| | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincolnshire, United Kingdom
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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7
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Fozard J, Becker B, Lurie T, Dasti A. Accuracy of Prehospital Services' Estimated Time to Arrival for Ground Transport to the Emergency Department. J Emerg Med 2024; 66:e581-e588. [PMID: 38553364 DOI: 10.1016/j.jemermed.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/08/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
BACKGROUND Emergency medical services (EMS) transporting patients to the emergency department (ED) typically call ahead to provide an estimated time to arrival (ETA). Accurate ETA facilitates ED preparation and resource allotment in anticipation of patient arrival. OBJECTIVE The study purposed to determine the accuracy of ETA provided by EMS ground units. METHODS We performed a single-center, prospective, observational study of ED patients arriving via EMS ground transport. The primary outcome was the time difference between EMS-reported ETA and actual time of arrival (ATA). The difference between ATA and ETA was compared using the two-sided Wilcoxon Signed-Rank Test. Subgroup analysis was performed to evaluate ETA accuracy for specific types of transports and assess variability by month and time of day. RESULTS We included 1176 patient transports in the final analysis. The overall median difference ATA-ETA was 3 min (interquartile range 1-5 min) with a range of -26-48 minutes (Z = -25.139, p < 0.001). EMS underestimated ETA in 961 cases (81.7%), and 94 ETAs (8.0%) were accurate to within 1 min. The largest difference between ATA and ETA occurred between 07:00-07:59 and 16:00-16:59 (5 min, interquartile range 2-7). CONCLUSION Our data demonstrate that prehospital providers underestimate time to ED arrival in most ground transports; however, the median difference between estimated and actual time to arrival is small.
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Affiliation(s)
- Jessica Fozard
- Department of Emergency Medicine, WellSpan York Hospital, York, Pennsylvania
| | - Brent Becker
- Department of Emergency Medicine, WellSpan York Hospital, York, Pennsylvania
| | - Tucker Lurie
- Department of Emergency Medicine, WellSpan York Hospital, York, Pennsylvania
| | - Aizad Dasti
- Department of Emergency Medicine, WellSpan York Hospital, York, Pennsylvania
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8
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Ward CE, Badolato GM, Taylor MF, Brown KM, Simpson JN, Chamberlain JM. Prevalence of Low-Acuity Pediatric Emergency Medical Services Transports to a Pediatric Emergency Department in an Urban Area. Pediatr Emerg Care 2024; 40:347-352. [PMID: 38355133 PMCID: PMC11096070 DOI: 10.1097/pec.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many patients transported by Emergency Medical Services (EMS) do not have emergent resource needs. Estimates for the proportion of pediatric EMS calls for low-acuity complaints, and thus potential candidates for alternative dispositions, vary widely and are often based on physician judgment. A more accurate reference standard should include patient assessments, interventions, and dispositions. The objective of this study was to describe the prevalence and characteristics of low-acuity pediatric EMS calls in an urban area. METHODS This is a prospective observational study of children transported by EMS to a tertiary care pediatric emergency department. Patient acuity was defined using a novel composite measure that included physiologic assessments, resources used, and disposition. Bivariable and multivariable logistic regression were conducted to assess for factors associated with low-acuity status. RESULTS A total of 996 patients were enrolled, of whom 32.9% (95% confidence interval, 30.0-36.0) were low acuity. Most of the sample was Black, non-Hispanic with a mean age of 7 years. When compared with adolescents, children younger than 1 year were more likely to be low acuity (adjusted odds ratio, 3.1 [1.9-5.1]). Patients in a motor vehicle crash were also more likely to be low acuity (adjusted odds ratio, 2.4 [1.2-4.6]). All other variables, including race, insurance status, chief complaint, and dispatch time, were not associated with low-acuity status. CONCLUSIONS One third of pediatric patients transported to the pediatric emergency department by EMS in this urban area are for low-acuity complaints. Further research is needed to determine low-acuity rates in other jurisdictions and whether EMS providers can accurately identify low-acuity patients to develop alternative EMS disposition programs for children.
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Affiliation(s)
| | - Gia M Badolato
- From the Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Michael F Taylor
- From the Division of Emergency Medicine, Children's National Hospital, Washington, DC
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9
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Fishe JN, Crisp AM, Riney L, Bertrand A, Burcham S, Hendry P, Semenova O, Blake KV, Salloum RG. Evaluation of the implementation of evidence-based pediatric asthma exacerbation treatments in a regional consortium of emergency medical Services Agencies. J Asthma 2024; 61:405-416. [PMID: 37930329 PMCID: PMC11035098 DOI: 10.1080/02770903.2023.2280917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Asthma exacerbations are a frequent reason for pediatric emergency medical services (EMS) encounters. The objective of this study was to examine the implementation of evidence-based treatments for pediatric asthma in a regional consortium of EMS agencies. METHODS This retrospective study applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework to data from an EMS agency consortium in the Cincinnati, Ohio region. The study analyzed one year before an oral systemic corticosteroid (OCS) option was added to the agencies' protocol, and five years after the protocol change. We constructed logistic regression models for the primary outcome of Reach, defined as the proportion of pediatric asthma patients who received a systemic corticosteroid. We modeled Maintenance (Reach measured monthly over time) using time series models. RESULTS A total of 713 patients were included, 133 pre- and 580 post-protocol change. In terms of Reach, 3% (n = 4) of eligible patients received a systemic corticosteroid pre-OCS versus 20% (n = 116) post-OCS. Multivariable modeling of Reach revealed the study period, EMS transport time, months since implementation of OCS, and number of bronchodilators administered by EMS as significant covariates for the administration of a systemic corticosteroid. For Maintenance, it took approximately two years to reach maximal administration of systemic corticosteroids. CONCLUSIONS Indicators of asthma severity and time since the protocol change were significantly associated with EMS administration of systemic corticosteroids to pediatric asthma patients. The two-year time for maximal Reach suggests further work is required to understand how to best implement evidence-based pediatric asthma treatments in EMS.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Amy M Crisp
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Lauren Riney
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Bertrand
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Shannon Burcham
- Department of Pediatrics, University of Florida College of Medicine, Cincinnati, OH, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Olga Semenova
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn V Blake
- Nemours Center for Pharmacogenomics and Translational Research, Nemours Children's Clinic, Pensacola, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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10
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Accorsi TAD, Eduardo AA, Moreira FT, Morbeck RA, Köhler KF, Lima KDA, Pedrotti CHS. Adherence to Emergency Department Referral Criteria in a Direct-to-Consumer Telemedicine Center. Telemed J E Health 2024; 30:1418-1424. [PMID: 38377569 DOI: 10.1089/tmj.2023.0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background: The safety of direct-to-consumer telemedicine (TM) is closely related to red flag detection and correct referrals. The adherence to referral criteria from current guidelines is not well quantified. Objective: To analyze the emergency department (ED) referral rate and adherence to referral guidelines in TM encounters of acutely ill patients calling a center that adopts stewardship protocols. Methods: This is a retrospective observational unicentric study, between March 2020 and March 2022, with patients who spontaneously sought direct-to-consumer urgent virtual medical assistance. A video-based teleconsultation was provided immediately after connection. Physicians managed situations according to their clinical judgment. Current guidelines, containing specific guidance for referral if red flags were identified, were available for consultation. Physicians' semiannual performance feedback was carried out. We analyzed the patterns for referral to immediate face-to-face medical evaluation and the agreement degree with the institutional guidelines. Results: A total of 232,197 patients were available, and 14,051 (6.05%) patients were referred to ED. A total of 8,829 (68.4%) referrals were based in specific guidelines according to the International Classification of Diseases hypothesis, and 8,708 (98.6%) were justified according to guidelines. Diarrhea had the highest guidelines' adherence to referral (97.6%), followed by COVID-19 (90%), headache (84.2%), and conjunctivitis (78.8%). Policies did not support 5,222 (31.6%) referrals, though 5,100 (97.6%) of these were justified according to the doctor's clinical judgment. Conclusion: TM doctors' assessment of acutely ill patients has high rates of adherence to guidelines regarding referral. Stewardship protocol adoption provides high rates of red flag description, even in the referral of nonpolicy diseases.
