Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Researchers interested in ensuring appropriate use of emergency medical services (EMS) resources have attempted to define safe and effective protocols for triage either at the time of dispatch or after on-scene evaluation. Published work in this area is difficult to evaluate because protocols and outcome criteria vary from study to study. The goal of the Neely Conference was to bring together EMS experts to define a set of criteria to be used in research studies evaluating dispatch triage and field triage systems. ⋯ EMS experts agreed on a standard set of triage criteria and outcome measures for evaluating triage protocols supporting alternative forms of transport and care.
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The primary goal of the Neely Conference project is to work toward defining a set of research criteria for medical necessity in emergency medical services (EMS). This paper reviews the extant literature on triage and nontransport decisions made in the field by EMS personnel, with emphasis on the methodologies that have been used to date. Two types of medical necessity standards are considered. ⋯ In some cases, the outcome measure is the judgment of a reviewing emergency physician or nurse, while in others specific outcome measures are used to judge the performance of the criteria and the decision making of the field providers. While review of the literature shows that no "standard" set of triage criteria have been generated or validated in determining medical necessity in EMS, there are certain themes that emerge from the literature, and these themes can likely form the basis of a consensus on elements of a medical necessity criteria that need to be validated and refined. These may include (for triage criteria) vital signs, chief complaints, and physical exam findings, and (for outcome measures) hospital admission, critical events, death, and diagnosis.
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To examine trends in paramedic rhythm misidentification rates in the use of adenosine for presumed paroxysmal supraventricular tachycardia (PSVT) over a ten-year period, and to determine variables associated with rhythm misidentification. ⋯ Paramedics in this emergency medical services system are more likely to use adenosine appropriately for patients with initial heart rates of >160 beats/min and a history of rapid heart rate or palpitations. Further studies are required to identify factors associated with rhythm interpretation errors in the prehospital setting as well as to evaluate error reduction strategies.
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To determine the feasibility of prehospital pain measurement among patients 13 years of age or older using a verbal and numeric rating scale and to assess the severity of pain in a prehospital patient population. ⋯ Prehospital pain assessment using a VRS and NRS was feasible in this patient population. Further studies are needed to confirm this finding in other settings. Moderate or severe pain was present in approximately 31% of patients.
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Use of ambulances for nonemergency and routine transportation is thought to be a serious and growing problem. Third-party payers frequently refuse payment when ambulance use is deemed inappropriate. The authors attempted to determine whether cases in which ambulance transport was denied were done appropriately. ⋯ In this population of patients for whom payment of their ambulance bill was denied, a high percentage of corresponding ED visits were for potentially serious medical problems.