Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Children have unique medical needs compared to adults. Emergency medical services personnel need proper equipment and training to care for children. The purpose of this study is to characterize emergency medical services pediatric basic life support to help better understand the needs of children transported by ambulance. ⋯ Median transport time was 14 minutes (IQR: 8-24). Median EMS total call time was 51 minutes (IQR: 33-77). The epidemiology of pediatric basic life support can help to guide efforts in both emergency medical services operations and training.
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The objective was to determine the nasal carriage prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among emergency medical service (EMS) personnel and the associated risk factors. A cross-sectional study was conducted among Ohio EMS personnel randomly sampled from 84 urban and rural agencies. Surveys assessing demographics, occupational history, health, cohabitation status, and hygiene practice were collected with nasal swabs from those who enrolled. ⋯ The high prevalence of MRSA in Ohio EMS personnel is both an occupational hazard and patient safety concern. Implementing methods to reinforce CDC guidelines for proper hygiene could decrease MRSA found in the EMS setting. Previous literature suggests that a reduction in MRSA colonization can lead to decreases in transmission and improved health for both patients and personnel.
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The primary objective of this observational study was to document the heart rate (HR) responses of firefighters during incident rehabilitation following firefighting activity in a high-rise building with a simulated fire on the 10th floor. Additionally, the study investigated potential factors, including firefighting workload, ambient temperature, firefighter movement, and individual characteristics, that may have affected HR during recovery. Firefighters (n = 198) were assigned to perform a simulation of fire suppression, search and rescue, or material support during one of six firefighting trials that involved different crew sizes and ascent modes, and were performed in different environmental conditions. After completing the simulated firefighting activity, firefighters reported to a rehabilitation area on the 8th floor. The rehabilitation area was staffed by firefighter/paramedics. HR was monitored continuously during simulated firefighting activity and a 15-minute rehabilitation period. Average HR during rehabilitation (HRmean) was calculated and compared across trials. Simulated firefighting activity was performed in the summer in Virginia, USA, and ambient conditions varied among trials (mean ± SD: 31 ± 4°C; 46 ± 15% relative humidity; 32 ± 4°C heat index). Duration of simulated firefighting activity ranged from 12.0 to 20.3 minutes among trials (mean: 15.4 ± 5.2 minutes). Over all trials, mean peak HR during simulations was 173 ± 18 beats·min(-1). Mean HR over all trials at entry into rehabilitation was 149 ± 24 beats·min(-1). Following 15 minutes of recovery, mean HR over all trials was 126 ± 23 beats·min(-1). Exploratory analyses revealed that higher workload during firefighting (stair trials), higher ambient temperature (≥30°C), greater movement during rehabilitation (≥0.1 g-force), higher age (≥45 years), and higher BMI (≥30.0 kg·m(-2)) were associated with higher HR responses during rehabilitation. During complex emergency operations, emergency medical service personnel will likely encounter considerable variability in HR responses upon initial evaluation and throughout rehabilitation. Following one bout of firefighting activity during a simulated fire scenario, HR decreased but remained elevated well above resting values following 15 minutes of rehabilitation. Based on current fire service recommendations, the majority of firefighters (88%) would not have been released from rehabilitation and eligible for reassignment after a 15-minute rehabilitation period following a brief bout of simulated firefighting activity. ⋯ medical monitoring, cardiac strain, firefighting.
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Observational Study
Utilizing Geographic Information Systems to Identify Clusters of Severe Sepsis Patients Presenting in the Out-of-Hospital Environment.
Understanding the geographic distribution of critical illness within a community may provide public health stakeholders with information that can be used to expedite access to specialized care. We hypothesized that severe sepsis patients transported by emergency medical services (EMS) exhibit geospatial clustering and that prehospital providers would recognize sepsis more frequently in patients transported from sepsis clusters. Retrospective review of a prospective, observational study of patients with severe sepsis transported to the emergency department (ED) by EMS and treated with early goal-directed therapy (EGDT). ⋯ age <18 or need for immediate surgery. Patient location at the time of EMS activation was recorded. Analysis of the addresses identified clusters, defined as a location in which EMS transported more than one patient experiencing the above associated signs and symptoms of septic shock. Other data collected included self-reported patient location as private residence or chronic care facility. One hundred sixty severe sepsis patients transported by EMS were eligible for analysis, presenting from 125 locations. Ninety-one patients (57%) presented from a private residence and 69 (37%) from a chronic care facility. Fifty (31%) patients were transported from 15 locations, with 25 of those transported from just 4 locations. Cluster patients tended to be older, come from medical facilities, and were more likely to have sepsis recognized by prehospital providers. Results from this study demonstrate low pre-hospital recognition of sepsis, as well as geospatially clustered presentations, most notably from skilled nursing facilities. Community education, public health initiatives, and EMS interventions could be targeted in such clusters of cases in order to both improve sepsis recognition and potentially expedite time-sensitive interventions.
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Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children. ⋯ Despite implementation of several best practice recommendations to improve prehospital pain treatment, few children have a documented pain score and even fewer receive opioid analgesia. Children with longer transport times, successful IV placement, and/or documentation of pain score(s) were more likely to receive prehospital analgesia.