ORCID Profile
0000-0002-5940-1840
Current Organisations
James Cook University
,
University of Texas at Austin Dell Medical School
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Informa UK Limited
Date: 28-07-2011
DOI: 10.3109/10903127.2011.598625
Abstract: With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS provider-initiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. In addition, EMS provider determination of nontransport for a specific situation should be supported by evidence in the peer-reviewed literature that the practice is safe. Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.
Publisher: American Public Health Association
Date: 12-2012
Abstract: Objectives. We reviewed the English-language literature on the energy burden and environmental impact of health services. Methods. We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services where possible, we calculated per patient or per event emissions. Results. We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. Conclusions. Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.
Publisher: American College of Physicians
Date: 12-12-2017
DOI: 10.7326/M17-0969
Publisher: Informa UK Limited
Date: 2004
DOI: 10.1080/312703004209
Publisher: Informa UK Limited
Date: 12-08-2020
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.AJEM.2018.08.031
Abstract: To compare OHCA outcomes in patients managed with mechanical versus manual CPR in an EMS system with a "pit crew" approach to resuscitation and a scripted sequence for the initiation of mechanical CPR. Through a year-long quality improvement effort we standardized the initial resuscitative efforts for OHCA, prioritizing a "pit crew" approach to high quality manual CPR, early defibrillation and basic airway management ahead of a scripted sequence for initiating mechanical CPR. We then analyzed outcomes for adult, non-traumatic OHCA attended in the following year (2016). We used a propensity score matched analysis to compare ROSC, survival to discharge, and neurologic status among patients managed with manual versus mechanical CPR while controlling for patient demographics and arrest characteristics. Of 444 eligible OHCAs, 217 received manual and 227 received mechanical CPR. Crude ROSC (39.2% vs. 29.1%) and survival to discharge (13.8% vs. 5.7%) were higher with manual CPR. In the propensity matched analysis (n = 176 manual CPR 176 mechanical CPR), both ROSC (38.6% vs. 28.4% difference: 10.2% CI: 0.4% to 20.0%) and survival to discharge (13.6% vs. 6.8% difference: 6.8% CI: 0.5% to 13.3%) remained significantly higher for patients receiving manual CPR. In this EMS system with a standardized, "pit crew" approach to OHCA that prioritized initial high-quality initial resuscitative efforts and scripted the sequence for initiating mechanical CPR, use of mechanical CPR was associated with decreased ROSC and decreased survival to discharge.
Publisher: Informa UK Limited
Date: 2000
DOI: 10.1080/10903120090941551
Abstract: Historically, motor vehicle crash (MVC)-related mortality is higher in rural areas than in urban areas. The authors evaluated whether the difference in rural and urban MVC deaths is persisting, and whether the frequency of patients being found dead at the scene, particularly in rural areas, is increasing. Fatal Accident Reporting System (FARS) data for 1977 through 1996 were reviewed. The authors determined the frequency with which crash deaths occurred, and calculated population-based and vehicle-miles-traveled-based crash death rates. They compared rates for urban and rural areas. A total of 875,405 crash deaths were included in the analysis. Both population-based and vehicle-miles-traveled-based MVC deaths have decreased over the last 20 years, but rural rates remain significantly higher than urban rates. Dead-at-scene rates may be increasing, and the rural dead-at-scene rate is higher than the urban rate. While MVC death rates are declining, the rural MVC death rate is still higher than the urban rate. Although these data may indicate some positive movement in the area of MVC-related deaths, differences in the rural and urban rates and the number of patients found dead on-scene remain as issues that require attention.
Publisher: Informa UK Limited
Date: 2007
Publisher: Informa UK Limited
Date: 2002
DOI: 10.1080/10903120290938067
Abstract: The standard of care for patients following blunt trauma includes midline palpation of vertebrae to rule out fractures. Previous studies have demonstrated that spinal immobilization does cause discomfort. To determine whether spinal immobilization causes changes in physical exam findings over time. This was a single-blinded, prospective study at a tertiary care university teaching hospital. Twenty healthy volunteers without previous back pain or injuries, 13 male and seven female, were fully immobilized for one hour, with a cervical collar and strapped to a long wooden backboard. Midline palpation of vertebrae to illicit pain was performed at 10-minute intervals. In addition, the participants were asked to rate neck and back pain on a scale from 1 to 10 (1 for no pain, and 10 for unbearable pain), to see whether subjective pain from immobilization correlated with tenderness to palpation. Three patients had point tenderness of cervical vertebrae within 40 minutes. Five patients developed point tenderness of vertebrae by 60 minutes. Eighteen of 20 participants complained of increasing discomfort over time. The median initial pain scale was 1 (range 1-1), in contrast to 4 (range 1-9) at 60 minutes, p < 0.05. This study shows that over time, standard immobilization causes a false-positive exam for midline vertebral tenderness. In order to reduce this high false-positive rate for midline vertebral tenderness, the authors recommend that, initially on arrival to the emergency department, immediate evaluation occur of all immobilized patients. Furthermore, backboards should be modified to reduce patient discomfort to prevent the iatrogenically induced midline vertebral tenderness, thereby reducing subsequent false-positive examinations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1097/TA.0000000000001731
Abstract: Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778 confidence interval, 1.769–4.363 p 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15% p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429 confidence interval, 0.776–2.625 p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.RESUSCITATION.2015.02.008
Abstract: While adjusting data for age, sex, race and/or socio-economic status is well established in out-of-hospital cardiac arrest (OHCA) research, there are shortcomings to reporting and comparing population-based OHCA outcomes. The purpose of this study was to derive a case-based standard population specific to EMS treated adult OHCA (SPOHCA) in the U.S., and demonstrate its application. The proposed SPOHCA was developed from three sources of multi-site OHCA data: the Cardiac Arrest Registry to Enhance Survival (CARES) the National EMS Information System (NEMSIS) and a published report from the Resuscitation Outcomes Consortium (ROC). OHCA data from a single EMS system were then used to demonstrate the application of SPOHCA. We report raw survival, population-based survival adjusted to the U.S. population, and the new SPOHCA-adjusted survival. Observed raw survival was 12.3%. Adjustment to the demographic make-up of the adult U.S. population produced an adjusted incidence of 94.2 OHCA per 100,000 p-y, with a survival rate of 9.8 per 100,000 p-y. Using the proposed SPOHCA to adjust survival data produced an adjusted survival rate of 12.4%. A case-based standard population provides for more practical interpretation of reported OHCA outcomes. We encourage a more widespread effort involving multiple stakeholders to further explore the effects of adjusting OHCA outcomes using the proposed SPOHCA instead of population-based demographics.
Publisher: Massachusetts Medical Society
Date: 12-08-2004
DOI: 10.1056/NEJMOA040566
Publisher: Informa UK Limited
Date: 03-08-2020
Publisher: Wiley
Date: 10-1998
DOI: 10.1111/J.1553-2712.1998.TB02774.X
Abstract: Two means of delivering artificial ventilation readily available to out-of-hospital personnel are the bag-valve (BV) and the O2-powered demand-valve (OPDV). However, use of the OPDV has been limited because of concerns that it may worsen an underlying pneumothorax. This study compared the changes in size of pneumothorax in swine ventilated with the 2 devices. Three swine were anesthetized, intubated, and instrumented with a femoral arterial line and a pediatric Swan-Ganz catheter. A chest tube was placed, the chest was opened, and the lung parenchyma was visualized. The lung was disrupted by a single stab with a #10 scalpel the chest was then sealed and a pneumothorax was created by injecting 30 mL of air through the chest tube. The animals were ventilated by 12 emergency medical technicians using either BV or OPDV. After 10 minutes of ventilation, the pneumothorax volume was measured. When comparing final pneumothorax volumes after 10 minutes of ventilation with the 2 devices, there was no significant difference (mean +/- SD = 40.8 +/- 28.2 mL vs 52.3 +/- 23.1 mL, p = 0.286). There is no difference in final pneumothorax volumes after OPDV or BV ventilation.
Publisher: Wiley
Date: 12-1996
DOI: 10.1111/J.1553-2712.1996.TB03368.X
Abstract: To determine whether skin staples can be used to secure central venous catheters as effectively as does suturing. A prospective, randomized trial of techniques to secure a central venous catheter was performed in a medical school human anatomy laboratory using human cadavers. Central lines were secured to the upper left thorax using either standard suture material (000 silk) or skin staples (5.7 mm x 3.8 mm). Once secured, an upward force was applied to the hub of the catheter perpendicular to the skin. The amount of force needed to break the catheter hub free of the skin was measured in kg. A total of 10 measurements were made for each of 3 methods for securing the catheters (2 sutures, 2 staples, 4 staples). In addition, the site of catheter breakage was recorded. Those catheter hubs secured by 2 sutures required a mean force of 3.1 +/- 0.5 kg to cause breakage, and the break always occurred at the suture. Those hubs secured by 2 staples gave way at 3.0 +/- 0.3 kg (p = NS), while those secured with 4 staples gave way at 4.5 +/- 1.4 kg (p < 0.05). Although 1 hub did break, in all other stapled cases, the break occurred at the staple. Based on this cadaver model, use of staples appears to be as effective as suturing for securing central venous catheters. Further studies of safety and time for placement are needed.
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.RESUSCITATION.2004.08.019
Abstract: Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills competency can be tested using a checklist of component skills, in idually graded "pass" or "fail." Scores are typically calculated as the percentage of skills passed, but may differ from an instructor's overall subjective assessment of simulated CPR or AED adequacy. To identify and evaluate composite measures (methods for scoring checklists) that reflect instructors' subjective assessments of CPR or AED skills performance best. Associations between instructor assessment and lay-volunteer skill performance were made using 6380 CPR and 3313 AED skill retention tests collected in the Public Access Defibrillation Trial. Checklists included CPR skills (e.g., calling 911, administering compressions) and AED skills (e.g., positioning electrodes, shocking within 90 s of AED arrival). The instructor's subjective overall assessment (adequate/inadequate) of CPR performance (perfusion) or AED competence (effective shock) was compared to composite measures. We evaluated the traditional composite measure (assigning equal weights to in idual skills) and several nontraditional composite measures (assigning variable weights). Skills performed out of sequence were further weighted from 0% (no credit) to 100% (full credit). Composite measures providing full credit for skills performed out of sequence and down-weighting process skills (e.g., calling 911, clearing oneself from the AED) had the strongest association with the instructor's subjective assessment the traditional CPR composite measure had the weakest association. Our findings suggest that instructors in public CPR and AED classes may tend to down-weight process skills and to excuse step sequencing errors when evaluating CPR and AED skills subjectively for overall proficiency. Testing methods that relate classroom performance to actual performance in the field and to clinical outcomes require further research.
Publisher: Informa UK Limited
Date: 1999
DOI: 10.1080/10903129908958959
Abstract: To determine whether paramedics and on-line physicians screen patients for use of sildenafil citrate (Viagra) prior to prehospital administration of nitrates. A prospective, observational study was performed over a one-month period in three EMS systems. Consecutive radio communications between on-line physicians and paramedics concerning male patients with cardiac complaints were monitored. Investigators observed the frequency with which on-line physicians screened for sildenafil use prior to ordering nitrates. After observation of the radio communications was completed, a written survey was distributed to all paramedics in the three EMS systems. Seventy-six physician-paramedic interactions were monitored. Nitrates were ordered by on-line physicians in 56 cases. No paramedic reported sildenafil use/nonuse, and no on-line physician inquired about the patient's potential use of the drug. Only half of the surveyed paramedics reported that they routinely screen for sildenafil use, and approximately a fourth reported that its use would not alter their management of chest pain patients. In this study, on-line physicians in three EMS settings did not screen for sildenafil use prior to ordering nitrates. While some paramedics do screen for sildenafil use, practice patterns among paramedics in these three systems were inconsistent.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.AJIC.2017.11.032
Abstract: Catheter-associated urinary tract infections (CAUTIs) are common nosocomial infections. In 2015, the Centers for Medicare and Medicaid Services began imposing financial penalties for institutions where CAUTI rates are higher than predicted. However, the surveillance definition for CAUTI is not a clinical diagnosis and may represent asymptomatic bacteriuria. The objective of this study was to compare rates of urinary catheterization and CAUTI before and after the implementation of a bundled intervention. This retrospective review evaluated trauma patients from January 2013-January 2015. The bundled intervention optimized the urinary catheterization process and culturing practices to reduce false positives. The CAUTI rate was defined as a positive surveillance CAUTI ided by total catheter days multiplied by 1,000 days. A total of 6,236 patients were included (pre: n = 5,003 post: n = 1,233). Fewer patients in the post bundle group received a urinary catheter (pre: 25% vs post: 16% P < .001). After bundle implementation, the CAUTI rate reduced over one third (pre: 4.07 vs post: 2.56 incidence rate ratio, 0.63 95% confidence interval, 0.19-2.07). Although the number of patients exposed to urinary catheters and catheter days was decreased, optimization of culturing practices was essential to prevent the CAUTI rate from increasing from a reduced denominator. Implementation of a CAUTI prevention bundle works synergistically to improve patient safety and hospital performance.
