Tiffany M Abramson, Elizabeth Burner, Sanjay Arora, Suzanne Wenzel, Marianne Gausche-Hill
OBJECTIVE: Persons experiencing homelessness (PEH) are among the most vulnerable populations and experience significant health disparities. Nationally, PEH utilize Emergency Medical Services (EMS) at disproportionately higher rates than their housed peers. Developing optimal strategies to care for PEH has become critically important. However, limited data exists on best practices, challenges, and experiences of providing care to PEH. The objective of this study was to describe the experiences, challenges and perspectives of operational EMS agency medical directors in Los Angeles (LA) County as they confront the homelessness crisis...
May 21, 2024: Prehospital Emergency Care
Bryan D Nelson, Conor J McLaughlin, Orlando E Rivera, Kashyap Kaul, Andrew J Ferdock, Zachary M Matuzsan, Ali R Yazdanyar, Jay V Gopal, Ayushi Y Patel, Rachael M Chaska, Bruce A Feldman, Jeanne L Jacoby
Background: An important method employed to reduce door to balloon time (DTBT) for ST segment elevation Myocardial Infarctions (STEMIs) is a prehospital MI alert. The purpose of this retrospective study was to examine the effects of an educational intervention using a novel decision support method of STEMI notification and prehospital electrocardiogram (ECG) transmission on DTBT. Methods: An ongoing database (4/4/2000 - present) is maintained to track STEMI alerts. In 2007, an MI alert program began; emergency medicine physicians could activate a "prehospital MI alert"...
May 21, 2024: Prehospital Emergency Care
Adam L Gottula, Man Qi, Bennett H Lane, Christopher R Shaw, Kari Gorder, Elizabeth Powell, Kyle Danielson, Anna Ciullo, Nicholas J Johnson, Joseph E Tonna, William R Hinckley, Amy Koshoffer, Rabab Al-Araji, Jason Bartos, Justin Benoit, Cindy H Hsu
INTRODUCTION: Evidence suggests that Extracorporeal Cardiopulmonary Resuscitation (ECPR) can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, when ECPR is indicated over 50% of potential candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the United States in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR Helicopter Emergency Medical Services (HEMS)-based system...
May 13, 2024: Prehospital Emergency Care
Andra M Farcas, Remle P Crowe, Jamie Kennel, Nicola Little, Ameera Haamid, Mario Andres Camacho, Tiffany Pleasant, Sylvia Owusu-Ansah, Anjni P Joiner, Rickquel Tripp, Joshua Kimbrell, Joseph M Grover, Stephanie Ashford, Brooke Burton, Jeffrey Uribe, Johanna C Innes, David I Page, Mike Taigman, Maia Dorsett
Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve...
May 10, 2024: Prehospital Emergency Care
Tyler S George, Nicklaus P Ashburn, Anna C Snavely, Bryan P Beaver, Michael A Chado, Harris Cannon, Casey G Costa, James E Winslow, R Darrell Nelson, Jason P Stopyra, Simon A Mahler
Background: A single dose epinephrine protocol (SDEP) for out-of-hospital cardiac arrest (OHCA) achieves similar survival to hospital discharge (SHD) rates as a multidose epinephrine protocol (MDEP). However, it is unknown if a SDEP improves SHD rates among patients with a shockable rhythm or those receiving bystander cardiopulmonary resuscitation (CPR). Methods: This pre-post study, spanning 11/01/2016-10/29/2019 at 5 North Carolina EMS systems, compared pre-implementation MDEP and post-implementation SDEP in patients ≥18 years old with non-traumatic OHCA...
