Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Abstract Objective. To examine the epidemiology, effectiveness, and safety of tocolytics, and the variation in use of standard treatments and predictive testing for women in preterm labor (PTL) transported to tertiary care. Methods. ⋯ Tocolytics were associated with decreased contraction frequency in more than two-thirds of those treated. However, nearly half those who did not receive the treatment also had decreased contractions, and the effect did not reach statistical significance. Variation in the type of tocolytic drug used suggests a need for clinical practice guidelines for tocolytic use during transport of PTL patients.
-
Abstract Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rates -have not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. ⋯ Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.
-
This study has two aims: 1) to describe linkage rates between ambulance data and external datasets for "episodes of care" and "patient only" linkages in New South Wales (NSW), Australia; and 2) to detect and report any systematic issues with linkage that relate to patients, and operational or clinical variables that may introduce bias in subsequent studies if not adequately addressed. During 2010-11, the Centre for Health Record Linkage (CHeReL) in NSW, linked the records for patients attended by NSW Ambulance paramedics for the period July 2006 to June 2009, with four external datasets: Emergency Department Data Collection; Admitted Patient Data Collection; NSW Registry of Births, Deaths and Marriages death registration data; and the Australian Bureau of Statistics mortality data. This study reports linkage rates in terms of those "expected" to link and those who were "not expected" to link with external databases within 24 hours of paramedic attendance. ⋯ For NSW Ambulance episodes of care that were expected to link to an external dataset but did not, nonlinkage to hospital admission records tended to decrease with age. For all other variables, issues relating to rates of linkage and nonlinkage were more indiscriminate. This quantification of the limitations of this large linked dataset will underpin the interpretation and results of ensuing studies that will inform future clinical and operational policies and practices at NSW Ambulance.
-
Comparative Study
Post-medication Hypotension after Administration of Sedatives and Opioids during Critical Care Transport.
Identification of modifiable risk factors for hypotension during critical care transport is important to optimize patient preparation, crew training, and patient safety. We set out to determine the incidence of hemodynamic deterioration after administration of opioids or sedatives during critical care transport, and identify patient- and transport-level predictors. ⋯ Post-medication hypotension occurred once in every 160 drug administrations and was associated with mechanical ventilation, baseline hemodynamic instability, transport duration, surgical diagnosis, and ACP crew. These findings provide targets for improvements in patient preparation, crew training, and clinical practices.
-
Abstract Background. Survival outcomes from out-of-hospital cardiac arrest (OHCA) in Asia are poor (2-11%). Bystander cardiopulmonary resuscitation (CPR) rates are relatively low in Asia. ⋯ Conclusion. Implementation of DA-CPR requires concerted efforts by EMS leaders and supervisors, dispatchers, hospital stakeholders, policy makers, and the general public. The DA-CPR trial implemented by the PAROS sites, if successful, can serve as a model for other countries considering such an intervention in their EMS systems.