Publisher: American Medical Association (AMA)
Date: 11-2018
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.ANNEMERGMED.2009.01.021
Abstract: Our objective is to evaluate the incremental cost-effectiveness of use of cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) by lay responders (CPR+AED) versus CPR only for cardiac arrest during a multicenter randomized trial. This was a prospective trial from July 2000 to September 2003 that randomly assigned 993 community units (eg, office buildings, public areas) in 24 sites to an emergency response system, using lay volunteers trained in CPR only or CPR+AED. Cost and quality of life data were collected with effectiveness data. The primary analysis evaluated the incremental cost-effectiveness of defibrillator use in public locations by using Markov modeling. CPR only had 14 survivors to discharge and CPR+AED had 29. CPR only had a mean of 0.58 (95% confidence interval [CI] 0.28 to 0.88) quality-adjusted life-years and a mean $42,400 (95% CI $22,100 to $62,600) costs. CPR+AED had mean 1.14 (95% CI 0.44 to 1.83) quality-adjusted life-years, mean $68,400 (95% CI $28,300 to $108,400) costs, and a long-term cost of mean $46,700 (95% CI $23,100 to $68,600) per quality-adjusted life-year. Results were sensitive to the effectiveness of the intervention, time horizon, location of arrest, and other factors. Training and equipping lay volunteers to defibrillate in public places may have an incremental cost-effectiveness that is similar to that of other common health interventions.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1097/TA.0000000000002047
Abstract: Platelet dysfunction, defined as adenosine diphosphate inhibition greater than 60% on thromboelastogram, is an independent predictor of increased mortality in patients with severe traumatic brain injury (TBI). We changed our practice to transfuse platelets for all patients with severe TBI and platelet dysfunction. We hypothesized that platelet transfusions would correct platelet dysfunction and improve mortality in patients with severe TBI. This retrospective review included adult trauma patients admitted to our Level I trauma center from July 2015 to October 2016 with severe TBI (head Abbreviated Injury Scale score ≥ 3) who presented with platelet dysfunction and subsequently received a platelet transfusion. Serial thromboelastograms were obtained to characterize the impact of platelet transfusion on clot strength. Subsequently, the platelet transfusion group was compared to a group of historical controls with severe TBI patients and platelet dysfunction who did not receive platelet transfusion. A total of 35 patients with severe TBI presented with platelet dysfunction. Following platelet transfusion clot strength improved as represented by decreased K time, increased α angle, maximum litude, and G-value, as well as correction of adenosine diphosphate inhibition. When comparing to 51 historic controls with severe TBI and platelet dysfunction, the 35 study patients who received a platelet transfusion had a lower mortality (9% vs. 35% p = 0.005). In stepwise logistic regression, platelet transfusion was independently associated with decreased mortality (odds ratio, 0.23 95% confidence interval, 0.06–0.92 p = 0.038). In patients with severe TBI and platelet dysfunction, platelet transfusions correct platelet inhibition and may be associated with decreased mortality. Therapeutic, level II.
Publisher: Informa UK Limited
Date: 2002
DOI: 10.1080/10903120290938751
Abstract: There are approximately 500,000 hospice patients in the United States. While hospice patients may desire only palliative care, they often access the emergency medical services (EMS) system, unaware that many EMS systems do not have specific palliative care protocols. This study was undertaken to determine the prevalence of palliative care protocols among EMS agencies in the United States, and to estimate the percentage of the U.S. population covered by such protocols. A survey requesting information about out-of-hospital palliative care protocols was mailed to the EMS agencies serving the 200 most populous U.S. cities. After four weeks a follow-up telephone call was made to those agencies that had not yet responded. The number of agencies with a palliative care protocol was determined, and the populations served by those agencies with and without palliative care protocols were calculated. Responses were received from 121 (60.5%) of the cities. Only seven (5.8%) of the responding cities' EMS agencies had a palliative care protocol. The population of cities covered by a palliative care protocol was just under 3 million, or slightly more than 6% of the 47.2 million people living in the responding cities. Most of the U.S. population is not served by an EMS agency with specific palliative care protocols. Until more EMS systems enact specific palliative care protocols, physicians treating the terminally ill should educate patients and families about appropriate use of the EMS system, and that EMS professionals may be required to provide more than supportive care.
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.AHJ.2005.01.042
Abstract: Few data exist regarding the retention of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills over time in relationship to characteristics of lay volunteer responders, training, or risk of exposure to victims. The purpose of this study was to describe the characteristics associated with adequate CPR and AED skill retention. Skill retention was tested 3 to 18 months (mean 6.9 +/- 3.5 months) after initial training. Instructors judged adequacy of performance of essential CPR or AED skills and provided an overall assessment (adequate/inadequate), which was used as the outcome. Data on 7261 laypersons trained in CPR (4358 also received AED training) in 24 sites across the United States and Canada were available from the Public Access Defibrillation (PAD) Trial. Characteristics of the volunteers, classes, and facilities were evaluated as predictors of performance adequacy. Adjusting for site, intervention assignment (CPR-only or CPR + AED), and time since initial training, volunteer characteristics associated with adequate CPR performance were age (OR 0.78 per 10-year increment), male sex (OR 1.44), minority (OR 0.62), married (OR 1.35), prior emergency experience (OR 1.66), prior CPR class (OR 1.68), prior advanced training (OR 1.59), and extracurricular CPR training (OR 1.91) (all P < .05). Characteristics associated with AED performance included age (OR 0.69), college education (OR 1.34), and native language other than English (OR 0.51) (all P < .05). Certain subgroups of lay volunteers may need targeted outreach programs in CPR and AED use, classes with longer training time, more practice, or more intense retraining to maintain their CPR and/or AED skills.
Publisher: Wiley
Date: 18-08-2010
DOI: 10.1111/J.1742-6723.2010.01319.X
Abstract: Short-term isolation might occur during pandemic disease or natural disasters. We sought to measure preparedness for short-term isolation in an Australian state during pandemic (H1N1) 2009. Data were collected as part of the Queensland Social Survey (QSS) 2009. Two questions related to preparedness for 3 days of isolation were incorporated into QSS 2009. Associations between demographic variables and preparedness were analysed using χ², with P < 0.05 considered statistically significant. Most respondents (93.6% confidence interval [CI] 92.2-94.9%) would have enough food to last 3 days, but only 53.6% (CI 50.9-56.4%) would have sufficient food and potable water if isolated for 3 days with an interruption in utility services. Subpopulations that were less likely to have sufficient food and potable water reserves for 3 days' isolation without utility services included single people, households with children under 18 years of age, people living in South-East Queensland or urban areas, those with higher levels of education and people employed in health or community service occupations. The majority of Queensland's population consider themselves to have sufficient food supplies to cope with isolation for a period of 3 days. Far fewer would have sufficient reserves if they were isolated for a similar period with an interruption in utility services. The lower level of preparedness among health and community service workers has implications for maintaining the continuity of health services.
Publisher: Elsevier BV
Date: 02-2023
Abstract: To evaluate the impact of changing energy prices on Australian ambulance systems. Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response labour-to-total expenditure ratio full-time equivalent employees (FTE) per 10,000 responses average salary median and 90th percentile response time and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries they were also positively associated with changes in injury compensation claims per 100 FTE. Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.
Publisher: Informa UK Limited
Date: 2001
Publisher: Cambridge University Press (CUP)
Date: 04-2019
DOI: 10.1017/S1049023X19000104
Abstract: First aid, particularly bystander cardiopulmonary resuscitation (CPR), is an important element in the chain of survival. However, little is known about what influences populations to undertake first aid/CPR training, update their training, and use of the training. The aim of this study was to explore the characteristics of people who have first aid/CPR training, those who have updated their training, and use of these skills. As part of the 2011 state-wide, computer-assisted telephone interviewing (CATI) survey of people over 18 years of age living in Queensland, Australia, stratified by gender and age group, three questions about first aid training, re-training, and skill uses were explored. Of the 1,277 respondents, 73.2% reported having undertaken some first aid/CPR training and 39.5% of those respondents had used their first aid/CPR skills. The majority of respondents (56.7%) had not updated their first aid/CPR skills in the past three years, and an additional 2.5% had never updated their skills. People who did not progress beyond year 10 in school and those in lower income groups were less likely to have undertaken first aid/CPR training. Males and people in lower income groups were less likely to have recently updated their first aid/CPR training. People with chronic health problems were in a unique demographic sub-group they were less likely to have undertaken first aid/CPR training but more likely to have administered first aid/CPR. Training initiatives that target people on the basis of education level, income group, and the existence of chronic health problems might be one strategy for improving bystander CPR rates when cardiac arrest occurs in the home. Franklin RC, Watt K, Aitken P, Brown LH, Leggat PA. Characteristics associated with first aid and cardiopulmonary resuscitation training and use in Queensland, Australia. Prehosp Disaster Med . 2019 (2):155–160
Publisher: Informa UK Limited
Date: 2000
DOI: 10.1080/10903120090941696
Abstract: To determine the time saving associated with lights and siren (L&S) use during emergency response in an urban EMS system. This prospective study evaluated ambulance response times from the location at time of dispatch to the scene of an emergency in an urban area. A control group of responses using L&S was compared with an experimental group that did not use L&S. An observer was assigned to ride along with ambulance crews and record actual times for all L&S responses. At a later date, an observer and an off-duty paramedic in an identical ambulance retraced the route--at the same time of day on the same day of the week--without using L&S and recorded the travel time. Response times for the two groups were compared using paired t-test. The 32 responses with L&S averaged 105.8 seconds (1 minute, 46 seconds) faster than those without (95% confidence interval: 60.2 to 151.5 seconds, p = 0.0001). The time difference ranged from 425 seconds (7 minutes, 5 seconds) faster with L&S to 210 seconds (3 minutes, 30 seconds) slower with L&S. In this urban EMS system, L&S reduce ambulance response times by an average of 1 minute, 46 seconds. Although statistically significant, this time saving is likely to be clinically relevant in only a very few cases. A large-scale multicenter L&S trial may help address this issue on a national level.
Publisher: Elsevier BV
Date: 02-1997
DOI: 10.1016/S0196-0644(97)70273-7
Abstract: To determine whether the environment of a moving ambulance affects the ability of our-of-hospital care providers to auscultate breath sounds. Out-of-hospital care providers assessed breath sounds with a previously described breath-sounds model in a quiet environment (control) and in a moving ambulance. The setting was a nonurban emergency medical services system and an interhospital transport agency based at a 600-plus-bed tertiary care center. The participants were physicians, transport nurses, and advanced life support EMS providers routinely involved in the emergency out-of-hospital treatment and transportation of the ill and injured. The accuracy with which participants identified the presence or absence of breath sounds in the two environments was compared with the use of the chi 2 test, with the alpha-value set at .05. The accuracy of breath-sounds assessment in the control environment was 96% (251 of 260) the sensitivity was 96% and the specificity 97%. The accuracy of breath-sounds assessment in the experimental environment was 54% (140 of 260) the sensitivity was .09% and the specificity 98%. Participants were significantly less likely to hear breath sounds in the moving ambulance than in the quiet room (P < .001). Assessment of breath sounds is h ered by the environment of a moving ambulance.
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/10903120903144809
Abstract: Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were searched using Cochrane Prehospital and Emergency Care Field search terms combined with the Medical Subject Headings (MeSH) terms "triage" "utilization review" "health services misuse" "severity of illness index," and "trauma severity indices." Two reviewers independently evaluated each title to identify relevant studies each abstract then underwent independent review to identify studies requiring full appraisal. Inclusion criteria were original research emergency responses determinations of medical necessity by U.S. paramedics and a reference standard comparison. The primary outcome measure of interest was the negative predictive value (NPV) of paramedic determinations. For studies reporting sufficient data, agreement between paramedic and reference standard determinations was measured using kappa sensitivity, specificity, and positive predictive value (PPV) were also calculated. From 9,752 identified titles, 214 abstracts were evaluated, with 61 studies selected for full review. Five studies met the inclusion criteria (interrater reliability, kappa = 0.75). Reference standards included physician opinion (n = 3), hospital admission (n = 1), and a composite of physician opinion and patient clinical circumstances (n = 1). The NPV ranged from 0.610 to 0.997. Results lacked homogeneity across studies meta-analysis using a random-effects model produced an aggregate NPV of 0.912 (95% confidence interval: 0.707-0.978). Only two studies reported complete 2 x 2 data: kappa was 0.105 and 0.427 sensitivity was 0.992 and 0.841 specificity was 0.356 and 0.581 and PPV was 0.158 and 0.823. The results of the few studies evaluating U.S. paramedic determinations of medical necessity for ambulance transport vary considerably, and only two studies report complete data. The aggregate NPV of the paramedic determinations is 0.91, with a lower confidence limit of 0.71. These data do not support the practice of paramedics' determining whether patients require ambulance transport. These findings have implications for EMS systems, emergency departments, and third-party payers.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 1994
DOI: 10.1016/0735-6757(94)90196-1
Abstract: In 1989, Ch ion et al recommended revising the Trauma Score to exclude capillary refill because it is "difficult to assess at night. . . ." However, a literature search produced no studies evaluating the effect of lighting conditions on the assessment of capillary refill. This study was undertaken to determine if any such effect exists. Three hundred nine participants at an emergency medical services (EMS) seminar were asked to assess each others' capillary refill in both light and dark environments. The participants were nurses, emergency medical technicians (EMTs), and paramedics who had been instructed in the assessment of capillary refill. In daylight conditions (partly cloudy day, lux meter = 15 to 16), capillary refill was reported as normal in 94.2% of the participants, delayed in 1.9% of the participants, and undetected in 3.9% of the participants. In dark conditions (moonlight or street l , lux meter = 4 to 6), capillary refill was reported as normal in 31.7% of the participants, delayed in 1.6% of the participants, and undetected in 66.7% of the participants. chi 2 analysis demonstrated a statistically significant difference between capillary refill assessment in light versus dark environments (P < .001).