May 7, 2024: Prehospital Emergency Care
Ira Harmon, Jennifer Brailsford, Isabel Sanchez-Cano, Jennifer Fishe
Introduction: Asthma exacerbations are a common cause of pediatric Emergency Medical Services (EMS) encounters. Accordingly, prehospital management of pediatric asthma exacerbations has been designated an EMS research priority. However, accurate identification of pediatric asthma exacerbations from the prehospital record is nuanced and difficult due to the heterogeneity of asthma symptoms, especially in children. Therefore, this study's objective was to develop a prehospital-specific pediatric asthma computable phenotype (CP) that could accurately identify prehospital encounters for pediatric asthma exacerbations...
May 7, 2024: Prehospital Emergency Care
Michael Berkenbush, Nicholas Sherman, Nikhil Jain, Peter Cosmi
Objective: The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport...
April 30, 2024: Prehospital Emergency Care
Matthew J Levy, Remle P Crowe, Heidi Abraham, Anna Bailey, Matt Blue, Reinhard Ekl, Eric Garfinkel, Joshua B Holloman, Jeff Hutchens, Ryan Jacobsen, Colin Johnson, Asa Margolis, Ruben Troncoso, Jefferson G Williams, J Brent Myers
OBJECTIVES: Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue...
April 29, 2024: Prehospital Emergency Care
Alexander D Muniz, Dominic J Gregorio, Scott A Studebaker, Aaron M Peth, Cole G Camacho, Bilie Williams, Douglas F Kupas, Lawrence H Brown
INTRODUCTION: Early administration of antibiotics for open fractures reduces serious bone and soft tissue infections. The effectiveness of antibiotics in reducing these infections is time-dependent, with various surgical associations recommending administration within one hour of injury, or within one hour of patient arrival to the emergency department (ED). The extent to which prehospital antibiotic administration in these situations might reduce the time to treatment has not been previously reported...
April 25, 2024: Prehospital Emergency Care
Kenton L Anderson, Monica R Saxena, Loretta W Matheson, Marc Gautreau, John F Brown, Leo Ishoda, Michael A Kohn
OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is a major health problem and one of the leading causes of death in adults older than 40. Multiple prior studies have demonstrated survival disparities based on race/ethnicity, but most of these focus on a single racial/ethnic group. This study evaluated OHCA variables and outcomes among on 5 racial/ethnic groups. METHODS: This is a retrospective review of data for adult patients in the Cardiac Arrest Registry to Enhance Survival (CARES) from 3 racially diverse urban counties in the San Francisco Bay Area from May 2009 to October 2021...
April 23, 2024: Prehospital Emergency Care
Mallori Wilson, Sean Stuart, Brittany Lassiter, Timothy Parker, Clyde Martin, Robert Healy, Christopher Treager, Eric Sulava, Lorie Gower, Pravina Fernandez, Emily Friedrich
OBJECTIVE: Hemorrhage is the leading cause of preventable death in civilian trauma centers and on the battlefield. One of the emerging treatment options for hemorrhage in austere environments is tranexamic acid (TXA). However, the landscape is not amenable to the current delivery standard. This study compared the pharmacokinetics of TXA via a standard 10-minute intravenous infusion (IV infusion), intravenous rapid push over 10 s (IV push), and intramuscular injection (IM) in a swine polytrauma and hemorrhagic shock model (trauma group) compared to uninjured controls (control group)...
April 18, 2024: Prehospital Emergency Care
Joshua Lowe
No abstract text is available yet for this article.
April 16, 2024: Prehospital Emergency Care
Michael Feldman, Fahad Bahaidarah, Mahbod Rahimi, Sara Howaidi, Linda Turner, P Richard Verbeek, Warren Cantor, Sheldon Cheskes, Ian Drennan, Kristen Gilmartin
OBJECTIVE: Current guidelines recommend that patients presenting with ST-elevation myocardial infarction (STEMI) to hospitals not capable of performing primary percutaneous coronary intervention (PCI) be transferred to a PCI-capable hospital if reperfusion can be accomplished within 120 minutes. Most STEMI patients are accompanied by an advanced care paramedic (ACP, equivalent to EMT-P), nurse, or physician who can manage complications should they arise. In our region, stable STEMI patients are transported by primary care paramedics (PCPs, similar scope of practice to advanced EMT) in cases where a nurse, physician, or ACP paramedic is not available...