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Ramgopal S, Owusu-Ansah S, Crowe RP, Okubo M, Martin-Gill C. Association of midazolam route of administration and need for recurrent dosing among children with seizures cared for by emergency medical services. Epilepsia 2024; 65:1294-1303. [PMID: 38470335 DOI: 10.1111/epi.17940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE National guidelines in the United States recommend the intramuscular and intranasal routes for midazolam for the management of seizures in the prehospital setting. We evaluated the association of route of midazolam administration with the use of additional benzodiazepine doses for children with seizures cared for by emergency medical services (EMS). METHODS We conducted a retrospective cohort study from a US multiagency EMS dataset for the years 2018-2022, including children transported to the hospital with a clinician impression of seizures, convulsions, or status epilepticus, and who received an initial correct weight-based dose of midazolam (.2 mg/kg intramuscular, .1 mg/kg intravenous, .2 mg/kg intranasal). We evaluated the association of route of initial midazolam administration with provision of additional benzodiazepine dose in logistic regression models adjusted for age, vital signs, pulse oximetry, level of consciousness, and time spent with the patient. RESULTS We included 2923 encounters with patients who received an appropriate weight-based dose of midazolam for seizures (46.3% intramuscular, 21.8% intranasal, 31.9% intravenous). The median time to the first dose of midazolam from EMS arrival was similar between children who received intramuscular (7.3 min, interquartile range [IQR] = 4.6-12.5) and intranasal midazolam (7.8 min, IQR = 4.5-13.4) and longer for intravenous midazolam (13.1 min, IQR = 8.2-19.4). At least one additional dose of midazolam was given to 21.4%. In multivariable models, intranasal midazolam was associated with higher odds (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.10-1.76) and intravenous midazolam was associated with similar odds (OR = 1.00, 95% CI = .80-1.26) of requiring additional doses of benzodiazepines relative to intramuscular midazolam. SIGNIFICANCE Intranasal midazolam was associated with greater odds of repeated benzodiazepine dosing relative to initial intramuscular administration, but confounding factors could have affected this finding. Further study of the dosing and/or the prioritization of the intranasal route for pediatric seizures by EMS clinicians is warranted.
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Affiliation(s)
- Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sylvia Owusu-Ansah
- Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Tetzlaff EJ, Cassan C, Goulet N, Gorman M, Hogya B, Kenny GP. "Breaking down in tears, soaked in sweat, and sick from the heat": Media-based composite narratives of first responders working during the 2021 Heat Dome. Am J Ind Med 2024; 67:442-452. [PMID: 38460501 DOI: 10.1002/ajim.23576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat-vulnerable community members succumbing to the heat. With 103 all-time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system-level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services. METHODS A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media-based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands-Resources (JD-R) model was applied as a theoretical framework for occupational burnout. RESULTS The media-based composite narratives highlighted that first responders faced record-breaking call volumes, increased mental-health-related claims, and exhaustive heat-related physiological stress. Using the JD-R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat-related illness). CONCLUSION The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system.
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Affiliation(s)
- Emily J Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Casey Cassan
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Melissa Gorman
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Brooks Hogya
- BC Emergency Health Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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13
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Jarman MP, Jin G, Chen A, Losina E, Weissman JS, Berry SD, Salim A. Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury. J Am Geriatr Soc 2024; 72:1384-1395. [PMID: 38418369 PMCID: PMC11090711 DOI: 10.1111/jgs.18830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. METHODS We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. RESULTS Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. CONCLUSIONS Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
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Affiliation(s)
- Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Annie Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena Losina
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woemn's Hospital, Boston, Massachusetts, United States
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Mausz J, Piquette D, Bradford R, Johnston M, Batt AM, Donnelly EA. Hazard Flagging as a Risk Mitigation Strategy for Violence against Emergency Medical Services. Healthcare (Basel) 2024; 12:909. [PMID: 38727466 PMCID: PMC11083417 DOI: 10.3390/healthcare12090909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Paramedics are increasingly being subjected to violence, creating the potential for significant physical and psychological harm. Where a patient has a history of violent behavior, hazard flags-applied either to the individual, their residential address, or phone number-can alert paramedics to the possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting process embedded in the electronic patient care record, we reviewed violence reports filed over a thirteen-month period since its inception in February 2021 to assess the effectiveness of hazard flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic supervisors can generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence reports were filed, for which paramedic supervisors generated hazard flags in 20% of cases (n = 99). In general, cases were not flagged either because the incident occurred at a location not amenable to flagging or because the supervisors felt that a hazard flag was not warranted based on the details in the report. Hazard flagging was associated with an increased risk of violence during subsequent paramedic attendance (Odds Ratio [OR] 6.21, p < 0.001). Nevertheless, the process appears to reliably identify persons who may be violent towards paramedics.
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Affiliation(s)
- Justin Mausz
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (D.P.); (M.J.)
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Dan Piquette
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (D.P.); (M.J.)
| | - Robert Bradford
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada;
| | - Mandy Johnston
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (D.P.); (M.J.)
| | - Alan M. Batt
- Faculty of Health Sciences, Queen’s University, 99 University Avenue, Kingston, ON K7L 3N6, Canada;
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC 3199, Australia
| | - Elizabeth A. Donnelly
- School of Social Work, University of Windsor, 167 Ferry Street, Room 213, Windsor, ON N9A 0C5, Canada;
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de Grunt MN, de Jong B, Hollmann MW, Ridderikhof ML, Weenink RP. Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain-A Narrative Review Based on a Systematic Literature Search. J Clin Med 2024; 13:2560. [PMID: 38731088 PMCID: PMC11084350 DOI: 10.3390/jcm13092560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic pain is frequently encountered in emergency care and requires immediate analgesia. Unfortunately, most trauma patients report sustained pain upon arrival at and discharge from the Emergency Department. Obtaining intravenous access to administer analgesics can be time-consuming, leading to treatment delay. This review provides an overview of analgesics with both fast onset and parenteral, non-intravenous routes of administration, and also indicates areas where more research is required.
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Affiliation(s)
- Midas N. de Grunt
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Bianca de Jong
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Milan L. Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Robert P. Weenink
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
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Tori M, Galardi C. Trends in Suspected Opioid Drug Overdose Events in Emergency Medical Service Encounters in South Carolina, 2019-2022. Public Health Rep 2024:333549241238697. [PMID: 38659370 DOI: 10.1177/00333549241238697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES The number of drug overdoses and drug-related deaths has increased across the United States in recent years. Reports of suspected opioid drug overdoses identified through emergency medical services (EMS) are valuable sources of information for shaping the public health response to drug overdoses. The objective of this study was to describe trends in the number of EMS-reported suspected opioid drug overdose events in South Carolina from 2019 through 2022. METHODS We included reports of suspected opioid drug overdoses if they met the definition of nonfatal opioid overdose syndrome in our analysis. We analyzed statewide data reported from EMS agencies to biospatial, Inc, from January 2019 through December 2022 to understand demographic trends for a statewide overdose and response program in South Carolina. RESULTS In 2022, a total of 11 078 suspected opioid drug overdose events, or 216.4 per 100 000 South Carolina residents, were reported by EMS. During the 4-year study period, the number of EMS-reported suspected opioid drug overdoses increased by 82%, with African American people experiencing a 133% increase and White people experiencing a 68% increase. The number of opioid overdoses increased among all age groups during the study period. Approximately 84% of opioid overdoses were reported in urban counties, but rural counties had a higher number of opioid overdose reports per capita than urban counties. CONCLUSIONS Monitoring trends in suspected opioid drug overdoses allows decision makers to adjust resources and programs for overdose response and is essential for local coordinated response. Continued monitoring of trends is needed for an equitable response to prevent opioid drug overdoses.
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Affiliation(s)
- Marco Tori
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Christina Galardi
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
- CDC Foundation, Atlanta, GA, USA
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Leonny S, Bowra J, Davis RA, Zuleta N, Hansen K, Large R, Yeung J. Review article: Telehealth in Emergency Medicine in Australasia: Advantages and barriers. Emerg Med Australas 2024. [PMID: 38649791 DOI: 10.1111/1742-6723.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick-and-mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain.
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Affiliation(s)
- Sheravika Leonny
- My Emergency Doctor, Sydney, New South Wales, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Justin Bowra
- My Emergency Doctor, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rebecca A Davis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Virtual Hospital, Sydney, New South Wales, Australia
| | - Natalia Zuleta
- WA Country Health Service, Perth, Western Australia, Australia
| | - Kim Hansen
- Virtual Emergency Department, Metro North, Brisbane, Queensland, Australia
- Critical Care, Women's and Children's Service Line, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Ruth Large
- New Zealand Telehealth Leadership Group, Christchurch, New Zealand
- Whakarongorau Aotearoa//New Zealand Telehealth Services, Auckland, New Zealand
| | - Justin Yeung
- WA Country Health Service, Perth, Western Australia, Australia
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Mausz J, D’Eath J, Jackson NA, Johnston M, Batt AM, Donnelly EA. Sexist, Racist, and Homophobic Violence against Paramedics in a Single Canadian Site. Int J Environ Res Public Health 2024; 21:505. [PMID: 38673416 PMCID: PMC11050378 DOI: 10.3390/ijerph21040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Violence against paramedics is widely recognized as a serious, but underreported, problem. While injurious physical attacks on paramedics are generally reported, non-physical violence is less likely to be documented. Verbal abuse can be very distressing, particularly if the harassment targets personal or cultural identities, such as race, ethnicity, gender, or sexual orientation. Leveraging a novel, point-of-event reporting process, our objective was to estimate the prevalence of harassment on identity grounds against paramedics in a single paramedic service in Ontario, Canada, and assess its potentially differential impact on emotional distress. In an analysis of 502 reports filed between 1 February 2021 and 28 February 2022, two paramedic supervisors independently coded the free-text narrative descriptions of violent encounters for themes suggestive of sexism, racism, and homophobia. We achieved high inter-rater agreement across the dimensions (k = 0.73-0.83), and after resolving discrepant cases, we found that one in four violent reports documented abuse on at least one of the identity grounds. In these cases, paramedics were 60% more likely to indicate being emotionally distressed than for other forms of violence. Our findings offer unique insight into the type of vitriol paramedics experience over the course of their work and its potential for psychological harm.