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.AJEM.2017.06.047
Abstract: The purpose of this study was to evaluate whether increased proliferation of mobile telephones has been associated with decreased MVC notification times and/or decreased MVC fatality rates in the United States (US). We used World Bank annual mobile phone market penetration data and US Fatality Analysis Reporting System (FARS) fatal MVC data for 1994-2014. For each year, phone proliferation was measured as mobile phones per 100 population. FARS data were used to calculate MVC notification time (time EMS notified - time MVC occurred) in minutes, and to determine the MVC fatality rate per billion vehicle miles traveled (BVMT). We used basic vector auto-regression modeling to explore relationships between changes in phone proliferation and subsequent changes in median and 90th percentile MVC notification times, as well as MVC fatality rates. From 1994 to 2014, larger year-over-year increases in phone proliferation were associated with larger decreases in 90th percentile notification times for MVCs occurring during daylight hours (p=0.004) and on the national highway system (p=0.046) two years subsequent, and crashes off the national highway system three years subsequent (p=0.023). There were no significant associations between changes in phone proliferation and subsequent changes in median crash notification times, nor with subsequent changes in MVC fatality rates. Between 1994 and 2014 increased mobile phone proliferation in the U.S. was associated with shorter 90th percentile EMS notification times for some subgroups of fatal MVCs, but not with decreases in median notification times or overall MVC fatality rates.
Publisher: Massachusetts Medical Society
Date: 10-09-2020
DOI: 10.1056/NEJMC2025923
Publisher: Informa UK Limited
Date: 13-04-2021
Publisher: Elsevier BV
Date: 04-2002
DOI: 10.1016/S0736-4679(01)00497-8
Abstract: The objective of this study was to determine if an Emergency Medicine (EM) rotation for medical students offers a unique educational opportunity, and to document those experiences. Thirty-three medical students at one teaching hospital recorded in a computer database information about their patient encounters during EM and Internal Medicine (IM) rotations. Data collected included the types of patients seen, the level of participation in patient care and decision making, and procedures performed. A total of 2740 patient encounters were recorded, 1564 EM and 1176 IM. Students on EM rotations were more likely than students on IM rotations to be involved in the initial evaluation (93.1% vs. 47.0%, respectively), diagnosis (93.5% vs. 44.7%, respectively), and decision making (93.3% vs. 43.5%, respectively) they were also more likely to perform procedures (31.7% vs. 8.5%, respectively). There were significant differences in the patient populations and disease processes encountered on the two rotations as well.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
Publisher: Springer Science and Business Media LLC
Date: 11-06-2015
DOI: 10.1017/CEM.2015.29
Abstract: A recent mixed-methods study on the state of emergency medical services (EMS) research in Canada led to the generation of nineteen actionable recommendations. As part of the dissemination plan, a survey was distributed to EMS stakeholders to determine the anticipated impact and feasibility of implementing these recommendations in Canadian systems. An online survey explored both the implementation impact and feasibility for each recommendation using a five-point scale. The s le consisted of participants from the Canadian National EMS Research Agenda study (published in 2013) and additional EMS research stakeholders identified through snowball s ling. Responses were analysed descriptively using median and plotted on a matrix. Participants reported any planned or ongoing initiatives related to the recommendations, and required or anticipated resources. Free text responses were analysed with simple content analysis, collated by recommendation. The survey was sent to 131 people, 94 (71.8%) of whom responded: 30 EMS managers/regulators (31.9%), 22 researchers (23.4%), 15 physicians (16.0%), 13 educators (13.8%), and 5 EMS providers (5.3%). Two recommendations (11%) had a median impact score of 4 (of 5) and feasibility score of 4 (of 5). Eight recommendations (42%) had an impact score of 5, with a feasibility score of 3. Nine recommendations (47%) had an impact score of 4 and a feasibility score of 3. For most recommendations, participants scored the anticipated impact higher than the feasibility to implement. Ongoing or planned initiatives exist pertaining to all recommendations except one. All of the recommendations will require additional resources to implement.
Publisher: Elsevier BV
Date: 07-2004
Publisher: Informa UK Limited
Date: 05-2010
DOI: 10.3109/10903121003790173
Abstract: Airway management is a key component of prehospital care for seriously ill and injured patients. Although endotracheal intubation has been a commonly performed prehospital procedure for nearly three decades, the safety and efficacy profile of prehospital intubation has been challenged in the last decade. Reported intubation success rates vary widely, and established benchmarks are lacking. We sought to determine pooled estimates for oral endotracheal intubation (OETI) and nasotracheal intubation (NTI) placement success rates through a meta-analysis of the literature. We performed a systematic literature search for all English-language articles reporting placement success rates for prehospital intubation. Studies of field procedures performed by prehospital personnel from any nation were included. All titles were reviewed independently by two authors using prespecified inclusion criteria. Pooled estimates of success rates for each airway technique, including drug-facilitated intubation (DFI) and rapid-sequence intubation (RSI), were calculated using a random-effects model. Historical trends were evaluated using meta-regression. Of 2,005 identified titles reviewed, 117 studies addressed OETI and 23 addressed NTI, encompassing a total of 57,132 prehospital patients. There was substantial interrater reliability in the review process (kappa = 0.81). The pooled estimates (and 95% confidence intervals [CIs]) for intervention success for nonphysician clinicians were as follows: overall non-RSI/non-DFI OETI success rate: 86.3% (82.6%-89.4%) OETI for non-cardiac arrest patients: 69.8% (50.9%-83.8%) DFI 86.8% (80.2%-91.4%) and RSI 96.7% (94.7%-98.0%). For pediatric patients, the paramedic OETI success rate was 83.2% (55.2%-95.2%). The overall NTI success rate for nonphysician clinicians was 75.9% (65.9%-83.7%). The historical trend of OETI reflects a 0.49% decline in success rates per year. We provide pooled estimates of placement success rates for prehospital airway interventions. For some patient and clinician characteristics, OETI has relatively low success rates. For nonarrest patients, DFI and RSI appear to increase success rates. Across all clinicians, NTI has a low rate of success, raising questions about the safety and efficacy of this procedure.
Publisher: Informa UK Limited
Date: 12-10-2020
DOI: 10.1080/10903127.2020.1819493
Abstract: Ketamine is gaining acceptance as an agent for prehospital pain control, but the associated risks of agitation, hallucinations and sedation have raised concern about its potential to prolong emergency department (ED) length of stay (LOS). This study compared ED LOS among EMS patients who received prehospital ketamine, fentanyl or morphine specifically for pain control. We hypothesized ED LOS would not differ between patients receiving the three medications. This retrospective observational study utilized the 2018 ESO Research Database, which includes more than 7.5 million EMS events attended by more than 1,200 agencies. Inclusion criteria were a 9-1-1 scene response age ≥ 18 years a recorded pain score greater than 4 an initial complaint or use of a treatment protocol indicating a painful condition prehospital administration of ketamine, fentanyl or morphine and ED LOS data available. Patients were excluded if they received a combination of the medications, or if there were indications that medication administration could have been for airway management (i.e., altered mental status, head injury, respiratory distress/depression) or agitation control (e.g., behavioral complaints). Kruskal-Wallis test was used to compare ED LOS among patients receiving each of the three medications. Of 9,548 patients who met the inclusion criteria, 119 received ketamine, 1,359 received morphine, and 8,070 received fentanyl. Patient and event characteristics did not significantly differ between the three groups. Median (IQR) ED LOS was 3.5 (2.5-6.1) hours for patients who received ketamine, 4.0 (2.7-6.1) hours for patients who received morphine, and 3.7 (2.6-5.4) hours for patients who received fentanyl (p = 0.002). In ED LOS is not longer for patients who receive prehospital ketamine, versus morphine or fentanyl, for management of isolated painful non-cardiorespiratory conditions.
Publisher: Informa UK Limited
Date: 1998
DOI: 10.1080/10903129808958837
Abstract: To determine whether EMS providers can accurately apply the clinical criteria for clearing cervical spines in trauma patients. EMS providers completed a data form based on their initial assessments of all adult trauma patients for whom the mechanism of injury indicated immobilization. Data collected included the presence or absence of: neck pain/tenderness altered mental status history of loss of consciousness drug/alcohol use neurologic deficit and other painful/distracting injury. After transport to the ED, emergency physicians (EPs) completed an identical data form based on their assessments. Immobilization was considered to be indicated if any one of the six criteria was present. The EPs and EMS providers were blinded to each other's assessments. Agreement between the EP and EMS assessments was analyzed using the kappa statistic. Five-hundred seventy-three patients were included in the study. The EP and EMS assessments matched in 78.7% (n = 451) of the cases. There were 44 (7.7%) patients for whom EP assessment indicated immobilization, but the EMS assessment did not. The kappa for the in idual components of the assessments ranged from 0.35 to 0.81, with the kappa for the decision to immobilize being 0.48. The EMS providers' assessments were generally more conservative than the EPs'. EMS and EP assessments to rule out cervical spinal injury have moderate to substantial agreement. However, the authors recommend that systems allowing EMS providers to decide whether to immobilize patients should follow those patients closely to ensure appropriate care and to provide immediate feedback to the EMS providers.
Publisher: Informa UK Limited
Date: 1999
Publisher: Elsevier BV
Date: 02-1997
DOI: 10.1016/S0300-9572(96)01043-X
Abstract: This study was undertaken to determine if checking for a pulse between initial defibrillations causes a clinically significant delay in the administration of the defibrillations. Ten emergency department nurses and 10 emergency medicine resident physicians were timed delivering three successive defibrillations (200, 300 and 360 J) to a manikin under three randomly assigned scenarios: (1) without pulse checks (2) with pulse checks performed by an assistant and (3) with pulse checks performed by the participant. All participants performed the three defibrillation scenarios using three different models of defibrillators. Repeated measures analysis of variance was used to compare mean defibrillation times for the three scenarios. The mean time was 20.4 +/- 1.0 s for defibrillation without pulse checks 20.2 +/- 1.2 s with pulse checks by an assistant and 22.0 +/- 2.0 s with pulse checks by the participant. There was a statistically significant difference between no pulse checks and pulse checks by the participant. No statistically significant difference was noted between no pulse checks and pulse checks by an assistant. We conclude that checking for a pulse does cause a statistically significant delay in the administration of defibrillations. This difference, however, is not likely to be clinically relevant.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.AJEM.2018.12.031
Abstract: To evaluate changes in insurance status among emergency department (ED) patients presenting in the two years immediately before and after full implementation of the Affordable Care Act (ACA). We evaluated National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department public use data for 2012-2015, categorizing patients as having any insurance (private Medicare Medicaid workers' compensation) or no insurance. We compared the pre- and post-ACA frequency of insurance coverage-overall and within the older (≥65), working-age (18-64) and pediatric (<18) subpopulations-using unadjusted odds ratios with 95% confidence intervals. We also conducted a difference-in-differences analysis comparing the change in insurance coverage among working-age patients with that observed for older Medicare-eligible patients, while controlling for sex, race and underlying temporal trends. Overall, the proportion of ED patients with any insurance did not significantly change from 2012 to 2013 to 2014-2015 (74.2% vs 77.7%) but the proportion of working-age adult patients with at least one form of insurance increased significantly, from 66.0% to 71.8% (OR 1.31, CI: 1.13-1.52). The difference-in-differences analysis confirmed the change in insurance coverage among working-age adults was greater than that seen in the reference population of Medicare-eligible adults (AOR 1.70, CI: 1.29-2.23). The increase was almost entirely attributable to increased Medicaid coverage. In the first two years following full implementation of the ACA, there was a significant increase in the proportion of working-age adult ED patients who had at least one form of health insurance. The increase appeared primarily associated with expansion of Medicaid.
Publisher: Diving and Hyperbaric Medicine Journal
Date: 31-03-2018
DOI: 10.28920/DHM48.1.2-9
Publisher: Informa UK Limited
Date: 03-09-2017
Publisher: SAGE Publications
Date: 09-2009
Publisher: Elsevier BV
Date: 2000
DOI: 10.1016/S1067-991X(00)90088-9
Abstract: Weather is one of many factors that affect safety in an air medical program. Syracuse, New York, has notoriously bad weather, and some have questioned whether an air medical service is practical given central New York's climate. This study was undertaken to determine the extent to which the area's climate could be expected to limit the availability of an air medical service. CAMTS weather minimums for rotor-wing programs were compared with 1996-1997 hourly weather observations from the Northeastern Regional Climate Center (NRCC) and sunrise/sunset data from the United States Naval Observatory to determine how frequently weather conditions could be expected to preclude an air medical response in the greater Syracuse area. Exactly 17,544 hourly observations were made. CAMTS weather minimums would have precluded local flights for 606 (3.5%) of these hours and cross-country flights for 1111 (6.3%) hours. Cross-country flights were more likely to be precluded than local flights (P = .001), and both local and cross-country flights were more likely to be precluded at nighttime than in the daytime (P = .001). All flights were more likely to be precluded during winter months than during summer months (P = .000). The weather in central New York generally does not preclude the operation of an air medical services system.