April 15, 2024: Prehospital Emergency Care
Yalcin Golcuk
No abstract text is available yet for this article.
April 8, 2024: Prehospital Emergency Care
Paige M Watkins, Peter Buzzacott, Hideo Tohira, David Majewski, Anne-Marie Hill, Deon Brink, Rudi Brits, Judith Finn
Objectives: The risk of falls increases with age and often requires an emergency medical service (EMS) response. We compared the characteristics of patients attended by EMS in response to repeat falls within 30 days and 12 months of their first EMS-attended fall; and explored the number of days between the index fall and the subsequent fall(s). Methods: This retrospective cohort study included all adults (> =18 years of age) who experienced their first EMS-attended fall between 1st January 2016 and 31st December 2020, followed up until 31 December 2021...
April 8, 2024: Prehospital Emergency Care
Michael W Hubble, Melisa Martin, Sara Houston, Stephen Taylor, Ginny R Kaplan
Objective: Previous investigations of the relationship between obesity and difficult airway management have provided mixed results. Almost universally, these studies were conducted in the hospital setting, and the influence of patient body weight on successful prehospital airway management remains unclear. Because patient weight could be one readily identifiable risk factor for problematic airway interventions, we sought to evaluate this relationship. Methods: We conducted a retrospective analysis using the 2020 ESO Data Collaborative dataset...
April 3, 2024: Prehospital Emergency Care
Travis M Curtis, Kaden M Sady, Jess T Randall, Patrick Kervin, Dawn M Mosher, Michael W Dailey
Introduction: We report a case of accelerated idioventricular rhythm (AIVR) identified by Emergency Medical Services (EMS) monitoring of an infant presenting with lethargy and respiratory distress. Accelerated idioventricular rhythms are rare ventricular rhythms originating from the His-Purkinje system or ventricular myocytes, consisting of >3 monomorphic beats with gradual onset and termination. 1 An AIVR is usually well-tolerated and does not require treatment, though sustained arrythmia may induce syncope, and the rhythm has been seen in newborn infants with congenital heart diseases...
March 29, 2024: Prehospital Emergency Care
Erick H Cheung, Denise A Whitfield, Adam Kipust, Richard Tadeo, Marianne Gausche-Hill
Introduction: Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders...
March 25, 2024: Prehospital Emergency Care
Sriram Ramgopal, Remle P Crowe, Lindsay Jaeger, Jennifer Fishe, Michelle L Macy, Christian Martin-Gill
Background. Children have differing utilization of emergency medical services (EMS) by socioeconomic status. We evaluated differences in prehospital care among children by the Child Opportunity Index (COI), the agreement between a child's COI at the scene and at home, and in-hospital outcomes for children by COI. Methods. We performed a retrospective study of pediatric (<18 years) scene encounters from approximately 2,000 United States EMS agencies from the 2021-2022 ESO Data Collaborative. We evaluated socioeconomic status using the multi-dimensional COI v2...
March 22, 2024: Prehospital Emergency Care
Laurel O'Connor, Stephanie Behar, Jade Refuerzo, Xhenifer Mele, Elsa Sundling, Sharon A Johnson, Jamie M Faro, Peter K Lindenauer, Kristin M Mattocks
Objective: Emergency services utilization is increasing in older adult populations. Many such encounters may be preventable with better access to acute care in the community. Mobile integrated health (MIH) programs leverage mobile resources to deliver care and services to patients in the out-of-hospital environment and have the potential to improve clinical outcomes and decrease health care costs; however, they have not been widely implemented. We assessed barriers, potential facilitators, and other factors critical to the implementation of MIH programs with key vested partners...
March 18, 2024: Prehospital Emergency Care
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