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Affiliation(s)
- Justin Mausz
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (J.D.); (N.A.J.); (M.J.)
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Joel D’Eath
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (J.D.); (N.A.J.); (M.J.)
| | - Nicholas A. Jackson
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (J.D.); (N.A.J.); (M.J.)
| | - Mandy Johnston
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (J.D.); (N.A.J.); (M.J.)
| | - Alan M. Batt
- Faculty of Health Sciences, Queen’s University, 99 University Avenue, Kingston, ON K7L 3N6, Canada;
- Department of Paramedicine, Monash University, Peninsula Campus, Building H, 47-49 Moorooduc Hwy, Frankston, VIC 3199, Australia
| | - Elizabeth A. Donnelly
- School of Social Work, University of Windsor, 167 Ferry Street, Room 213, Windsor, ON N9A 0C5, Canada;
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Burgos-Esteban A, Quintana-Diaz M, Cordón-Hurtado V, Giménez-Luzuriaga M, Santolalla-Arnedo I, de Viñaspre-Hernández RR, Gea-Caballero V, Santos-Sánchez JA, Navas-Echazarreta N, Rodríguez-Calvo A, Sánchez-Conde P, Juárez-Vela R. Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study. Front Public Health 2024; 12:1375431. [PMID: 38694974 PMCID: PMC11061842 DOI: 10.3389/fpubh.2024.1375431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care. Aim This study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022. Matherial and methods We performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year. Results A total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma. Discussion IO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible.
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Affiliation(s)
- Amaya Burgos-Esteban
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Department of Nursing, Research Group in Care, University of La Rioja, Logroño, Spain
- Rioja Health Service, Logroño, Spain
| | - Manuel Quintana-Diaz
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Intensive Care Department, University Hospital La Paz, Madrid, Spain
| | | | - Marta Giménez-Luzuriaga
- Department of Nursing, Research Group in Care, University of La Rioja, Logroño, Spain
- Rioja Health Service, Logroño, Spain
| | - Iván Santolalla-Arnedo
- Department of Nursing, Research Group in Care, University of La Rioja, Logroño, Spain
- Rioja Health Service, Logroño, Spain
| | | | | | | | - Noelia Navas-Echazarreta
- Department of Nursing, Research Group in Care, University of La Rioja, Logroño, Spain
- Rioja Health Service, Logroño, Spain
| | | | | | - Raúl Juárez-Vela
- Department of Nursing, Research Group in Care, University of La Rioja, Logroño, Spain
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Bulte CSE, Mansvelder FJ, Loer SA, Bloemers FW, Den Hartog D, Van Lieshout EMM, Hoogerwerf N, van der Naalt J, Absalom AR, Peerdeman SM, Giannakopoulos GF, Schwarte LA, Schober P, Bossers SM. Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury. J Clin Med 2024; 13:2249. [PMID: 38673522 PMCID: PMC11051010 DOI: 10.3390/jcm13082249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.
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Affiliation(s)
- Carolien S. E. Bulte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Floor J. Mansvelder
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Stephan A. Loer
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Frank W. Bloemers
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Esther M. M. Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Nico Hoogerwerf
- Department of Anesthesiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Helicopter Emergency Medical Service Lifeliner 3, 5408 SM Volkel, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Anthony R. Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Saskia M. Peerdeman
- Department of Neurosurgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Georgios F. Giannakopoulos
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Lothar A. Schwarte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Sebastiaan M. Bossers
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
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Tunks Leach K, Demant D, Simpson P, Lewis J, Levett-Jones T. Chaplaincy and spiritual care in Australian ambulance services: an exploratory cross-sectional study. J Health Care Chaplain 2024:1-24. [PMID: 38574262 DOI: 10.1080/08854726.2024.2323371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Ambulance staff wellbeing programs aim to support the bio-psycho-social and sometimes spiritual needs of paramedics. While evidence demonstrates strong connections between spirituality and/or religion to wellbeing outcomes, little is known about spiritual care in ambulance services or its impact. The aim of this study was to investigate paramedics' perspectives on the role and value of Australian ambulance chaplains. A cross-sectional online study of registered paramedics in Australia was conducted between November and December 2022. Analysis of the 150 responses identified that paramedics viewed the chaplain's role as one built on professional caring relationships that provided proactive and reactive care in paramedic workplaces. Chaplains were perceived to promote wellbeing by incorporating emotional, psychological, social and spiritual care, and assisting paramedics to access additional support. Perceived religiousness of chaplains and organisational factors were barriers to paramedics accessing chaplains, while pre-existing relationships and shared experiences positively influenced paramedics decision to seek chaplain support.
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Affiliation(s)
- Katie Tunks Leach
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Daniel Demant
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, OLD, Australia
| | - Paul Simpson
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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22
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Meilandt C, Qvortrup M, Bøtker MT, Folke F, Borup L, Christensen HC, Milling L, Lauridsen KG, Løfgren B. Association Between Defibrillation Using LIFEPAK 15 or ZOLL X Series and Survival Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study. J Am Heart Assoc 2024; 13:e033913. [PMID: 38533945 DOI: 10.1161/jaha.123.033913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Defibrillation is essential for achieving return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) with shockable rhythms. This study aimed to investigate if the type of defibrillator used was associated with ROSC in OHCA. METHODS AND RESULTS This study included adult patients with OHCA from the Danish Cardiac Arrest Registry from 2016 to 2021 with at least 1 defibrillation by the emergency medical services. We used multivariable logistic regression and a difference-in-difference analysis, including all patients with or without emergency medical services shock to assess the causal inference of using the different defibrillator models (LIFEPAK or ZOLL) for OHCA defibrillation. Among 6516 patients, 77% were male, the median age (quartile 1; quartile 3) was 70 (59; 79), and 57% achieved ROSC. In total, 5514 patients (85%) were defibrillated using LIFEPAK (ROSC: 56%) and 1002 patients (15%) were defibrillated using ZOLL (ROSC: 63%). Patients defibrillated using ZOLL had an increased adjusted odds ratio (aOR) for ROSC compared with LIFEPAK (aOR, 1.22 [95% CI, 1.04-1.43]). There was no significant difference in 30-day mortality (aOR, 1.11 [95% CI, 0.95-1.30]). Patients without emergency medical services defibrillation, but treated by ZOLL-equipped emergency medical services, had a nonsignificant aOR for ROSC compared with LIFEPAK (aOR, 1.10 [95% CI, 0.99-1.23]) and the difference-in-difference analysis was not statistically significant (OR, 1.10 [95% CI, 0.91-1.34]). CONCLUSIONS Defibrillation using ZOLL X Series was associated with increased odds for ROSC compared with defibrillation using LIFEPAK 15 for patients with OHCA. However, a difference-in-difference analysis suggested that other factors may be responsible for the observed association.
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Affiliation(s)
- Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
- Department of Research and Development Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
| | - Mette Qvortrup
- Department of Cardiology Viborg Regional Hospital Viborg Denmark
| | - Morten Thingemann Bøtker
- Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
- Department of Research and Development Prehospital Emergency Medical Services, Central Denmark Region Aarhus Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Cardiology Herlev Gentofte University Hospital Herlev Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Borup
- Prehospital Emergency Medical Services, North Denmark Region Aalborg Denmark
| | | | - Louise Milling
- The Prehospital Research Unit, Region of Southern Denmark Odense Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine Aarhus University Aarhus Denmark
- Department of Medicine Randers Regional Hospital Randers Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine Aarhus University Aarhus Denmark
- Department of Medicine Randers Regional Hospital Randers Denmark
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Benoit JL, Hogan AN, Connelly KM, McMullan JT. Intra-arrest blood-based biomarkers for out-of-hospital cardiac arrest: A scoping review. J Am Coll Emerg Physicians Open 2024; 5:e13131. [PMID: 38500598 PMCID: PMC10945310 DOI: 10.1002/emp2.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/20/2024] Open
Abstract
Objective Blood-based biomarkers play a central role in the diagnosis and treatment of critically ill patients, yet none are routinely measured during the intra-arrest phase of out-of-hospital cardiac arrest (OHCA). Our objective was to describe methodological aspects, sources of evidence, and gaps in research surrounding intra-arrest blood-based biomarkers for OHCA. Methods We used scoping review methodology to summarize existing literature. The protocol was designed a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. Inclusion criteria were peer-reviewed scientific studies on OHCA patients with at least one blood draw intra-arrest. We excluded in-hospital cardiac arrest and animal studies. There were no language, date, or study design exclusions. We conducted an electronic literature search using PubMed and Embase and hand-searched secondary literature. Data charting/synthesis were performed in duplicate using standardized data extraction templates. Results The search strategy identified 11,834 records, with 118 studies evaluating 105 blood-based biomarkers included. Only eight studies (7%) had complete reporting. The median number of studies per biomarker was 2 (interquartile range 1-4). Most studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had samples collected by paramedics. Pediatric patients were included in only three studies (3%). Out of eight predefined biomarker categories of use, only two were routinely assessed: prognostic (97/105, 92%) and diagnostic (61/105, 58%). Conclusions Despite a large body of literature on intra-arrest blood-based biomarkers for OHCA, gaps in methodology and knowledge are widespread.