Publisher: Oxford University Press (OUP)
Date: 09-2010
DOI: 10.1111/J.1708-8305.2010.00445.X
Abstract: Global disease outbreaks, such as the recent Pandemic (H1N1) 2009 (the so-called Swine flu), may have an impact on travel, including raising the concerns of travelers. The objective of this study was to examine the level of concern of Australians regarding travel during Pandemic (H1N1) 2009 and how this impacted on their travel. Data were collected by interviews as part of the Queensland Social Survey (QSS) 2009. Specific questions were incorporated regarding travel and Pandemic (H1N1) 2009. Multivariate logistic regression was used to analyze associations between demographic variables and concern and likelihood of cancelling travel. There were 1,292 respondents (41.5% response rate). The s le was nearly equally ided between males and females (50.2% vs 49.8%). Younger people (18-34 y) were under-represented in the s le older people (> 55 y) were over-represented in the s le. About half (53.2%) of respondents indicated some level of concern about Pandemic (H1N1) 2009 when traveling and just over one-third (35.5%) indicated they would likely cancel their air travel if they had a cough and fever that lasted more than one day. When cross-tabulating these responses, people who expressed concern regarding Pandemic (H1N1) 2009 when they traveled were more likely than those without concern to cancel their air travel if they had a cough and fever lasting more than one day (44.7% vs 27.7%, χ² = 33.53, p < 0.001). People with higher levels of education [adjusted odds ratio (AOR): 0.651], people with higher incomes (AOR: 0.528) and people living outside of metropolitan Southeast Queensland (AOR: 0.589) were less likely to be concerned about Pandemic (H1N1) 2009 when traveling, and younger people (AOR: 0.469) were less likely than others to cancel travel if they had a cough and fever. Pandemic (H1N1) 2009 was of some concern to more than half of Queensland travelers. None-the-less, the majority of Queenslanders would not have postponed their own travel, even if they exhibited symptoms consistent with Pandemic (H1N1) 2009.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Informa UK Limited
Date: 2005
DOI: 10.1080/10903120590962238
Abstract: One of the eight major recommendations put forth by the National EMS Research Agenda Implementation Project in 2002 was the development of an emergency medical services (EMS) research strategic plan. Using a modified Delphi technique along with a consensus conference approach, a strategic plan for EMS research was created. The plan includes recommendations for concentrating efforts by EMS researchers, policy makers, and funding resources with the ultimate goal of improving clinical outcomes. Clinical issues targeted for additional research efforts include evaluation and treatment of patients with asthma, acute cardiac ischemia, circulatory shock, major injury, pain, acute stroke, and traumatic brain injury. The plan calls for developing, evaluating, and validating improved measurement tools and techniques. Additional research to improve the education of EMS personnel as well as system design and operation is also suggested. Implementation of the EMS research strategic plan will improve both the delivery of services and the care of in iduals who access the emergency medical system.
Publisher: Elsevier BV
Date: 04-2004
Publisher: Informa UK Limited
Date: 1999
DOI: 10.1080/10903129908958925
Abstract: To determine whether EMS educational programs in North Carolina adequately prepare paramedics, and whether there is additional value to an associate of applied science (AAS) degree education in EMS when compared with traditional certificate training programs. Surveys were developed and distributed to EMS administrators, AAS paramedics, and certificate paramedics. The administrators were asked to rate the performance of both AAS and certificate paramedics in the areas of preemployment evaluation, patient-care skills, and non-patient-care duties. The paramedics were asked to rate their preparation for specific responsibilities within those three categories. All of the participants were asked to describe the requirements for employment within their EMS systems, and any preferences given to AAS paramedics. The administrators rated both AAS and certificate paramedics as good or excellent in all three categories. The paramedics also rated their preparation for patient care as good or excellent. The certificate paramedics rated their preparation for eight non-patient-care duties significantly lower than did the AAS paramedics. The eight areas were: 1) verbal communication, 2) reading ability, 3) leadership, 4) conflict resolution, 5) computer skills, 6) teaching skills, 7) personal health/hygiene, and 8) Occupational Safety and Health Administration (OSHA) compliance. Fewer than half of the EMS administrators reported preferences in hiring (46.2%) or promotion (39.6%) for AAS paramedics, but at least half (50.0% and 54.2%) of the AAS paramedics worked in systems offering such preferences. While administrators and paramedics believe the current EMS educational programs in North Carolina adequately prepare students to function as paramedics, there are identifiable areas that require additional emphasis. There appears to be additional value to an AAS education when compared with traditional certificate EMS educational programs.
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.RESUSCITATION.2006.06.036
Abstract: To evaluate the characteristics of volunteers responding to emergencies in the North American Public Access Defibrillation (PAD) Trial. The PAD Trial was a prospective evaluation of cardiac arrest survival in community facilities randomized to cardiopulmonary resuscitation (CPR) or to CPR with automated external defibrillators (AEDs). The PAD volunteers' characteristics were analyzed using Poisson regression clustered on the facility and offset by the number of emergency episodes to which volunteers were exposed. A total of 19,320 volunteers in 1260 facilities were trained to provide emergency care. Of these, 8169 volunteers were participating actively at their facility during a time when one or more emergency episodes occurred. There were 1971 emergency episodes responded to by 1245 volunteers. The treatment arm (CPR-only versus CPR+AED) was not associated with the likelihood of volunteer participation in an episode. Likewise, the volunteers' age or sex did not affect response. Volunteers more likely to respond were supervisory/management or security personnel, non-minority participants, volunteers with previous CPR training, volunteers with previous experience in emergency care and those who passed the PAD CPR skills follow-up test. Volunteers who had a formal education beyond a high school level were less likely to respond. Volunteers with previous emergency training and positions of responsibility in their facility had a greater likelihood of participation in medical emergencies in the PAD Trial.
Publisher: Elsevier BV
Date: 11-1994
DOI: 10.1016/0735-6757(94)90025-6
Abstract: Blood pressure measurements in a moving ambulance can be difficult to obtain. Sirens, engine noise, and road noise can all interfere with the accurate detection of a patient's blood pressure. This study was undertaken to determine the influence of ambulance noise and vibration on auscultated blood pressures. A model was developed that used dynamic pressures to simulate systolic Korotkoff sounds. Forty-nine emergency personnel were asked to obtain blood pressures using the model in both a quiet environment and in a moving ambulance. A total of 485 blood pressure measurements were obtained. Systolic pressures were randomized to two settings: 76 mm Hg and 138 mm Hg. Stationary readings were compared with moving readings using analysis of variance for repeated measures. Systolic blood pressure measurements obtained in the quiet environment averaged 133 +/- 5 mm Hg at the high setting, and 45 +/- 6 mm Hg at the low setting. Systolic blood pressure measurements obtained in a moving ambulance averaged 86 +/- 7 mm Hg at the high setting, and 41 +/- 7 mm Hg at the low setting. The average differences between quiet and moving measurements were 47 mm Hg at the "high" setting (P .01). At physiological levels, blood pressures obtained in moving ambulances differ significantly from those obtained in a quiet environment, which may be caused by road noise and ambulance motion.
Publisher: Massachusetts Medical Society
Date: 08-03-2001
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.AAP.2019.105284
Abstract: Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.
Publisher: Elsevier BV
Date: 04-1995
DOI: 10.1016/S0196-0644(95)70267-9
Abstract: To determine whether ambulance transport time from the scene to the emergency department is faster with warning lights and siren than that without. In a convenience s le, transport times and routes of ambulances using lights and sirens were recorded by an observer. The time also was recorded by a paramedic who drove an ambulance without lights and siren over identical routes during simulated transports at the same time of day and on the same day of the week as the corresponding lights-and-siren transport. An emergency medical service system in a city with a population of 46,000. Emergency medical technicians and paramedics. Fifty transport times with lights and siren averaged 43.5 seconds faster than the transport times without lights and siren [t = 4.21, P = .0001]. In this setting, the 43.5-second mean time savings does not warrant the use of lights and siren during ambulance transport, except in rare situations or clinical circumstances.
Publisher: Informa UK Limited
Date: 1997
DOI: 10.1080/10903129708958822
Abstract: The widespread use of orotracheal intubation with rapid-sequence induction has made it difficult for emergency medical services (EMS) professionals to gain experience in nasotracheal intubation (NTI) in a controlled and supervised setting. The purpose of this study was to determine whether a training session on NTI with a breathing manikin can be used to improve the self-assessed skill level and comfort of EMS professionals. A prospective trial was conducted with a convenience s le of 33 EMS professionals, previously trained in NTI techniques. For the training session, a Laerdal airway manikin was modified by replacing the lungs with self-inflating resuscitation bag. The bag could then be squeezed to simulate breathing, with an inspiratory and expiratory phase. Following didactic instruction, and with direct supervision, each participant practiced NTI using this breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self-assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre- and postintervention scores were compared using the Wilcoxon signed-rank test, alpha = 0.01. Following the training session, the comfort level for NTI by the participants increased significantly from a median value of 2 to 7 (p = 0.001). Furthermore, the self-assessed skill level for NTI following the training session increased significantly from a median value of 4 to 8 (p = 0.0001). As expected, there were no significant differences noted in self-assessed skill level for orotracheal intubation following the training session. However, there was statistically significant improvement in self-assessed comfort levels for orotracheal intubation after the skills laboratory, p = 0.0001. For EMS professionals, a training session for NTI using a relatively inexpensive and easily assembled breathing manikin model increases both comfort and self-assessed skill level.
Publisher: Informa UK Limited
Date: 1997
DOI: 10.1080/10903129708958821
Abstract: The National Standard Curriculum for paramedics is currently being revised. There is little scientific evidence of what does and what does not work in prehospital care, and of whether the National Standard Curriculum prepares paramedics for the field. To provide some basis for the current revisions to the National Standard Curriculum, the authors determined which prehospital skills are perceived by paramedics to be the most important, and whether the emphasis placed on those skills during initial and continuing education programs corresponds with the perceived importance. Surveys listing 21 paramedic skills were mailed to the directors of 41 EMS agencies who agreed to participate in the study. The directors distributed the surveys to 1,364 paramedics affiliated with their organizations. The participants were asked to rate the importance of each skill, and the emphasis placed on each skill during their initial and continuing education. Skills were ranked on a scale of 0 to 4, with 0 representing no importance or emphasis, and 4 representing the most possible importance or emphasis. Six-hundred of the 1,364 (44%) surveys were returned. Respondents had a mean of 9.9 +/- 5.6 years of EMS experience, and 5.4 +/- 4.0 years of experience as paramedics. The three skills ranked highest in importance were: 1) endotracheal intubation 2) defibrillation and 3) assessment. Importance in prehospital care was ranked equal to or higher than emphasis in both initial and continuing education for all skills except splinting and urinary catheterization, which received higher rankings for emphasis in initial education. Emphasis in initial education equaled or exceeded the emphasis in continuing education for all skills except intraosseous infusion. The perceived importance of most prehospital skills is very high, and exceeds the emphasis placed on those skills during both initial and continuing education programs. These findings have implications for medical directors, EMS instructors, and persons involved with the revision of the National Standard Curriculum.
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.JEMERMED.2006.04.011
Abstract: This study examines whether female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians. A convenience s le of adult patients seen while a trained observer was on duty in an academic Emergency Department constituted the study population. After the first physician contact, the observer asked the patient if a physician had seen the patient yet. The observer recorded the physician's sex, the patient's response, sex, age, and race. The frequencies that male and female physicians were recognized as physicians were compared. For the 184 physician-patient contacts evaluated, 98/105 (93.3%) of males were recognized as physicians and 62/79 (78.5%) of females were recognized as physicians. Females were significantly less likely than males to be recognized as physicians (chi-square, p = 0.003). Female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians.
Publisher: Informa UK Limited
Date: 1997
DOI: 10.1080/10903129708958820
Abstract: To measure the accuracy of lead II rhythm strip interpretations performed by advanced life support (ALS) emergency medical technicians (EMTs) in a rural emergency medical services (EMS) system. An electronic rhythm simulator was used to produce 24 three-lead electrocardiogram (ECG) rhythm strips. The rhythms were shown to 57 ALS EMTs participating in regularly scheduled continuing education classes. The participants were asked to identify the rhythms. The three-lead ECG interpretations were generally accurate, although there was some difficulty in distinguishing between specific types of tachydysrhythmia and atrioventricular (AV) block. The overall accuracy of the rhythm interpretations was 79.2%, ranging from 45.6% (second-degree type II heart block) to 98.2% (sinus bradycardia). The sensitivity for specific tachydysrhythmias ranged from 68.4% (supraventricular tachycardia) to 86.0% (atrial fibrillation) the sensitivity for specific types of AV block ranged from 45.6% (second-degree, type II) to 71.9% (third-degree). In this EMS system, ECG interpretations are generally accurate, with tachydysrhythmias and AV blocks being the source of most discrepancies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.AJEM.2014.11.011
Abstract: Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems. Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random s le of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined. Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%). Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.RESUSCITATION.2005.10.029
Abstract: Bystander CPR rates remain low. One reason may be that the thought of responding to an emergency is so stressful that it decreases the willingness of laypersons to respond. The purpose of this study was to quantify the amount of stress experienced by lay responders to a medical emergency and to identify barriers that may have impeded their response to the event. Responses from 1243 laypersons responding to an emergency during the Public Access Defibrillation Trial were analyzed in a mixed methods study. Stress related to the event was recorded using a 0 (none) to 5 (severe) scale. Qualitative responses to the question of "What was most difficult?" about the event were analyzed using content analysis. Reported stress levels were low overall (mean 1.2, median 1.0). Laypersons responding to an emergency presumed to be a cardiac arrest had higher stress than those involved in other events (median 2.0 versus 1.0). Stress levels were higher in residential than in public settings (mean 1.41, median 1.0 versus mean 1.13, median 1.0). Those who fit a certain profile (females, non-native English speakers) reported statistically higher stress levels than others. A total of 614 qualitative responses were studied and aggregated into four major categories of difficulty: practical issues characteristics of the victim interpersonal issues thoughts and feelings of the lay responder. Most difficulties were in the category of practical issues. Among these study volunteer lay responders, low levels of stress were reported. Incorporating descriptions of the difficulties experienced by lay responders in CPR/AED training curricula may make courses more realistic and useful.
Publisher: Elsevier BV
Date: 12-2002
Publisher: Informa UK Limited
Date: 1998
DOI: 10.1080/10903129808958858
Abstract: The safe operation of ambulances using warning lights and siren requires both the public and emergency medical technician (EMT) drivers to understand and obey relevant traffic laws. However, EMTs may be unfamiliar with these laws. The purpose of this study was to evaluate EMTs' knowledge of traffic laws related to the operation of ambulances with warning lights and sirens. North Carolina EMTs participating in a statewide EMS conference October 6-8, 1995, completed a five-question survey. Knowledge of ambulance speed limits, yielding at intersections, yielding in roadways, and following distances was assessed using a multiple-choice format. Demographic data pertaining to EMT age, years of experience, paid vs volunteer status, driver's education courses, and past accident involvement were also obtained. Proportions were compared using chi-square analysis, alpha = 0.05. Two-hundred ninety-three of 308 (95%) EMTs attending the conference completed questionnaires. The median number of correct responses to the five knowledge questions was 1 (range 0-4). Thirty-three percent of the EMTs knew that other vehicles are required by law to yield while either approaching or being overtaken by an ambulance with warning lights and sirens 2% knew that due regard for safety is the only requirement of an ambulance approaching a red light at an intersection 14% knew that the minimum following distance behind an ambulance is one city block and 28% knew that there is no speed limit on ambulances with warning lights and sirens. Respondents were more likely to score above the median if they had taken one or more emergency driver's education courses or had nine years or more of EMS experience. In this s le, EMT knowledge of basic traffic laws pertaining to ambulance operation is poor. Emergency driver's education courses and increased experience appear to be related to increased knowledge scores. Increased training for EMTs about traffic laws may improve the safe operation of ambulances.
Publisher: Southern Medical Association
Date: 04-2002
Publisher: Informa UK Limited
Date: 2004
DOI: 10.1080/312703004362
Publisher: Public Library of Science (PLoS)
Date: 16-09-2013
Publisher: Springer Science and Business Media LLC
Date: 16-03-2010
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/10903120500366128
Abstract: The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone. To describe the types of facilities that participated in the trial and to report the incidence of CA and survival in these different types of facilities. In this post-hoc analysis of PAD Trial data, the physical characteristics of the participating facilities and the numbers of presumed CAs, treatable CAs, and survivors are reported for each category of facilities. There were 625 presumed CAs at 1,260 participating facilities. Just under half (n = 291) of the presumed CAs were classified as treatable CAs. Treatable CAs occurred at a rate of 2.9 per 1,000 person-years of exposure rates were highest in fitness centers (5.1) and golf courses (4.8) and lowest in office complexes (0.7) and hotels (0.7). Survival from treatable CA was highest in recreational complexes (0.5), public transportation sites (0.4), and fitness centers (0.4) and lowest in office complexes (0.1) and residential facilities (0.0). During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers and golf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, and fitness centers.
Publisher: Informa UK Limited
Date: 2003
DOI: 10.1080/312703002235
Abstract: The manufacturer of the laryngeal mask airway (LMA) reports success rates of 30-93% by practitioners attempting tracheal intubation through the LMA-Classic. No prior studies describe success rates through the (disposable) LMA-Unique by paramedics. The objective of this study was to measure the success rate of paramedics attempting to intubate the trachea blindly through the LMA-Unique. During a paramedic refresher class and an emergency medical services teaching day conference, paramedics previously trained in the use of the LMA-Unique as a "rescue" airway device were instructed in the technique of tracheal intubation through the LMA-Unique. A Laerdal LMA-mannequin was immobilized with an extrication collar and held by an investigator in the head-neutral position. Paramedics were first asked to insert the LMA-Unique as previously trained, and to confirm adequate ventilation by seeing inflation of the mannequin's lungs. Then, subjects were asked to pass a well-lubricated 6-0 Mallinckrodt endotracheal tube through the LMA-Unique within a 60-second period. Tracheal placement of the endotracheal tube was then confirmed by visualization of the expanding mannequin lungs. Rates of success of LMA-Unique placement and endotracheal tube placement were measured. Fifty of the 52 (96% CI 91% to 100%) paramedics successfully inserted the LMA-Unique on the first attempt. Only 11 of the 52 (21% CI 10% to 32%) paramedics were successful in blind placement of the endotracheal tube into the trachea through the LMA-Unique within a 60-second period. The failures (41 of the 52) were visually confirmed to be located in the esophagus. In this study, when attempting blind tracheal intubation through the LMA-Unique, paramedics were rarely successful in tracheal placement. Basic LMA-Unique insertion, however, had a very high success rate.
Publisher: Elsevier BV
Date: 07-2007
Publisher: Wiley
Date: 07-1999
Publisher: Elsevier BV
Date: 1996
DOI: 10.1016/S0735-6757(96)90012-1
Abstract: African swine fever virus (ASFV) belongs to the family of The online version contains supplementary material available at 10.1007/s13337-021-00719-x.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.RESUSCITATION.2005.10.030
Abstract: The adverse event (AE) profile of lay volunteer CPR and public access defibrillation (PAD) programs is unknown. We undertook to investigate the frequency, severity, and type of AE's occurring in widespread PAD implementation. A randomized-controlled clinical trial. One thousand two hundred and sixty public and residential facilities in the US and Canada. On-site, volunteer, lay personnel trained in CPR only compared to CPR plus automated external defibrillators (AEDs). Persons experiencing possible cardiac arrest receiving lay volunteer first response with CPR+AED compared with CPR alone. An AE is defined as an event of significance that caused, or had the potential to cause, harm to a patient or volunteer, or a criminal act. AE data were collected prospectively. Twenty thousand three hundred and ninety six lay volunteers were trained in either CPR or CPR+AED. One thousand seven hundred and sixteen AEDs were placed in units randomized to the AED arm. There were 26,389 exposure months. Only 36 AE's were reported. There were two patient-related AEs: both patients experienced rib fractures. There were seven volunteer-related AE's: one had a muscle pull, four experienced significant emotional distress and two reported pressure by their employee to participate. There were 27 AED-related AEs: 17 episodes of theft involving 20 devices, three involved AEDs that were placed in locations inaccessible to the volunteer, four AEDs had mechanical problems not affecting patient safety, and three devices were improperly maintained by the facility. There were no inappropriate shocks and no failures to shock when indicated (95% upper bound for probability of inappropriate shock or failure to shock = 0.0012). AED use following widespread training of lay-persons in CPR and AED is generally safe for the volunteer and the patient. Lay volunteers may report significant, usually transient, emotional stress following response to a potential cardiac arrest. Within the context of this prospective, randomized multi-center study, AEDs have an exceptionally high safety profile when used by trained lay responders.
Publisher: Informa UK Limited
Date: 1997
DOI: 10.1080/10903129708958791
Abstract: Activated charcoal (AC) has been proven useful in many toxic ingestions. Theoretically, administration of AC in the prehospital environment could save valuable time in the treatment of patients who have sustained potentially toxic oral ingestions. The purpose of this study was to determine the frequency of prehospital AC administration and to identify time savings that could potentially result from field AC administration. Adult patients with a chief complaint of toxic ingestion who had complete emergency medical services (EMS) and emergency department (ED) records and no medical treatment (gastric emptying, AC administration) prior to EMS arrival were eligible for inclusion. Data obtained from EMS and ED records included time of EMS departure from the scene, time of EMS arrival at the ED, and time of administration of AC in the ED. Since most EMS agencies in this system do not insert gastric tubes, patients requiring gastric tube placement for administration of AC were excluded. Twenty-nine of 117 (24.8%) adult patients received oral AC with no other intervention. None of the 117 patients received AC in the prehospital setting. The EMS transport time for these patients ranged from 5 to 43 minutes (mean 16.2 +/- 9.7 minutes). The delay from ED arrival to AC administration ranged from 5 to 94 minutes (mean 48.8 +/- 24.1 minutes), and was more than 60 minutes for 14 (48.2%) of the patients. The total time interval from scene departure to ED AC administration ranged from 17 to 111 minutes (mean 65.0 +/- 25.9 minutes). In a selected subset of patients who tolerate oral AC, prehospital administration of AC could result in earlier and potentially more efficacious AC therapy. Prospective study of the benefits and feasibility of prehospital AC administration is indicated.
Publisher: Cambridge University Press (CUP)
Date: 25-09-2012
DOI: 10.1017/S1049023X12001392
Abstract: The need to manage psychological symptoms after disasters can result in an increase in the prescription of psychotropic drugs, including antidepressants and anxiolytics. Therefore, an increase in the prescription of antidepressants and anxiolytics could be an indicator of general psychological distress in the community. The purpose of this study was to determine if there was a change in the rate of prescription of antidepressant and anxiolytic drugs following Cyclone Yasi. A quantitative evaluation of new prescriptions of antidepressants and anxiolytics was conducted. The total number of new prescriptions for these drugs was calculated for the period six months after the cyclone and compared with the same six month period in the preceding year. Two control drugs were also included to rule out changes in the general rate of drug prescription in the affected communities. After Cyclone Yasi, there was an increase in the prescription of antidepressant drugs across all age and gender groups in the affected communities except for males 14-54 years of age. The prescription of anxiolytic drugs decreased immediately after the cyclone, but increased by the end of the six-month post-cyclone period. Control drug prescription did not change. There was a quantifiable increase in the prescription of antidepressant drugs following Cyclone Yasi that may indicate an increase in psychosocial distress in the community. Usher K , Brown LH , Buettner P , Glass B , Boon H , West C , Grasso J , Chamberlain-Salaun J , Woods C . Rate of prescription of antidepressant and anxiolytic drugs after Cyclone Yasi in North Queensland . Prehosp Disaster Med . 2012 27 ( 6 ):1-5 .
Publisher: American Public Health Association
Date: 08-2017
Abstract: Objectives. To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. Methods. We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics. Results. Pre–recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post–recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled 95% confidence interval = −0.4, +0.9). Conclusions. Three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization. Future studies over a longer time remain warranted.
Publisher: Wiley
Date: 04-2014
Abstract: Describe the characteristics, reasons for leaving and outcomes of patients who did not wait (DNW) to be seen by a health practitioner in a regional Australian ED. Prospective observational study of a convenience s le of ED DNW patients presenting to The Townsville Hospital between June 2011 and July 2012. Seven days from each month were selected, and DNW patients presenting on those days were enrolled. An investigator attempted to contact every DNW patient by telephone in the following week to elicit reasons for leaving, subsequent health contacts, outcomes and suggestions for system improvements. Additional outcome information was obtained from hospital electronic medical records. Nearly 15 000 patients presented on the study days, with 648 (4.3%) DNWs: 415 (64.0%) adults, 193 (29.8%) children (1-16 years old) and 40 (6.2%) infants. Thirty-eight (5.9%) patients who DNW were Australasian Triage Scale (ATS) category 3, 546 (84.3%) were ATS category 4 and 64 (9.9%) were ATS category 5. Most DNW patients presented on Sundays and between 1600 and 2359. Just over half of the patients who DNW (52.9%) sought additional medical treatment, with 4.9% requiring subsequent hospital admission. Three psychiatric patients who DNW required urgent mental health interventions organised by the investigators. Frustration with perceived waiting times was the most common reason for leaving without being seen. Regional Australia ED patients who DNW often still require medical care, with approximately 1 in 20 requiring subsequent hospital admission. Patients with psychiatric conditions who DNW might be at particular risk.