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Affiliation(s)
- Justin L. Benoit
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Andrew N. Hogan
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
| | | | - Jason T. McMullan
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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24
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Tannheimer M, Reinke M, Lechner R. Comparison of Laryngeal Mask Airway Seal Between Anesthesiologists and Individuals Without Previous Airway Experience. J Emerg Med 2024; 66:e470-e476. [PMID: 38461134 DOI: 10.1016/j.jemermed.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 03/11/2024]
Abstract
BACKGROUND Tracheal intubation is the gold standard for airway management in emergency medicine, but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA). OBJECTIVE The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against unfixed ones. METHODS In a body donor model, LMA application was evaluated between medical students without previous airway experience and anesthesiologists by comparing the sealing of the larynx using a water column applied to the esophagus. RESULTS LMAs were successfully applied in 46 out of 55 (83.6%) attempts by medical students and in 30 out of 39 (76.9%) attempts by anesthesiologists. Among medical students, 14.1% of all LMA applications were primarily leaky, compared with 18.8% in anesthesiologists. Esophageal sealing was better in Thiel-fixed specimens (leakage 10.9%) compared with unfixed specimens (leakage 22.9%). Our data showed no significant difference between anesthesiologists and medical students in terms of sealing of LMA. Therefore, we conclude that medical students without previous airway experience can quickly learn to apply LMA sufficiently and thus, achieve aspiration protection similar to anesthesiologists. CONCLUSION Medical students without previous airway experience can successfully insert LMAs after a short introduction. Thiel-fixed specimens are suitable for studies as well as for training in LMA application.
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Affiliation(s)
- Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, Ulm, Germany; Department of General and Visceral Surgery, Krankenhaus Blaubeuren, Blaubeuren, Germany
| | - Martin Reinke
- Institute of Anatomy and Cell Biology, University of Ulm, Ulm, Germany; Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bundeswehr Hospital Ulm, Ulm, Germany; Medical Service, Police Baden-Württemberg, Stuttgart, Germany
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Abstract
BACKGROUND Agriculture is a hazardous industry with undocumented injury events. Credible surveillance measures are critical for this industry, especially to guide injury prevention programs with targeted recommendations for specific commodity groups and populations. This multi-phase study explored the feasibility for two state agency databases, the Ohio Bureau of Workers' Compensation (BWC) Program and the Emergency Medical Services Incident Reporting System (EMSIRS), to augment the state's Bureau of Labor Statistics (BLS) annual reports. METHODS BWC data described injury claims in agricultural workplaces from 1999 to 2008. State EMSIRS data described the types of medical emergencies for which EMS services were requested to Ohio farms in 2013-2014. Descriptive analyses were performed on each distinctive source. RESULTS Over 14,000 BWC claims were analyzed, with primary nature of injury identified as sprains and strains of bodily extremities; falls were the most common cause of injury. The EMSIRS data provided 1,376 cases, where EMS services were requested to Ohio farms at injury onset. Some cases had possibility to be excluded in CFOI or employment claims data, with 24% patients 65 years and older and 6% children 13 years and younger. The primary cause of injury was falls, and the highest reported injury type was blunt trauma. CONCLUSIONS Both BWC and EMSIRS databases showed the potential to enhance Ohio's agricultural surveillance data with viable information not found in previously used systems. Each agency database had its own merits to further clarify and quantify morbidity. When used together, these sources enrich surveillance statistics to describe Ohio's agricultural injury incidents.
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Affiliation(s)
- S Dee Jepsen
- Department of Food, Agricultural, and Biological Engineering, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Andrea Costin
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Jed Bookman
- Department of Food, Agricultural, and Biological Engineering, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Gail Kaye
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Levi D, Hoogendoorn J, Samuels S, Maguire L, Troncoso R, Gunn S, Katz M, VanDillen C, Miller SA, Falk JL, Katz SH, Papa L. The i-gel ® supraglottic airway device compared to endotracheal intubation as the initial prehospital advanced airway device: A natural experiment during the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2024; 5:e13150. [PMID: 38576603 PMCID: PMC10992989 DOI: 10.1002/emp2.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Unlike randomized controlled trials, practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings where there may be reluctance to adopt new practices. We present the results of a natural experiment that was driven by mandated COVID-19 pandemic-driven shift from endotracheal intubation (ETI) to the i-gel® supraglottic airway (SGA) as a primary advanced airway management device in the prehospital setting to reduce emergency medical services (EMS) personnel exposure to potentially infectious secretions. The objective was to compare first-pass success and timing to successful airway placement between ETI and the i-gel® SGA under extenuating circumstances. Methods This pre/post study compared airway placement metrics in prehospital patients requiring advance airway management for non-trauma-related conditions. Data from EMS records were extracted over 2 years, 12 months pre-pandemic, and 12 months post-pandemic. During the pre-COVID-19 year, the EMS protocols utilized ETI as the primary advanced airway device (ETI group). Post-pandemic paramedics were mandated to utilize i-gel® SGA as the primary advanced airway device to reduce exposure to secretions (SGA group). Results There were 199 adult patients, 83 (42%) in the ETI group and 116 (58%) in the SGA group. First-pass success was significantly higher with SGA 96% (92%-99%) than ETI 68% (57%-78%) with paramedics citing the inability to visualize the airway in 52% of ETI cases. Time to first-pass success was significantly shorter in the SGA group (5.9 min [5.1-6.7 min]) than in the ETI group (8.3 min [6.9-9.6 min]), as was time to overall successful placement at 6.0 min (5.1-6.8 min) versus 9.6 min (8.2-11.1 min), respectively. Multiple placement attempts were required in 26% of ETI cases and 1% of the SGA cases. There were no statistically significant differences in the number and types of complications between the cohorts. Return of spontaneous circulation (on/before emergency department [ED] arrival), mortality at 28 days, intensive care unit length of stay, or ventilator-free days between the groups were not statistically different between the groups. Conclusion In this natural experiment, the SGA performed significantly better than ETI in first-pass airway device placement success and was significantly faster in achieving first-pass success, and overall airway placement, thus potentially reducing exposure to respiratory pathogens. Practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings and in systems with a low frequency of tracheal intubations.
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Affiliation(s)
- Daniel Levi
- Department of Emergency MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Joris Hoogendoorn
- Department of Emergency MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Shenae Samuels
- Department of Emergency MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Lindsay Maguire
- Department of Emergency MedicineOrlando Health Orlando Regional Medical CenterOrlandoFloridaUSA
| | - Ruben Troncoso
- Pembroke Pines Fire Rescue DepartmentPembroke PinesFloridaUSA
| | - Scott Gunn
- Pembroke Pines Fire Rescue DepartmentPembroke PinesFloridaUSA
| | | | - Christine VanDillen
- Department of Emergency MedicineOrlando Health Orlando Regional Medical CenterOrlandoFloridaUSA
| | - Susan A. Miller
- Department of Emergency MedicineOrlando Health Orlando Regional Medical CenterOrlandoFloridaUSA
| | - Jay L. Falk
- Department of Emergency MedicineOrlando Health Orlando Regional Medical CenterOrlandoFloridaUSA
| | - Steven H. Katz
- Department of Emergency MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Linda Papa
- Department of Emergency MedicineOrlando Health Orlando Regional Medical CenterOrlandoFloridaUSA
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Matsunaga M, Donnelly P, Chen JJ. Hospital usage for oral and dental conditions in Hawaii: A cross-sectional study using the 2021 Hawaii statewide hospital data. J Public Health Dent 2024. [PMID: 38509055 DOI: 10.1111/jphd.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social-demographic factors associated with the identified ED visits. METHODS This was a cross-sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non-traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC. RESULTS Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21-44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0-9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu). CONCLUSIONS Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals.
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Affiliation(s)
- Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Patrick Donnelly
- Hawai'i Oral Health Coalition, Hawai'i Public Health Institute, Honolulu, Hawaii, USA
| | - John J Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
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Saper JK, Macy ML, Martin-Gill C, Ramgopal S. Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers. Acad Pediatr 2024:S1876-2859(24)00107-4. [PMID: 38492632 DOI: 10.1016/j.acap.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs. METHODS We performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019-2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed. RESULTS Of 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n = 60,716), systemic illness (n = 23,583), and psychiatric/behavioral health (n = 13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital. CONCLUSIONS EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.