Publisher: Informa UK Limited
Date: 1999
DOI: 10.1080/10903129908958903
Abstract: To determine the extent to which prehospital patient care protocols incorporate the findings of the peer-reviewed scientific EMS literature. Using a computerized literature search, articles published from eight institutions known to be active in prehospital care research were identified and obtained from the local health sciences library. Animal or bench research, analysis of administrative practices, evaluation of educational or quality assurance techniques, collective reviews, and air medical articles were excluded. We compared the findings of each article with the guidelines contained in 12 sets of prehospital care protocols, ranking them as: 1) consistent 2) partially consistent 3) not discussed or 4) not consistent. The rankings for the article-protocol comparisons for each EMS system were compared using the Kruskal-Wallis test. Forty-nine papers were compared with 12 sets of protocols, resulting in 588 comparisons. More than half (53.1%, n = 312) of the comparisons were ranked as "consistent." Only 28 (4.8%) of the comparisons were found to be "not consistent." There was no significant difference in the rankings assigned to the comparisons for protocols from each in idual system, nor in the rankings for protocols from the EMS system associated with the source of the article, from other systems with academic affiliations, and from systems without academic affiliations. Most EMS protocols are consistent with the published peer-reviewed research. There is no difference in the level of consistency when comparing protocols from EMS systems associated with the source of the articles, those associated with other academic institutions, and those without strong academic affiliations.
Publisher: Informa UK Limited
Date: 1997
DOI: 10.1080/10903129708958808
Abstract: Routine vital signs assessment is considered a fundamental component of patient assessment. This study was undertaken to determine whether advanced life support (ALS) emergency medical services (EMS) providers depend on vital signs information in managing their patients. Emergency medical technician-paramedics (EMT-Ps) and EMT-Intermediates (EMT-Is) were presented with 20 randomized patient scenarios that did not included vital signs information. The participants were asked to identify all of the interventions they would perform for each hypothetical patient. At least six weeks later the same scenarios were presented in a new order, with vital signs information, and the participants again identified the interventions they would perform. The participants' estimations of the patients' blood pressures, as well as the frequencies with which 18 specific interventions were performed, were compared for the no-vital signs and the vital signs groups using chi-square of Fisher's exact test, with an alpha value of 0.05 considered significant. Fourteen EMT-Ps and 16 EMT-Is completed both the no-vital signs and vital signs portions of the study, for a total of 1,160 hypothetical patient encounters. When vital signs were given, the EMT-Is were more likely to apply a cardiac monitor (65.2% vs 80.1%, p = 0.000), more likely to start at least one intravenous (i.v.) line (82.1% vs 87.8%, p = 0.038), and more likely to administer a medication (1.3% vs 5.6%, p = 0.003). The EMT-Ps were also more likely to apply a cardiac monitor (84.4% vs 90.3%, p = 0.041), more likely to run an i.v. at a "wide open" rate (9.5% vs 19.0%, p = 0.004), and less likely to identify patients as being hypotensive (39.9% vs 26.4%, p = 0.004). The presence or absence of vital signs information does influence some of the patient care decisions of EMS providers however, the clinical implications of these decisions are unclear. Further studies are needed to determine whether ALS providers can adequately manage actual patients without obtaining vital signs.
Publisher: Informa UK Limited
Date: 19-04-2019
DOI: 10.1080/10903127.2019.1595235
Abstract: Anaphylaxis is a life-threatening condition with a known effective prehospital intervention: parenteral epinephrine. The National Association of EMS Physicians (NAEMSP) advocates for emergency medical services (EMS) providers to be allowed to carry and administer epinephrine. Some states constrain epinephrine administration by basic life support (BLS) providers to administration using epinephrine auto-injectors (EAIs), but the cost and supply of EAIs limits the ability of some EMS agencies to provide epinephrine for anaphylaxis. This literature review and consensus report describes the extant literature and the practical and policy issues related to non-EAI administration of epinephrine for anaphylaxis, and serves as a supplementary resource document for the revised NAEMSP position statement on the use of epinephrine in the out-of-hospital treatment of anaphylaxis, complementing (but not replacing) prior resource documents. The report concludes that there is some evidence that intramuscular injection of epinephrine drawn up from a vial or ule by appropriately trained EMS providers-without limitation to specific certification levels-is safe, facilitates timely treatment of patients, and reduces costs.
Publisher: Informa UK Limited
Date: 07-08-2020
Publisher: Informa UK Limited
Date: 1998
DOI: 10.1080/10903129808958871
Abstract: The Prehospital Care Research Forum sponsors both oral and poster presentations of emergency medical services (EMS) research in conjunction with JEMS Corporation's annual EMS Today Conference. Attendance at the research presentations, historically, has been poor. This descriptive study was designed to measure the readability of the Prehospital Care Research Forum abstracts in order to determine whether the abstracts are difficult to read, and thus are a deterrent to attendance at the oral and poster research presentations. The 31 abstracts published in the 1995 Prehospital Care Research Forum supplement to the Journal of Emergency Medical Services were analyzed using a computerized reading-level testing program. Six different reading-level tests were used to determine the readability of the abstracts. The overall reading level for the 31 abstracts ranged from grade 7 to grade 20, with a mean grade level of 12.3. The mean Flesch reading ease score for the 31 abstracts ranged from 3.4 to 66.1, with a mean score of 36.0 +/- 14.4. The abstracts for the Prehospital Care Research Forum presentations are not overly difficult to read. It is unlikely that readability of the abstracts is a factor in the interest, or lack of interest, in the proceedings of the Prehospital Care Research Forum.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-10-2020
DOI: 10.1097/TA.0000000000002962
Abstract: Whether magnetic resonance imaging (MRI) adds value to surgical planning for patients with acute traumatic cervical spinal cord injury (ATCSCI) remains controversial. In this study, we compared surgeons' operative planning decisions with and without preoperative MRI. We had two hypotheses: (1) the surgical plan for ATCSCI would not change substantially after the MRI and (2) intersurgeon agreement on the surgical plan would also not change substantially after the MRI. We performed a vignette-based survey study that included a retrospective review of all adult trauma patients who presented to our American College of Surgeons-verified level 1 trauma center from 2010 to 2019 with signs of acute quadriplegia and underwent computed tomography (CT), MRI, and subsequent cervical spine surgery within 48 hours of admission. We abstracted patient demographics, admission physiology, and injury details. Patient clinical scenarios were presented to three spine surgeons, first with only the CT and then, a minimum of 2 weeks later, with both the CT and MRI. At each presentation, the surgeons identified their surgical plan, which included timing (none, , , hours), approach (anterior, posterior, circumferential), and targeted vertebral levels. The outcomes were change in surgical plan and intersurgeon agreement. We used Fleiss' kappa ( κ ) to measure intersurgeon agreement. Twenty-nine patients met the criteria and were included. Ninety-three percent of the surgical plans were changed after the MRI. Intersurgeon agreement was “slight” to “fair” both before the MRI (timing, κ = 0.22 approach, κ = 0.35 levels, κ = 0.13) and after the MRI (timing, κ = 0.06 approach, κ = 0.27 levels, κ = 0.10). Surgical plans for ATCSCI changed substantially when the MRI was presented in addition to the CT however, intersurgeon agreement regarding the surgical plan was low and not improved by the addition of the MRI. Diagnostic, level II.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.AENJ.2014.05.002
Abstract: Oxygen "wafting" provides a non-contact oxygen alternative for uncooperative paediatric patients in the emergency department (ED). The aim of this study was to identify the combination of oxygen delivery device, flow rate and device positioning that delivers the highest concentration of wafted oxygen. ED nursing staff were surveyed to determine current oxygen wafting practice. A simulated patient and oxygen sensor were used to compare wafted oxygen concentrations for six delivery devices in various positions and oxygen flow rates. Only oxygen tubing and the paediatric non-rebreather mask consistently delivered wafted oxygen concentrations above 30%. The paediatric non-rebreather held below the face produced concentrations ranging from 26.1% (10 cm) to 39.8% (5 cm). At 15 L/min, tubing held in front of the face produced concentrations ranging from 31.2% (15 cm) to 56.7% (5 cm) reducing the flow rate to 6-8 L/min had no meaningful effect on the delivered oxygen concentration. When tubing was used below the face, flow rates between 6 and 8 L/min produced somewhat higher concentrations than 15 L/min (5 cm: 36.3% vs. 30.9%). When delivering oxygen by wafting, the highest oxygen concentrations are achieved when positioning tubing 5-15 cm in front of the face or positioning tubing or a paediatric non-rebreather mask 5-10 cm below the face at 10-15 L/min flow. This should be considered when using oxygen wafting in the ED.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.AMJ.2010.11.010
Abstract: Airway management is a key component of air medical care for seriously ill and injured patients. This meta-analysis of the prehospital airway management literature explored the pooled air-medical placement success rates for oral endotracheal intubation (OETI), including rapid sequence intubation (RSI) and drug-facilitated intubation (DFI), nasotracheal intubation (NTI), blind insertion airway devices (BIAD), and surgical cricothyrotomy (SCRIC). We performed a systematic literature search for all English language articles reporting success rates for airway procedures performed in the prehospital setting. After identifying articles specific to the air-medical environment, pooled estimates of success rates for each airway technique were calculated using a random effects meta-analysis model. Thirty-six unique studies, encompassing 4,574 procedures, reported airway management success rates in the air medical environment. The pooled estimates (95% CI) for intervention success across all clinicians and patients were: OETI (without RSI/DFI): 86.4% (81.2%-90.3%) DFI: 95.1% (84.1%-98.6%) RSI: 96.7% (94.8%-97.9%) NTI: 76.1% (71.9%-79.9%) BIAD: 94.0% (85.8%-97.6%) and SCRIC: 90.8% (80.6%-95.9%). We provide pooled estimates for airway management procedural success rates in the air medical setting. These data can be used by program managers and medical directors in determining the most appropriate airway management procedures to incorporate into their services and for benchmarking in quality improvement activities.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.AJEM.2017.03.033
Abstract: When hospital-based specialists including emergency physicians, anesthesiologists, pathologists and radiologists are not included in the same insurance networks as their parent hospitals, it creates confusion and leads to unexpected costs for patients. This study explored the frequency with which hospital-based physicians at academic medical centers are not included in the network directories for the same insurance networks as their parent teaching hospitals. We studied teaching hospitals with residency programs in all four hospital-based specialties. Using insurance plan provider directories, we determined whether each teaching hospital was in-network for randomly selected locally available insurance plans offered through the federal and state marketplace exchanges. For each established hospital-network relationship, we then determined whether hospital-based specialists were included in the provider network directory by searching for the name of each specialty's residency program director and the name of the physician practice group. We identified 79 teaching hospitals participating in 144 locally available insurance plan networks. Hospital-based specialist inclusion in these hospital-network relationships was: emergency physicians: 50.0% (CI: 40%-59%) anesthesiologists: 50.0% (CI: 42%-58%) pathologists: 45.4% (CI: 37%-54%) and radiologists: 55.1% (46%-64%). Inclusion of all four hospital-based specialties occurred in only 45.0% (CI: 36%-54%) of the hospital-network relationships. For insurance plans offered through the federal and state marketplace exchanges, hospital-based specialists frequently are not included in the directories for the insurance networks in which their parent teaching hospitals participate. Further research is needed to explore this issue at non-academic hospitals and for off-exchange insurance products, and to determine effective policy solutions.
Publisher: Elsevier BV
Date: 02-2003
DOI: 10.1016/S0300-9572(02)00442-2
Abstract: The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, will form part of a comprehensive, integrated community approach to the treatment of OOH-CA. The study is being conducted at 24 field centers in the United States and Canada. Approximately 1000 community units (e.g. apartment or office buildings, gated communities, sports facilities, senior centers, shopping malls, etc.) were randomized to treatment by trained laypersons who will provide either cardiopulmonary resuscitation (CPR) alone or CPR plus use of an AED, while awaiting arrival of the community's emergency medical services responders. The primary endpoint is the number of OOH-CA victims who survive to hospital discharge. Secondary endpoints include neurological status, health-related quality of life (HRQL), cost, and cost-effectiveness. Data collection will last approximately 15 months and is expected to be completed in September 2003.