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Affiliation(s)
- Jennifer K Saper
- Division of Advanced General Pediatrics and Primary Care (JK Saper), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (JK Saper and ML Macy); Stanley Manne Children's Research Institute; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Michelle L Macy
- Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (JK Saper and ML Macy); Stanley Manne Children's Research Institute; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Emergency Medicine (ML Macy and S Ramgopal); Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Christian Martin-Gill
- Department of Emergency Medicine (C Martin-Gill), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sriram Ramgopal
- Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Emergency Medicine (ML Macy and S Ramgopal); Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Carmo HDO, Peduzzi M, Tronchin DMR. Team climate and job satisfaction in a mobile emergency service: a multilevel study. Rev Lat Am Enfermagem 2024; 32:e4110. [PMID: 38511733 PMCID: PMC10949847 DOI: 10.1590/1518-8345.6872.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/12/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE to investigate the relationship between team climate and job satisfaction among professionals working in mobile pre-hospital care. METHOD this is a quantitative, correlational study carried out in a mobile pre-hospital care service in the São Paulo Metropolitan Region. The participants were 95 professionals, allocated to 40 teams, who answered three questionnaires: sociodemographic/labor data, Team Climate Scale and S20/23 Job Satisfaction Scale. Descriptive statistics and multilevel linear models were used for the analysis, including moderation effects. The Backward method was used to ascertain the order of significance. RESULTS in the models, the relationships between satisfaction with hierarchical relationships and the factor "support for new ideas" moderated for men and "task orientation" for women were significant. For satisfaction with the physical environment, "working hours" and "participation in the team" were significant and, for intrinsic satisfaction, the regime, working hours and the factors "team objectives", "participation in the team" and "support for new ideas" remained significant, as did the moderation effect between length of service, "participation in the team" and "support for new ideas". CONCLUSION team climate is influenced by job satisfaction in a heterogeneous way and the moderating effect of this relationship is associated with gender and length of service. BACKGROUND (1) There was a positive perception of the team climate and job satisfaction. BACKGROUND (2)The team climate influenced job satisfaction in a heterogeneous way. BACKGROUND (3) The moderating effect of this relationship was associated with gender and working hours. BACKGROUND (4) The working regime and working hours directly affected intrinsic satisfaction.
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Affiliation(s)
| | - Marina Peduzzi
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
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Brown ZL, Cuestas JP, Matthews KJ, Shumaker JT, Moore DW, Cole R. Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments. J Spec Oper Med 2024:ZEDS-YB8N. [PMID: 38408046 DOI: 10.55460/zeds-yb8n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Blood is a highly valuable medical resource that necessitates strict guidelines to ensure the safety and well-being of the recipient. Since the onset of the war in Ukraine there has been an increased demand for training in emergency fresh whole blood transfusion (EFWBT) to improve damage control resuscitation capabilities. To meet this demand, we developed, implemented, and evaluated a training program aimed at enhancing Ukrainian EFWBT proficiency. METHODS Eight Ukrainian healthcare professionals (UHPs), including six physicians and two medics, completed our training, derived from the Joint Trauma System Clinical Practice Guidelines, Tactical Combat Casualty Care (TCCC) Guidelines, 75th Ranger Regiment Ranger O-Low Titer (ROLO) program, and Marine Corps Valkyrie program. Participants were assessed on their confidence in the practical application and administrative oversight requirements of an EFWBT program. A cross-comparison was conducted between a larger data set of third-year medical students from the Uniformed Services University and the UHPs to determine the statistical significance of the program. RESULTS The difference in mean scores of UHPs during preand post-training was statistically significant (p<0.001). Additionally, the average rate of improvement was greater for the UHPs compared with the third-year medical students (p=0.000065). CONCLUSION Our study revealed that the application of an EFWBT training program for UHPs can significantly increase confidence in their ability to conduct EFWBTs on the battlefield. Further larger-scale research is needed to determine the impact of this training on performance outcomes.
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Cárdaba-García RM, Soto-Cámara R, García-Santa-Basilia N, Matellán-Hernández MP, Onrubia-Baticón H, Martínez-Caballero CM, Thuissard-Vasallo IJ, Navalpotro-Pascual S. Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care. J Adv Nurs 2024. [PMID: 38444126 DOI: 10.1111/jan.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/19/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services. DESIGN Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021). METHODS The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health. RESULTS The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care. CONCLUSIONS Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality. IMPLICATIONS The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. REPORTING METHOD We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.
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Affiliation(s)
- Rosa María Cárdaba-García
- Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
| | - Raúl Soto-Cámara
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Department of Health Sciences, University of Burgos, Burgos, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Noemi García-Santa-Basilia
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - María Paz Matellán-Hernández
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Henar Onrubia-Baticón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Carmen María Martínez-Caballero
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | | | - Susana Navalpotro-Pascual
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Department of Nursing, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Emergency Medical Service of Madrid-SUMMA 112, Madrid, Spain
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AlAbdullah G, Al Ahmed F, Alatiyyah ZJ, Alibraheem G, Almuqahwi A. Barriers Impact the Primary Healthcare Providers When Dealing With Emergency Cases: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia. Cureus 2024; 16:e57344. [PMID: 38690472 PMCID: PMC11060754 DOI: 10.7759/cureus.57344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Being the first in-line care providers, primary healthcare (PHC) physicians may encounter all forms of medical emergencies, ranging from minor complaints to major life-threatening events; therefore, this study aims to assess the PHC physicians' knowledge and attitude related to the diagnosis and management of emergency cases as well as their preferences for emergency medicine training courses and their preferred methods of training. Methods A descriptive cross-sectional study was conducted among physicians working at PHC in Al-Ahsa, Saudi Arabia, between November and December 2023, excluding those who do not work at PHC. The minimum required sample size was 192. A self-administered online questionnaire was developed using Google Forms and distributed conveniently through social media platforms. It consists of 22 items categorized into four sections: The first section focused on demographic information; the second section assessed knowledge related to the diagnosis and management of emergency cases commonly encountered in PHC, along with actual management experiences; the third section gauged physicians' attitudes, and the fourth section explored participants' preferences for emergency medicine courses and their preferred methods of training in this field. The Kruskal-Wallis rank sum and Wilcoxon rank sum tests were employed to identify predictors of knowledge and attitude. Results The study involved 193 participants, with 96 (50%) females and a median age of 30 years. The participants included 43 (22%) consultants, 69 (36%) family residents, 30 (16%) general practitioners, and 50 (26%) specialists. Participants reported a median of 4.0 years of experience in PHC in Saudi Arabia. The majority, 69 (36%), reported working in the hospital emergency department, with a reported median duration of three months. Roughly 84% of PHC physicians had a positive attitude toward emergency cases diagnosis and management, while 92% showed fair diagnostic knowledge of emergency cases, and 73% showed fair management knowledge. Higher knowledge in the diagnosis and management of PHC was linked to increasing age, being consultants, being employed in the emergency department, and having higher years of experience in PHC (p < 0.05). A positive attitude toward PHC was found to be associated with working as a consultant and being employed in the emergency department (p < 0.05). Approximately 133 (68.9%) expressed a preference for a course in wound care trauma, followed by central nervous system emergencies (n = 124, 64.2%), coronary artery disease emergencies (n = 116, 60.1%), and obstetrics/gynecologic emergencies (n = 114, 59.1%) with 160 (82.9%) favored training through practice in PHC under supervision of qualified staff. Conclusion While many PHC centers are well equipped and prepared for early stabilization and management of emergency cases, PHC physicians showed low competency in dealing with emergency cases. This indicates a great need for enhancing physician's knowledge and skills regarding emergency situations. Nevertheless, courses like basic life support (BLS) and advanced trauma life support (ATLS) should be the bare minimum requirements for PHC physicians. Mote advance training and lectures should be organized to enhance PHC physician competencies to deal with different emergencies.
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Donnelly MR, Barie PS, Schubl SD. Impact of the Coronavirus Disease 2019 Pandemic on Utilization of Emergency Medical Services in New York City. Surg Infect (Larchmt) 2024; 25:95-100. [PMID: 38294840 DOI: 10.1089/sur.2023.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: This study evaluates trends in the utilization of emergency medical services (EMS) in New York City, the "epicenter" of the first "wave" of the coronavirus pandemic. We hypothesize that EMS call volumes decreased overall in New York City during the first year of the pandemic, specifically with respect to trauma/injury calls. Contrarily, we posit that calls for "sick" events increased given pervasive fear of virus transmission. Materials and Methods: Retrospective New York City EMS calls data (January 1, 2019 to December 31, 2020) were obtained from the NYC Open Data/EMS Incident Dispatch database. Total EMS calls, trauma/injury calls, and "sick" event calls were collected for New York City and for all five boroughs. Census data for each borough were used to weigh daily EMS calls per 100,000 individuals. Mann-Whitney U tests were used to compare pre-pandemic (2019 to March 2020) versus pandemic (April 2020 to December 2020) EMS call volumes, p = 0.05. Results: Median daily EMS calls per 100,000 individuals decreased 21.6% at the start of the pandemic across New York City (pre-pandemic, 3,262 calls; pandemic, 2,556 calls; p < 0.001) and similarly decreased when stratified by borough (all, p < 0.001). Median daily trauma/injury and sick event calls per 100,000 also decreased in New York City and the five boroughs from pre-pandemic to pandemic time periods (all, p < 0.001). Discussion and Conclusions: These data reflect an unprecedented window into EMS utilization during an infectious disease pandemic. As decreased EMS utilization for multiple conditions likely reflects delayed or impeded access to care, utilization data have important implications for provision of acute care services during possible future disruptions related to the pandemic.