Publisher: Wiley
Date: 28-08-2012
DOI: 10.1111/J.1742-6723.2012.01591.X
Abstract: To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions. A two-phase study of operational and financial data from a convenience s le of Australian ambulance operations to inventory their energy consumption and greenhouse gas emissions for 1 year. State- and territory-based ambulance systems serving 58% of Australia's population and performing 59% of Australia's ambulance responses provided data for the study. Emissions for the participating systems totalled 67 390 metric tons of carbon dioxide equivalents. For ground ambulance operations, emissions averaged 22 kg of carbon dioxide equivalents per ambulance response, 30 kg of carbon dioxide equivalents per patient transport and 3 kg of carbon dioxide equivalents per capita. Vehicle fuels accounted for 58% of the emissions from ground ambulance operations, with the remainder primarily attributable to electricity consumption. Emissions from air ambulance transport were nearly 200 times those for ground ambulance transport. On a national level, emissions from Australian ambulance operations are estimated to be between 110 000 and 120 000 tons of carbon dioxide equivalents each year. Vehicle fuels are the primary source of emissions for ground ambulance operations. Emissions from air ambulance transport are substantially higher than those for ground ambulance transport.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AJEM.2015.04.046
Abstract: The objective of the study is to compare outcomes in blunt trauma patients managed with prehospital insertion of an extraglottic airway device (EGD) vs endotracheal intubation (ETI). The null hypothesis was that there would be no difference in mortality for the 2 groups. This is a retrospective study of blunt trauma patients with Glasgow Coma Scale score less than or equal to 8 transported by ground emergency medical services directly from the scene of injury to a single urban level 1 trauma center. Patients managed with only noninvasive airway techniques were excluded, leaving patients undergoing either EGD placement or ETI. Outcomes included in-emergency department (ED) traumatic arrest and hospital mortality. Multivariable logistic regression was used to control for the potential confounding effects of demographic and clinical variables. For all analyses, P < .05 was used to establish statistical significance. In bivariate analysis, patients managed with EGD were more likely than those managed with ETI to have an in-ED traumatic arrest (36.5% vs 17.1% P = .005), but eventual hospital mortality did not significantly differ between the 2 groups (75.7% vs 67.1% P = .228). After controlling for demographic and clinical characteristics, patients managed with EGD were no more likely than patients managed with ETI to experience traumatic arrest in the ED (adjusted odds ratio, 1.67 95% confidence interval, 0.72-3.89), and there was also no difference in overall hospital mortality (adjusted odds ratio, 0.912 95% confidence interval, 0.36-2.30). In this preliminary, retrospective analysis, we found no difference in overall survival among trauma patients managed with prehospital EGD and those managed with prehospital ETI.
Publisher: Elsevier BV
Date: 11-2002
Publisher: Wiley
Date: 08-2005
DOI: 10.1197/J.AEM.2005.03.525
Abstract: The Public Access Defibrillation (PAD) Trial was a randomized, controlled trial designed to measure survival to hospital discharge following out-of-hospital cardiac arrest (OOH-CA) in community facilities trained and equipped to provide PAD, compared with community facilities trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. To report the implementation of community-based lay responder emergency response programs in 1,260 participating facilities recruited for the PAD Trial in the United States and Canada. This was a descriptive study of the characteristics of participating facilities, volunteers, and automated external defibrillator (AED) placements compiled by the PAD Trial, and a qualitative study of factors that facilitated or impeded implementation of emergency lay responder programs using focus groups of PAD Trial site coordinators. The PAD Trial enrolled 1,260 community facilities (14.8% residential), with 20,400 lay volunteers (mean +/- standard deviation = 13.4 +/- 10.7 per facility) trained to respond to OOH-CA. The 598 locations randomized to receive AEDs required 2.7 +/- 1.8 AEDs per facility. Volunteer attrition was high, 36% after two years. Barriers to recruitment and implementation included identification of appropriate "at-risk" facilities, lack of interest or fear of litigation by a facility key decision maker, lack of motivated potential volunteer responders, training and retraining resource requirements, and lack of an existing communication/response infrastructure. These data indicate that implementation of community-based lay responder programs is feasible in many types of facilities, although these programs require substantial resources and commitment, and many barriers to implementation of effective PAD programs exist.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.AJEM.2016.09.002
Abstract: The objective was to examine the effect of hydrocodone-containing product (HCP) rescheduling on the proportion of prescriptions for HCPs given to patients discharged from the emergency department (ED). Electronic queries of ED records were used to identify patients aged 15 years and older discharged with a pain-related prescription in the 12 months before and after HCP rescheduling. Prescriptions were classified as HCPs other Schedule II medications (eg, oxycodone products) other Schedule III medications (eg, codeine products) and non-Schedule II/III products (eg, nonsteroidal anti-inflammatory drugs). We compared the proportions of patients receiving each type of prescription before and after rescheduling using χ Before rescheduling, 58.1% (95% confidence interval [CI], 57.4-58.7) of patients receiving a pain-related prescription received an HCP after rescheduling, 13.2% (95% CI, 12.7-13.7) received an HCP (P < .001). Concurrently, other Schedule III prescriptions increased (pre: 11.7% [CI, 11.3-12.2] vs post: 44.9% [CI, 44.2-45.6], P < .001)), as did non-Schedule II/III prescriptions (pre: 51.8% [CI, 51.2-52.5] vs post: 59.3% [CI, 58.6-60.0], P < .001). When controlling for demographic characteristics, patients remained less likely to receive an HCP after rescheduling (adjusted odds ratio [AOR], 0.11 CI, 0.10-0.11) and more likely to receive other Schedule III (AOR, 6.1 CI, 5.8-6.5) and non-Schedule II/III (AOR, 1.4 CI, 1.3-1.4) products. Rescheduling HCPs from Schedule III to Schedule II led to a substantial decrease in HCP prescriptions in our ED and an increase in prescriptions for other Schedule III and non-Schedule II/III products.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 02-1998
Abstract: To determine whether quantitative measurement of end-tidal carbon dioxide (ETCO2) can differentiate between cardiac and obstructive causes of respiratory distress. Prospective observational study. Emergency department (ED) of a tertiary care hospital. Adult patients who presented to the ED with moderate-to-severe dyspnea. Patients were excluded if they were unable to cooperate with the performance of peak expiratory flow rate (PEFR) or ETCO2 tests, were younger than 18 years of age, or had received prehospital intervention for their respiratory distress. Physicians obtained an ETCO2 level and PEFR prior to ED pharmacologic intervention. A hand-held capnometer with digital read-out was used to obtain the ETCO2 level. The patient's age, sex, initial vital signs, breath sounds and medication history, the presence or absence of diaphoresis and/or orthopnea, the duration of symptoms, the chest radiograph interpretation, and final diagnosis were also recorded. Forty-two patients were eligible for inclusion in the analysis. The mean ETCO2 level was 31.1+/-9.4 mm Hg the mean PEFR was 161.3+/-53.1 L/min. The ETCO2 levels for pulmonary edema/congestive heart failure (CHF) patients differed significantly from those of asthma/COPD patients (27.1+/-7.8 mm Hg vs 33.4+/-9.6 mm Hg p=0.0375). However, no single ETCO2 level was found to be a reliable predictor of diagnosis. ETCO2 levels for pulmonary edema/CHF patients differ significantly from those of asthma/COPD patients. However, no single ETCO2 level reliably differentiates between the two disease processes.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.AMEPRE.2019.06.023
Abstract: Recreational radio-controlled hobbyist aircraft-particularly "drones"-have become increasingly popular in the last decade. The purpose of this study is to describe injuries associated with hobbyist drones and compare them with injuries associated with other hobbyist aircraft. In this 2018 cross-sectional analysis of National Electronic Injury Surveillance System data for 2010-2017, case narrative fields were searched to identify emergency department visits related to hobbyist aircraft injuries. The incidence of hobbyist aircraft injuries was estimated, and summary statistics, chi-square tests, and t-tests were used to describe and compare the demographic and clinical characteristics of drone and other hobbyist aircraft-related cases. An estimated 12,842 hobbyist aircraft injuries presented to U.S. emergency departments during 2010-2017. An increased incidence attributable to drone-related injuries emerged in 2015. Overall, most injuries involved male patients aged 50 years on average. Propeller injuries were the leading mechanism. An estimated 270 patients required hospital admission. Patients injured by drones were younger (mean, 34 years vs 58 years p<0.001) and more likely to be female than patients injured by hobbyist planes. Drone-related injuries were more likely than plane-related injuries to result from blunt trauma (e.g., being struck or falling during aircraft retrieval 40.5% vs 7.9%, p<0.001). Helicopter-related injuries more closely resembled drone-related injuries than plane-related injuries. Hobbyist aircraft-related injuries are increasing, particularly drone-related injuries. Tailored injury prevention measures and product safety materials are needed to address all hobbyist aircraft-related injuries, with a particular focus on drone-related injury prevention measures.
Publisher: Informa UK Limited
Date: 03-03-2010
DOI: 10.3109/10903120903564530
Abstract: To describe requirements of physicians wishing to function as primary field emergency medical services (EMS) providers and variation of these requirements among states. A simple mailed survey was developed and distributed to all 50 U.S. state EMS directors. The survey gathered information about each state's regulations concerning physicians performing as a primary EMS crew member. Data were entered into a Microsoft Excel spreadsheet and reported using simple descriptive statistics, including proportions and 95% confidence intervals (CIs). Forty-four (88%) of the states responded. In 32 states (73%), physicians can work as a primary member of either a basic life support (BLS) or an advanced life support (ALS) ambulance crew without any specific additional training. In 30 states (68%), physicians can work as a primary member of either a BLS or an ALS ambulance crew without any specific prehospital certification. All of the reporting states will allow a physician to become certified as an emergency medical technician (EMT) or paramedic and then work as a primary member of a BLS or ALS ambulance crew. Seventy-nine percent allow the provision of physician-level care on BLS ambulances, and 81% on ALS ambulances. There was no meaningful difference between the training requirements for becoming a certified BLS provider vs. a certified ALS provider. States were significantly less likely to require a skills examination of physicians wishing to become certified as a BLS provider (9%) compared with those wishing to become certified as an ALS provider (82%). Most states allow physicians to become certified prehospital care providers, although few states require physicians wishing to work as a primary EMS provider to do so, or even to undergo any specific EMS training. There is no national standardization of the preparatory requirements of physicians wishing to provide in-field EMS.
Publisher: Elsevier BV
Date: 11-2015
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.AJEM.2007.08.009
Abstract: The purpose of this study was to determine the prevalence of incidentally discovered hyperglycemia in patients with non-glucose-related complaints and to consider the potential care implications. A retrospective chart review identified patients older than 18 years with obtained serum glucose levels. Patients with diabetic ketoacidosis were excluded. Three levels of hyperglycemia (> or = 126, > or = 140, and > or = 200 mg/dL) were considered. Of 2473 adult patients, 290 patients (11.7%) had serum glucose values greater than or equal to 126 mg/dL. There were 154 patients with hyperglycemia and no prior history of diabetes (6.2% of the emergency department [ED] population, 53.1% of those with hyperglycemia). More than half of the patients found to be hyperglycemic had no known history of diabetes and were being seen for a non-glucose-related complaint. The reason for this prevalence and its impact on the health of these patients is unclear. Whether ED intervention would be helpful remains unanswered.
Publisher: Informa UK Limited
Date: 2003
DOI: 10.1080/10903120390936770
Abstract: To determine the level of wireless enhanced 911 readiness among New York's primary public safety answering points. This descriptive study utilized a simple, single-page survey that was distributed in August 2001, with telephone follow-up concluding in January 2002. Surveys were distributed to directors of the primary public safety answering points in each of New York's 62 counties. Information was requested regarding current readiness for providing wireless enhanced 911 service, hardware and software needs for implementing the service, and the estimated costs for obtaining the necessary hardware and software. Two directors did not respond and could not be contacted by telephone three declined participation one did not operate an answering point and seven provided incomplete responses, resulting in usable data from 49 (79%) of the state's public safety answering points. Only 27% of the responding public safety answering points were currently wireless enhanced 911 ready. Specific needs included obtaining or upgrading computer systems (16%), computer-aided dispatch systems (53%), mapping software (71%), telephone systems (27%), and local exchange carrier trunk lines (42%). The total estimated hardware and software costs for achieving wireless enhanced 911 readiness was between 16 million and 20 million dollars. New York's primary public safety answering points are not currently ready to provide wireless enhanced 911 service, and the cost for achieving readiness could be as high as 20 million dollars.
Publisher: Elsevier BV
Date: 11-1997
DOI: 10.1016/S0735-6757(97)90179-0
Abstract: This study examined whether emergency medical technicians (EMTs) withhold oxygen from hypothetical patients whom emergency physicians would treat with high-flow oxygen, particularly chronic obstructive pulmonary disease (COPD) patients. A survey describing 12 hypothetical patients was distributed to 33 emergency physicians, 30 newly trained EMTs, and 27 experienced EMTs. For each patient, the respondents were asked to identify the most appropriate prehospital oxygen administration rate as "low flow" or "high flow". Using an alpha value of .05, chi 2 analysis was used to compare the frequency of high-flow oxygen administration for the three groups. Newly trained EMTs were significantly more likely than physicians to administer high-flow oxygen to patients with COPD who were not receiving home oxygen. Otherwise, the oxygen administration practices of EMTs were not inconsistent with those of emergency physicians.
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.AJEM.2005.05.013
Abstract: The United States Pharmacopeia recently published a general chapter specifically addressing on-ambulance storage of medications, including a suggestion for stock rotation. This study describes the effectiveness of a simple stock rotation strategy in mitigating EMS medication exposure to excessive heat and cold. Previously collected on-ambulance temperature data from 5 US cities were randomly res led to generate model exposures of 2 days to 6 months duration. The temperature measurements for every other 24-hour period were then set at 20 degrees C to model the rotation of medications into a controlled environment. For each model, we then determined consistency with the official United States Pharmacopeia definition of controlled room temperature. Without stock rotation, excessive heat occurred in 39.9% of the model exposures. With stock rotation, exposures to excessive heat occurred in less than 1% of northern city models and in 2.9% of the central US models. Stock rotation did not reduce heat exposures in the models for southern cities.