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Affiliation(s)
- Megan R Donnelly
- Department of Surgery, UC Irvine Health, Orange, California, USA
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
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Mäki LJ, Kontunen PJ, Kaartinen JM, Castrén MK. Value-based care of older people-The impact of an acute outreach service unit on emergency medical service missions: A quasi-experimental study. Scand J Caring Sci 2024; 38:169-176. [PMID: 37807498 DOI: 10.1111/scs.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Transfers to the emergency department can be burdensome for the residents of long-term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse-led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on-site care to LTRCF residents to reduce transfers to the emergency department. METHODS This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six-month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A-D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. RESULTS Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%-22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%-30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%-41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. CONCLUSIONS LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs.
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Affiliation(s)
- Lauri J Mäki
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Kontunen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Päijät-Häme Social and Health Care, Lahti, Finland
| | - Johanna M Kaartinen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Maaret K Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Munday HDB, Whitley GA. Sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome: a rapid evidence review. Br Paramed J 2024; 8:21-29. [PMID: 38445111 PMCID: PMC10910288 DOI: 10.29045/14784726.2024.3.8.4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Chest pain is a frequent symptom suffered by adult patients attended by ambulance. Evidence suggests female patients may suffer different symptoms to their male counterparts, potentiating differences in pre-hospital time delays, assessment and treatment. Objective To explore the sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome (ACS). Methods A rapid evidence review was conducted following the Cochrane rapid review guidelines. MEDLINE and CINAHL Complete were searched via EBSCOhost on 2 February 2023, and reference lists of included studies and reviews were screened. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to perform critical appraisal, and a narrative synthesis was conducted. Results From 216 articles screened, nine were included, representing over 3.1 million patients from five different countries. Female patients were more likely to suffer delays in time to first electrocardiogram (ECG) and delays in transport time to the emergency department by ambulance. Female patients were also less likely to receive an ECG, aspirin, glyceryl trinitrate and other analgesics. Conclusion There are sex disparities in the pre-hospital ambulance delay, assessment and treatment of patients with ACS. Future research is urgently needed to fully understand the reasons for these observations.
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Affiliation(s)
| | - Gregory Adam Whitley
- University of Lincoln; East Midlands Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-2586-6815
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Ali M, Dekker L, Daems JD, Ali M, van Zwet EW, Steyerberg EW, Duvekot MHC, Nguyen TTM, Moudrous W, van de Wijdeven RM, Visser MC, de Laat KF, Kerkhoff H, van den Wijngaard IR, Dippel DWJ, Roozenbeek B, Kruyt ND, Wermer MJH. Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke. Stroke 2024; 55:548-554. [PMID: 38299328 PMCID: PMC10896195 DOI: 10.1161/strokeaha.123.044898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. METHODS We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. RESULTS Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. CONCLUSIONS aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.
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Affiliation(s)
- Mariam Ali
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Luuk Dekker
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Jasper D Daems
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (J.D.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Erik W van Zwet
- Department of Biomedical Data Sciences (E.W.v.Z., E.W.S.), Leiden University Medical Center, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences (E.W.v.Z., E.W.S.), Leiden University Medical Center, the Netherlands
| | - Martijne H C Duvekot
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., H.K.)
| | - T Truc My Nguyen
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Walid Moudrous
- Department of Neurology, Maasstad Hospital, Rotterdam, the Netherlands (W.M.)
| | - Ruben M van de Wijdeven
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marieke C Visser
- Department of Neurology (M.C.V.)
- Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.C.V.)
| | - Karlijn F de Laat
- Department of Neurology, Haga Hospital, the Hague, the Netherlands (K.F.d.L.)
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., H.K.)
| | - Ido R van den Wijngaard
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands (I.R.v.d.W.)
- University Neurovascular Center Leiden-The Hague, the Netherlands (I.R.v.d.W., N.D.K.)
| | - Diederik W J Dippel
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- University Neurovascular Center Leiden-The Hague, the Netherlands (I.R.v.d.W., N.D.K.)
| | - Marieke J H Wermer
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- Department of Neurology, University Medical Centre Groningen, University of Groningen, the Netherlands (M.J.H.W.)
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Smith AB, Jung M, Pressler SJ. Pain and Heart Failure During Transport by Emergency Medical Services and Its Associated Outcomes: Hospitalization, Mortality, and Length of Stay. West J Nurs Res 2024; 46:172-182. [PMID: 38230416 PMCID: PMC10922995 DOI: 10.1177/01939459231223128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Over 22% of patients with heart failure (HF) are transported by emergency medical services (EMSs) for a primary complaint of pain. The relationship between a primary complaint of pain on hospitalization status, mortality, or length of stay following transport by EMS is understudied. OBJECTIVES The objective of this study was to determine whether a primary complaint of pain during EMS transport predicted hospitalization status, mortality, or inpatient length of stay. METHODS In this retrospective longitudinal cohort study, data were analyzed from electronic health records of 3539 patients with HF. Descriptive statistics and multivariate logistic and linear regression analyses were used to achieve study objectives. RESULTS Demographics were mean age 64.83 years (standard deviation [SD] = 14.58); gender 57.3% women, 42.7% men; self-reported race 56.2% black, 43.2% white, and 0.7% other. Of 3539 patients, 2346 (66.3%) were hospitalized, 149 (4.2%) died, and the mean length of stay was 6.02 (SD = 7.55) days. A primary complaint of pain did not predict increased odds of in-hospital mortality but did predict 39% lower odds of hospitalization (p < .001), and 26.7% shorter length of stay (p < .001). Chest pain predicted 49% lower odds of hospitalization (p < .001) and 34.1% (p < .001) shorter length of stay, whereas generalized pain predicted 45% lower odds of hospitalization (p = .044) following post-hoc analysis. CONCLUSIONS A primary complaint of chest pain predicted lower odds of hospitalization and shorter length of stay, possibly due to established treatment regimens. Additional research is needed to examine chronic pain rather than a primary complaint of pain.
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Affiliation(s)
- Asa B. Smith
- School of Nursing, Indiana University, Indiana USA
| | - Miyeon Jung
- School of Nursing, Indiana University, Indiana USA
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Mantas-Jiménez S, Reig-García G, Roqueta-Vall-Llosera M, Camara-Liebana D, Masià-Plana A, Lluch-Canut MT, Juvinya-Canal D. Positive mental health and sense of coherence among emergency medical service professionals. Front Public Health 2024; 12:1344872. [PMID: 38444442 PMCID: PMC10912187 DOI: 10.3389/fpubh.2024.1344872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Background Positive mental health (PMH) is a construct used to define and evaluate health from a positive perspective. Healthcare professionals in the emergency ambulance service are more likely to experience mental health disorders than the overall population. The demographic and occupational variables and Sense of Coherence (SOC) can act as predictors of PMH and can serve as protective elements against stress and demanding situations in the work environment. Objective This study aimed to evaluate PMH and its relationship with demographic and occupational variables and determine if SOC is a predictive variable for PMH in health professionals working in the emergency ambulance service. Methods A descriptive, cross-sectional, and correlational study was conducted with a sample of 406 healthcare professionals from the emergency ambulance service in eight health regions of Catalonia, Spain. The following variables were analyzed: Age, biological sex, household members, dependents family members, professional category, type of contract, job satisfaction and sense of collaboration with other institutions. The following assessment instruments were used: Positive Mental Health Questionnaire and Sense of Coherence scale. Results High scores were obtained in Positive Mental Health (PMH). Study participants who reported feeling completely satisfied in their work also showed a significant relationship with all PMH factors: greater satisfaction with their personal life, in their helpful prosocial attitude toward others, in their capability to deal effectively with stress and navigate conflict scenarios, in their ability to solve problems and self-realization, greater empathy and ability to understand the feelings of others, greater ability to establish interpersonal relationships. Comprehensibility, as a dimension of SOC, was identified as a predictor for some factors of PMH: a greater personal satisfaction, self-control, autonomy, interpersonal skills and total PMHQ. More than 43% of positive mental health in health professionals is explained by higher Meaningfulness and Comprehensibility values of the SOC, the absence of dependent family members and having a non-graduate background. Conclusion Healthcare workers in the emergency ambulance service had high PMH. Meaningfulness (ME) and Comprehensibility (C), dimensions of SOC, were identified as model predictors of greater PMH, showing higher scores in most of PMH factors. To enhance SOC as a mental health promotion measure, resilience programs should be implemented to help professionals develop skills to face and overcome adverse situations. Educating in stress management thought networks are key elements to strengthen SOC. Managers in emergency medical services play a key role in transforming healthcare work environments to promote positive outcomes in the mental health of their healthcare workers.