Publisher: Elsevier BV
Date: 05-1995
DOI: 10.1016/0736-4679(95)00001-Q
Abstract: Advanced cardiac life support (ACLS) guidelines from the American Heart Association (AHA) now recommend not checking for a pulse between the initial three defibrillations for pulseless patients in ventricular tachycardia or fibrillation. The AHA asserts that checking for a pulse needlessly delays defibrillation. This study was undertaken to determine if pulse checks delay defibrillation by EMT-Defibrillators (EMT-Ds) using a semiautomatic defibrillator (SAED). Twenty-seven EMT-Ds demonstrated delivery of three successive defibrillations during two test scenarios: once with and once without pulse checks after the first and second defibrillations. The time from the first to third defibrillation was recorded. The mean time to deliver the defibrillations was 60.2 +/- 6.2 seconds with pulse checks and 57.5 +/- 4.6 seconds without pulse checks. The difference, 2.7 +/- 5.9 seconds, was statistically significant (P = 0.026). Pulse checks by EMT-Ds do delay administration of defibrillations, but consideration should be given to reinstating pulse checks as a part of the AHA guidelines, since this delay is of questionable clinical significance.
Publisher: Wiley
Date: 02-1996
DOI: 10.1111/J.1553-2712.1996.TB03412.X
Abstract: Medication errors are common in hospitals. These errors can result in adverse drug events (ADEs), which can reduce the health and well-being of patients', and their relatives and caregivers. Interventions have been developed to reduce medication errors, including those that occur at the administration stage. We aimed to elicit willingness-to-pay (WTP) values to prevent hospital medication administration errors. An online, contingent valuation (CV) survey was conducted, using the random card-sort elicitation method, to elicit WTP to prevent medication errors. A representative s le of the UK public. Seven medication error scenarios, varying in the potential for harm and the severity of harm, were valued. Scenarios were developed with input from: clinical experts, focus groups with members of the public and piloting. Mean and median WTP values were calculated, excluding protest responses or those that failed a logic test. A two-part model (logit, generalised linear model) regression analysis was conducted to explore predictive characteristics of WTP. Responses were collected from 1001 in iduals. The proportion of respondents willing to pay to prevent a medication error increased as the severity of the ADE increased and was highest for scenarios that described actual harm occurring. Mean WTP across the scenarios ranged from £45 (95% CI £36 to £54) to £278 (95% CI £200 to £355). Several factors influenced both the value and likelihood of WTP, such as: income, known experience of medication errors, sex, field of work, marriage status, education level and employment status. Predictors of WTP were not, however, consistent across scenarios. This CV study highlights how the UK public value preventing medication errors. The findings from this study could be used to carry out a cost-benefit analysis which could inform implementation decisions on the use of technology to reduce medication administration errors in UK hospitals.
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/10903120903144973
Abstract: In this proof-of-concept study, we evaluated the availability of emergency medical services (EMS) system energy consumption data required to calculate a carbon footprint. Two erse North American EMS systems with more than 125,000 combined annual unit responses agreed to report their energy consumption for the last fiscal or calendar year using a data-collection tool based on Carbon Trust recommendations. They also identified the source of information (e.g., bills, logs, receipts), whether the amounts reported were directly measured or estimated, and whether any of the amounts were prorated from shared facilities (e.g., electricity for a shared office building). For this proof-of-concept study, we report only descriptive data about the availability of data and aggregate carbon emissions. Both systems reported diesel fuel, gasoline, and electricity consumption. One system used natural gas one system used aviation fuel. Direct measurement of consumption using utility bills and statements was possible for these energy types. One system prorated natural gas and electricity usage one system was able to estimate commercial air travel. Annual carbon dioxide (CO(2)) emissions for these two systems totaled 11.1 million pounds of CO(2). The largest source of CO(2) emissions was diesel fuel (39%), followed by electricity (23%). These EMS systems were able to provide the data necessary to determine their carbon footprints. Future research could include broader study to establish EMS-specific norms for carbon emissions, benchmarking of these metrics between different EMS systems, and the assessment of programs designed to reduce EMS carbon emissions.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/10903120701204797
Abstract: Most EMS systems determine the number of crews they will deploy in their communities and when those crews will be scheduled based on anticipated call volumes. Many systems use historical data to calculate their anticipated call volumes, a method of prediction known as demand pattern analysis. To evaluate the accuracy of call volume predictions calculated using demand pattern analysis. Seven EMS systems provided 73 consecutive weeks of hourly call volume data. The first 20 weeks of data were used to calculate three common demand pattern analysis constructs for call volume prediction: average peak demand (AP), smoothed average peak demand (SAP), and 90th percentile rank (90%R). The 21st week served as a buffer. Actual call volumes in the last 52 weeks were then compared to the predicted call volumes by using descriptive statistics. There were 61,152 hourly observations in the test period. All three constructs accurately predicted peaks and troughs in call volume but not exact call volume. Predictions were accurate (+/-1 call) 13% of the time using AP, 10% using SAP, and 19% using 90%R. Call volumes were overestimated 83% of the time using AP, 86% using SAP, and 74% using 90%R. When call volumes were overestimated, predictions exceeded actual call volume by a median (Interquartile range) of 4 (2-6) calls for AP, 4 (2-6) for SAP, and 3 (2-5) for 90%R. Call volumes were underestimated 4% of time using AP, 4% using SAP, and 7% using 90%R predictions. When call volumes were underestimated, call volumes exceeded predictions by a median (Interquartile range maximum under estimation) of 1 (1-2 18) call for AP, 1 (1-2 18) for SAP, and 2 (1-3 20) for 90%R. Results did not vary between systems. Generally, demand pattern analysis estimated or overestimated call volume, making it a reasonable predictor for ambulance staffing patterns. However, it did underestimate call volume between 4% and 7% of the time. Communities need to determine if these rates of over-and underestimation are acceptable given their resources and local priorities.
Publisher: Informa UK Limited
Date: 08-2010
DOI: 10.3109/10903127.2010.497903
Abstract: Airway management is a key component of prehospital care for seriously ill and injured patients. Oral endotracheal intubation (OETI) is the definitive airway of choice in most emergency medical services (EMS) systems. However, OETI may not be an approved skill for some clinicians or may prove problematic in certain patients because of anatomic abnormalities, trauma, or inadequate relaxation. In these situations alternative airways are frequently employed. However, the reported success rates for these devices vary widely, and established benchmarks are lacking. We sought to determine pooled estimates of the success rates of alternative airway devices (AADs) and needle cricothyrotomy (NCRIC) and surgical cricothyrotomy (SCRIC) placement through a meta-analysis of the literature. We performed a systematic literature search for all English-language articles reporting success rates for AADs, SCRIC, and NCRIC. Studies of field procedures performed by prehospital personnel from any nation were included. All titles were reviewed independently by two authors using prespecified inclusion criteria. Pooled estimates of success rates for each airway technique were calculated using a random-effects meta-analysis model. Of 2,005 prehospital airway titles identified, 35 unique studies were retained for analysis of AAD success rates, encompassing a total of 10,172 prehospital patients. The success rates for SCRIC and NCRIC were analyzed across an additional 21 studies totaling 512 patients. The pooled estimates (and 95% confidence intervals [CIs]) for intervention success across all clinicians and patients were as follows: esophageal obturator airway-esophageal gastric tube airway (EOA-EGTA) 92.6% (90.1%-94.5%) pharyngeotracheal lumen airway (PTLA) 82.1% (74.0%-88.0%) esophageal-tracheal Combitube (ETC) 85.4% (77.3%-91.0%) laryngeal mask airway (LMA) 87.4% (79.0%-92.8%) King Laryngeal Tube airway (King LT) 96.5% (71.2%-99.7%) NCRIC 65.8% (42.3%-83.59%) and SCRIC 90.5% (84.8%-94.2%). We provide pooled estimates for prehospital AAD, NCRIC, and SCRIC airway interventions. Of the AADs, the King LT demonstrated the highest insertion success rate (96.5%), although this estimate is based on limited data, and data regarding its ventilatory effectiveness are lacking more data are available for the ETC and LMA. The ETC, LMA, and PTLA all had similar-but lower-success rates (82.1%-87.4%). NCRIC has a low rate of success (65.8%) SCRIC has a much higher success rate (90.5%) and should be considered the preferred percutaneous rescue airway.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.ANNEMERGMED.2018.09.032
Abstract: We compare reported crash rates for US ambulances responding to or transporting patients from a 911 emergency scene with or without lights and sirens. Our null hypothesis is that there will be no difference in the rate of ambulance crashes whether lights and sirens are used. For this retrospective cohort study, we used the 2016 National EMS Information System data set to identify 911 scene responses and subsequent patient transports by transport-capable emergency medical services (EMS) units. We used the system's "response mode to scene" and "transport mode from scene" fields to determine lights and sirens use. We used the "type of response delay" and "type of transport delay" fields to identify responses and transports that were delayed because of a crash involving the ambulance. We calculated the rate of crash-related delays per 100,000 responses or transports and used multivariable logistic regression with clustered (by agency) standard errors to calculate adjusted odds ratios (AORs) (with 95% confidence intervals [CIs]) for the association between crash-related delays and lights and sirens use for responses and transports separately. Among 19 million included 911 scene responses, the response phase crash rate was 4.6 of 100,000 without lights and sirens and 5.4 of 100,000 with lights and sirens (AOR 1.5 95% CI 1.2 to 1.9). For the transport phase, the crash rate was 7.0 of 100,000 without lights and sirens and 17.1 of 100,000 with lights and sirens (AOR 2.9 95% CI 2.2 to 3.9). Excluding responses and transports with only partial lights and sirens use did not meaningfully alter the results (response AOR 1.5, 95% CI 1.2 to 1.9 transport AOR 2.8, 95% CI 2.1 to 3.8). Ambulance use of lights and sirens is associated with increased risk of ambulance crashes. The association is greatest during the transport phase. EMS providers should weigh these risks against any potential time savings associated with lights and sirens use.
Publisher: Informa UK Limited
Date: 2001
DOI: 10.1080/10903120190940038
Abstract: To evaluate the ability of paramedics to learn and apply the skill of introducer-aided oral intubation in the setting of the simulated "difficult airway." The authors hypothesized that, following a brief introduction to the device, intubation success rates would not differ for traditional and introducer-aided intubations of an immobilized airway mannequin. During a paramedic recertification class, experienced paramedics were given a brief didactic introduction to the "bougie-like" Flex Guide endotracheal tube introducer (ETTI). The participants were then asked to intubate adult mannequins immobilized in the head-neutral position, with and without the ETTI. "Successful placement" was defined as completion of the procedure within 30 seconds and endotracheal tube position confirmed by the investigator with direct visualization. For both traditional and ETTI intubations, 34 (97%) of the 35 paramedics successfully intubated within 30 seconds. The two unsuccessful intubation attempts were recognized by the paramedic as esophageal intubations, and correct tube placement was obtained within an additional 30 seconds. In this study, use of the ETTI was mastered by the participants after only a brief didactic introduction to the device, with their ability to intubate an immobilized mannequin using the ETTI being equal to their ability to perform traditional intubation. These results suggest that use of the ETTI is easily learned, and may support the device's role in the prehospital management of the difficult airway.
Publisher: Informa UK Limited
Date: 2011
DOI: 10.3109/10903127.2010.519818
Abstract: This study was undertaken to characterize the carbon emissions from a broad s le of North American emergency medical services (EMS) agencies, and to begin the process of establishing voluntary EMS-related emission targets. Fifteen erse North American EMS systems with more than 550,000 combined annual responses and serving a population of 6.3 million reported their direct and purchased ("Tier 2") energy consumption for one year. We calculated total carbon dioxide equivalent (CO(2)e) emissions using Environmental Protection Agency, Energy Information Administration, and locality-specific emission conversion factors. We also calculated per-response and population-based emissions. We report descriptive summary data. Participants included government "third-service" (n = 4), public utility model (n = 1), private contractor (n = 6), and rural rescue squad (n = 4) systems. Call volumes ranged from 800 to 114,280 (median 20,093 interquartile range [IQR] 1,100-55,217). Emissions totaled 46,941,690 pounds of CO(2)e (21,289 metric tons) 75% of emissions were from diesel or gasoline. For systems providing complete Tier 2 data, median emissions per response were 80.7 (IQR 65.1-106.5) pounds of CO(2)e and median emissions per service-area resident were 7.8 (IQR 4.7-11.2) pounds of CO(2)e. Two systems reported aviation fuel consumption for air medical services, with emissions of 2,395 pounds of CO(2)e per flight, or 0.7 pounds of CO(2)e per service-area resident. EMS operations produce substantial carbon emissions, primarily from vehicle-related fuel consumption. The 75th percentiles from our data suggest 106.5 pounds of CO(2)e per unit response and/or 11.2 pounds of CO(2)e per service-area resident as preliminary maximum emission targets. Air medical services can anticipate higher per-flight but lower population-based emissions.
Location: United States of America
No related grants have been discovered for Lawrence Brown.