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Affiliation(s)
- Susana Mantas-Jiménez
- Department of Nursing, University of Girona, Girona, Spain
- Research Group Health and Healthcare, University of Girona, Girona, Spain
| | - Glòria Reig-García
- Department of Nursing, University of Girona, Girona, Spain
- Research Group Health and Healthcare, University of Girona, Girona, Spain
| | - Marta Roqueta-Vall-Llosera
- Department of Nursing, University of Girona, Girona, Spain
- Health Gender and Aging Research Group, Girona, Spain
| | - David Camara-Liebana
- Department of Nursing, University of Girona, Girona, Spain
- Department of Psychology, Quality of Life Research Institute, Universitat de Girona, Girona, Spain
| | - Afra Masià-Plana
- Department of Nursing, University of Girona, Girona, Spain
- Research Group Health and Healthcare, University of Girona, Girona, Spain
| | | | - Dolors Juvinya-Canal
- Department of Nursing, University of Girona, Girona, Spain
- Research Group Health and Healthcare, University of Girona, Girona, Spain
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Eichinger M, Shah K, Palt N, Eichlseder M, Pichler A, Zoidl P, Zajic P, Rief M. Association of prehospital lactate levels with base excess in various emergencies - a retrospective study. Clin Chem Lab Med 2024; 0:cclm-2024-0060. [PMID: 38373063 DOI: 10.1515/cclm-2024-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications. METHODS We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman's rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders. RESULTS In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman's ρ, -0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of -0.35 (95 % CI: -0.39, -0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types. CONCLUSIONS Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid-base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.
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Affiliation(s)
- Michael Eichinger
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Karan Shah
- Section of Biostatistics, Quantitative Health Sciences, 2569 Cleveland Clinic , Cleveland, OH, USA
| | - Niklas Palt
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Michael Eichlseder
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Alexander Pichler
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Philipp Zoidl
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Paul Zajic
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Martin Rief
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
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Zachrison KS, Cash RE, Boggs KM, Hayden EM, Sullivan AF, Camargo CA. Emergency Department and Health Care System Factors Associated with Telehealth Innovation During the COVID-19 Pandemic. Telemed J E Health 2024; 30:527-535. [PMID: 37523311 DOI: 10.1089/tmj.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Methods: We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Results: Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Conclusions: Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
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Hansen PM, Nielsen MS, Rehn M, Lassen AT, Mikkelsen S, Perner A, Brøchner AC. Ambulance and helicopter response time. Association with patient outcome and illness severity: Protocol of a systematic literature review and meta-analysis. Acta Anaesthesiol Scand 2024; 68:287-296. [PMID: 37870745 DOI: 10.1111/aas.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Response time for emergency medical service units is a key performance indicator. Studies have shown reduced response time association with improved outcome for specific critical conditions. To achieve short response time, emergency vehicles utilize lights and sirens, and crews are allowed to be non-compliant with traffic rules, posing a risk for accident. The purpose of the systematic review and meta-analysis is to provide an overview of the current body of evidence regarding the association, if any, between ambulance and helicopter response time and major complications and mortality in patients conveyed by ambulance and/or helicopter. Our secondary aim will be to enhance knowledge in the field of criteria-based dispatch to provide decision makers with evidence to optimize dispatch of limited resources. RESEARCH QUESTIONS What is the association between overall emergency medical services unit response time and patient outcomes, major complications, and time-critical conditions? What is the internal and external validity of the included literature? METHODS We plan the systematic review and meta-analysis to be in accordance with the Cochrane Handbook and Joanna Briggs Institute Manual for Systematic Reviews. The methodology will include formulating the review questions using a Population, Exposure, and Outcome framework. Every study design is eligible, including qualitative, quantitative, and mixed-methods designs. We will include all articles in English, Scandinavian, German, French and Portuguese in this systematic review. RESULTS We will publish results from the systematic review and meta-analysis in a peer-reviewed journal and we will present the results at scientific conferences and meetings. Results will also be available at www.ahrtemis.dk. CONCLUSION We will base our conclusions on the findings of the review and meta-analysis.
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Affiliation(s)
- Peter Martin Hansen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital Svendborg, Odense C, Denmark
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
| | - Martine Siw Nielsen
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
| | - Marius Rehn
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | | | - Søren Mikkelsen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark
| | - Anders Perner
- Department of Anesthesiology and Intensive Care Medicine, Rigshospitalet, København Ø, Denmark
| | - Anne Craveiro Brøchner
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
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Chua MT, Boon Y, Yeoh CK, Li Z, Goh CJM, Kuan WS. Point-of-care ultrasound use in COVID-19: a narrative review. Ann Transl Med 2024; 12:13. [PMID: 38304913 PMCID: PMC10777239 DOI: 10.21037/atm-23-1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective The coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 resulted in significant mortality from respiratory tract infections. Existing imaging modalities such as chest X-ray (CXR) lacks sensitivity in its diagnosis while computed tomography (CT) scan carries risks of radiation and contamination. Point-of-care ultrasound (POCUS) has the advantage of bedside testing with higher diagnostic accuracy. We aim to describe the various applications of POCUS for patients with suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the emergency department (ED) and intensive care unit (ICU). Methods We performed literature search on the use of POCUS in the diagnosis and management of COVID-19 in MEDLINE, Embase and Scopus databases using the following search terms: "ultrasonography", "ultrasound", "COVID-19", "SARS-CoV-2", "SARS-CoV-2 variants", "emergency services", "emergency department" and "intensive care units". Search was performed independently by two reviewers with any discrepancy adjudicated by a third member. Key Content and Findings Lung POCUS in patients with COVID-19 shows different ultrasonographic features from pulmonary oedema, bacterial pneumonia, and other viral pneumonia, thus useful in differentiating between these conditions. It is more sensitive than CXR, and more accessible and widely available than CT scan. POCUS can be used to diagnose COVID-19 pneumonia, screen for COVID-19-related pulmonary and extrapulmonary complications, and guide management of ICU patients, such as timing of ventilator weaning based on lung POCUS findings. Conclusions POCUS is a useful and rapid point-of-care modality that can be used to aid in diagnosis, management, and risk stratification of COVID-19 patients in different healthcare settings.
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Affiliation(s)
- Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuru Boon
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew Kiat Yeoh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carmen Jia Man Goh
- Emergency Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Torres-Ness CR, Desai SA. Cardiac Arrest After Adenosine Administration in Compensatory Tachycardia: A Case Report. Cureus 2024; 16:e54780. [PMID: 38405639 PMCID: PMC10890913 DOI: 10.7759/cureus.54780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/27/2024] Open
Abstract
Compensatory tachycardia, an increased heart rate responding to stressors, requires careful consideration in treatment. This case report outlines a scenario where emergency medical services (EMS) misinterpreted a patient's electrocardiogram (EKG) as paroxysmal supraventricular tachycardia (PSVT) and administered adenosine, resulting in sudden cardiac arrest. Despite the rarity of deaths post-adenosine, this case highlights the potential risks of its use in inappropriate clinical scenarios. The patient, later diagnosed with a pulmonary embolism, had a compensatory heart rate that was disrupted after adenosine administration. While adenosine remains a safe and effective treatment for PSVT, this case report serves as a warning to EMS systems about the risks associated with its increased misuse, especially given the trends of prehospital EKG misinterpretation.
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Affiliation(s)
- Craig R Torres-Ness
- Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, USA
- Emergency Medicine, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Sonia A Desai
- Emergency Medicine, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
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Holmstrom L, Bednarski B, Chugh H, Aziz H, Pham HN, Sargsyan A, Uy-Evanado A, Dey D, Salvucci A, Jui J, Reinier K, Slomka PJ, Chugh SS. Artificial Intelligence Model Predicts Sudden Cardiac Arrest Manifesting With Pulseless Electric Activity Versus Ventricular Fibrillation. Circ Arrhythm Electrophysiol 2024; 17:e012338. [PMID: 38284289 PMCID: PMC10876166 DOI: 10.1161/circep.123.012338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation. Development of novel treatments requires fundamental clinical studies, but access to the true initial rhythm has been a limiting factor. METHODS Using demographics and detailed clinical variables, we trained and tested an AI model (extreme gradient boosting) to differentiate PEA-SCA versus VF-SCA in a novel setting that provided the true initial rhythm. A subgroup of SCAs are witnessed by emergency medical services personnel, and because the response time is zero, the true SCA initial rhythm is recorded. The internal cohort consisted of 421 emergency medical services-witnessed out-of-hospital SCAs with PEA or VF as the initial rhythm in the Portland, Oregon metropolitan area. External validation was performed in 220 emergency medical services-witnessed SCAs from Ventura, CA. RESULTS In the internal cohort, the artificial intelligence model achieved an area under the receiver operating characteristic curve of 0.68 (95% CI, 0.61-0.76). Model performance was similar in the external cohort, achieving an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.59-0.84). Anemia, older age, increased weight, and dyspnea as a warning symptom were the most important features of PEA-SCA; younger age, chest pain as a warning symptom and established coronary artery disease were important features associated with VF. CONCLUSIONS The artificial intelligence model identified novel features of PEA-SCA, differentiated from VF-SCA and was successfully replicated in an external cohort. These findings enhance the mechanistic understanding of PEA-SCA with potential implications for developing novel management strategies.
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Affiliation(s)
- Lauri Holmstrom
- Division of Artificial Intelligence in Medicine, Department of Medicine (L.H., B.B., D.D., P.J.S., S.S.C.)
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Bryan Bednarski
- Division of Artificial Intelligence in Medicine, Department of Medicine (L.H., B.B., D.D., P.J.S., S.S.C.)
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Habiba Aziz
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Hoang Nhat Pham
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Arayik Sargsyan
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Damini Dey
- Division of Artificial Intelligence in Medicine, Department of Medicine (L.H., B.B., D.D., P.J.S., S.S.C.)
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.)
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
| | - Piotr J. Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine (L.H., B.B., D.D., P.J.S., S.S.C.)
| | - Sumeet S. Chugh
- Division of Artificial Intelligence in Medicine, Department of Medicine (L.H., B.B., D.D., P.J.S., S.S.C.)
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles (L.H., H.C., H.A., H.N.P., A.S., A.U.-E., K.R., S.S.C.)
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Kienbacher CL, Wei G, Rhodes JM, Herkner H, Roth D, Williams KA. Risk factors for pediatric intoxications in the prehospital setting. A geospatial survey. Front Public Health 2024; 12:1296250. [PMID: 38333741 PMCID: PMC10851149 DOI: 10.3389/fpubh.2024.1296250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Background Socioeconomic factors and the COVID-19 pandemic influence children's physical and mental health. We aimed to investigate the association between a census tract's median household income [MHI in United States Dollars ($)] and pediatric intoxications in Rhode Island, the smallest state in the United States of America. Geographical hotspots, as well as interactions with the COVID-19 pandemic, should be identified. Methods This study is a retrospective analysis of ambulance calls for pediatric (<18 years) intoxication in Rhode Island between March 1st, 2018, and February 28th, 2022. March 1st, 2020 was considered the beginning of the COVID-19 pandemic. Prehospital data were joined with information from the United States Census Bureau. The census tracts' case counts and MHI were examined using Poisson regression. Geographical clusters were identified with the Global Moran's I and local indicators of spatial association tests in ArcGIS Pro (Esri Corporation, Redlands, CA). Results Inclusion criteria were met by 208 incidents (48% female, median age 16 (IQR 15 to 17) years). The regression model showed a 0.6% increase (IRR 1.006, 95% CI [1.002, 1.01], p = 0.003) in pediatric intoxications for every $ 1,000 increase in MHI. Interaction analysis showed that the effect of MHI was less pronounced during the pandemic (IRR 0.98, 95% CI [0.964, 0.997], p = 0.02). Thirty-four (14%) of the 244 census tracts contributed to geographical clusters, which changed after the onset of the pandemic. Conclusion Higher median household income could be a risk factor for pediatric intoxications. Geographical hotspots changed with the pandemic.
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Affiliation(s)
- Calvin Lukas Kienbacher
- Division of Emergency Medical Services, Department of Emergency Medicine, Brown University, Providence, RI, United States
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Guixing Wei
- Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, Providence, RI, United States
| | - Jason M. Rhodes
- Rhode Island Department of Health, Center for Emergency Medical Services, Providence, RI, United States
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Kenneth A. Williams
- Division of Emergency Medical Services, Department of Emergency Medicine, Brown University, Providence, RI, United States
- Rhode Island Department of Health, Center for Emergency Medical Services, Providence, RI, United States
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Ratti MFG, Martingano I, Otero PD, Otero CM, Farina JM, Rubin L, Luna D, Esteban JA, Pedretti AS, Rodríguez MDLP, Cid MSD, Martínez BJ. Unscheduled Emergency Department Revisits Within 48 Hours of Discharge. Stud Health Technol Inform 2024; 310:304-308. [PMID: 38269814 DOI: 10.3233/shti230976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study aimed to analyze early revisits (within 48 hours of discharge) in an Emergency Department. Among the 178,295 visits, 11,686 were revisits, resulting in a rate of 6.55% (95%CI 6.43-6.67). A total of 1,410 revisits required hospitalization, and 252 were due to preventable errors (17.87%). These errors were mainly related to an inadequate therapeutic plan at discharge (47.22%), an incomplete diagnostic process (29.37%), and misdiagnoses (13.10%). These findings represent a technology-enabled clinical audit tool. Electronic Healthcare Records have the potential to: provide quality metrics of hospital performance, help to keep revisit rates updated (assessment through a real-time dashboard), and improve clinical management (by transparency initiatives about errors, and a supportive learning environment regarding lessons learned).
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Affiliation(s)
| | - Ignacio Martingano
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paula Daniela Otero
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Martin Otero
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Luciana Rubin
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Luna
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Ariel Esteban
- Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana Soledad Pedretti
- Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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48
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Otaguro T, Motomura T, Funaki Y, Fukuyama Y, Nishimoto T, Hara Y, Yokobori S. Effectiveness of a Doctor Dispatch System Activated by an Advanced Automatic Collision Notification after a Single-Vehicle Accident: A Case Report. J NIPPON MED SCH 2024; 90:465-469. [PMID: 36436920 DOI: 10.1272/jnms.jnms.2023_90-606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 79-year-old woman collided with a cliff in a passenger automobile. The fire department acknowledged an automated collision notification from the D-Call Net (DCN) at 1 min after the accident and called for doctors by helicopter ( "Doctor-Heli" [DH] in Japan) 9 min after the injury. The DH reached the victim 28 min after the injury, and examination revealed pain in the right side of her chest, tachypnea, and a weak radial artery pulse (indicating shock). The DH arrived at the hospital 49 min after the injury. Thoracic drainage was performed for right-sided tension pneumothorax. She recovered from shock but was diagnosed with flail chest and placed on a respirator. She was extubated on postoperative day 6 and transferred to a rehabilitation hospital on postoperative day 57. Because of the DCN, the patient received treatment 15 min earlier than she would have with the conventional system. Emergency response task forces must develop strategies for connecting DCN warnings to rapid medical response systems.
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Affiliation(s)
- Takanobu Otaguro
- Shock and Trauma Center, Hokusoh HEMS, Nippon Medical School Chiba Hokusoh Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Tomokazu Motomura
- Shock and Trauma Center, Hokusoh HEMS, Nippon Medical School Chiba Hokusoh Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yutaka Funaki
- Shock and Trauma Center, Hokusoh HEMS, Nippon Medical School Chiba Hokusoh Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yuita Fukuyama
- Shock and Trauma Center, Hokusoh HEMS, Nippon Medical School Chiba Hokusoh Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | | | - Yoshiaki Hara
- Shock and Trauma Center, Hokusoh HEMS, Nippon Medical School Chiba Hokusoh Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Zachrison KS, Reeves MJ. Stroke Systems of Care 2.0: Moving Toward Definability, Accountability, and Equity. Stroke 2024. [PMID: 38197264 DOI: 10.1161/strokeaha.123.044263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (K.S.Z.)
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
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50
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Friedman NMG, Bivens MJ. Expanding access to substance misuse services through emergency medical services: envisioning a novel partnership for addiction medicine clinicians. Am J Drug Alcohol Abuse 2024; 50:8-11. [PMID: 38212992 DOI: 10.1080/00952990.2023.2286585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024]
Abstract
Emergency medical services (EMS) can be an invaluable ally of addiction medicine clinicians, but the potential role of EMS in combating the opioid epidemic has been under-realized. EMS has historically focused on emergency response and resuscitation in cases of overdose; however, EMS is also well-positioned to build rapport with persons who use drugs (PWUD), provide harm reduction services, and connect PWUD with additional treatment services and resources. A select number of EMS organizations have begun to offer substance-related programming that extends beyond resuscitation, but these offerings remain limited in scope and impact. This perspective argues that addiction medicine clinicians can bolster the ability of EMS to provide high quality substance-related services by engaging in prehospital care education, program development and research, and clinical care. This perspective shares practical strategies for addiction medicine clinicians to partner with EMS and considers several potential barriers that must be overcome, including bureaucratic challenges, variability in the scope of practice of EMS providers across different locations, and limited funding.
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Affiliation(s)
| | - Matthew J Bivens
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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