Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Introduction: Emergency Medical Services (EMS) providers may identify and preferentially transport patients experiencing large vessel occlusion (LVO) stroke to appropriate treatment centers. The Rapid Arterial oCclusion Evaluation (RACE) scale was created for prehospital LVO detection, yet few studies have evaluated its function in real-world EMS settings. Our objective was to assess the prehospital performance of the RACE scale for detecting LVO stroke following implementation at a large suburban/rural agency in the United States. ⋯ A RACE score ≥5 for both LVO and ICH demonstrated sensitivity: 63%, specificity: 77%, PPV: 47% and NPV: 86%. Conclusion: The RACE scale demonstrated acceptable discrimination, yet the sensitivity and positive predictive value were lower in this cohort of EMS professionals in the United States than in the original validation study conducted in Spain. Further work is needed to determine the optimal prehospital screening tool for identification of LVO.
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Objective: Dual sequential defibrillation (DSD) - successive defibrillations with two defibrillators - offers a novel approach to refractory ventricular fibrillation (RVF) and tachycardia (VF/VT). While associated with rescue shock success, the effect of DSD upon out-of-hospital cardiac arrest (OHCA) is unknown. We evaluated the association of DSD with survival after refractory VF/VT OHCA. ⋯ Conclusions: Compared with conventional defibrillation, DSD was associated with lower odds of prehospital ROSC. Defibrillation type was not associated with other OHCA endpoints. DSD may not be beneficial in refractory VF/VT OHCA.
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Objectives: Pediatric behavioral health disorders and related emergency department visits are increasing, but effects on emergency medical services (EMS) are unknown. This study's objective was to describe the statewide epidemiology of pediatric behavioral health-related EMS encounters in Florida, including mental health and substance use. Methods: This analysis is a retrospective study of pediatric behavioral health-related EMS encounters from Florida's statewide EMS Tracking and Reporting Systems Database from 2011 to 2016. ⋯ Conclusions: Pediatric behavioral-health related EMS encounters had a significant proportion of suspected ingestions/substance use, and we found disproportionate effects on rural agencies. Increases in EMS resource utilization (including longer EMS times) occurred in certain settings with limited behavioral health infrastructure. Those findings suggest an opportunity for community paramedicine to alleviate EMS utilization and decrease the frequency of pediatric behavioral health emergencies.
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Objective: The aim of this study was to determine the frequency of automatic external defibrillator (AED) retrieval and placement by bystander callers when prompted by an Emergency Medical Dispatcher (EMD). Methods: This retrospective descriptive study utilized a convenience sample of emergency dispatch data collected from 23 Emergency Communication Centers (ECCs) spanning 14 states across the United States (U. S.) from July 11, 2014 to August 13, 2018, including all cases in which the EMD recorded any response to the AED availability prompt. ⋯ A majority (72.0%; n = 417) of the time, rescuers who were sent to get an AED were unable to retrieve it, with single rescuers being successful more often (57.1% unable to retrieve, vs 73.6% for multiple rescuers). Conclusions: AEDs are reported as available by only a small percentage of callers to 911, and in the majority of cases in which a bystander rescuer is sent to retrieve an AED, one is never located or used. Sending someone to retrieve the AED may be more appropriate in multiple-rescuer situations than when a single bystander rescuer is alone on scene.
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Objective: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We analyzed the Singapore cohort of Pan-Asia Resuscitation Outcome Study (PAROS), a multi-center, prospective OHCA registry between 2010 and 2015. The Singapore Socioeconomic Disadvantage Index (SEDI) score, obtained according to zip code, was used as surrogate for neighborhood SES. ⋯ Ethnicity did not reach statistical significance (p = 0.072) in forward selection model of Utstein survival, while SEDI score and category were not significant (p > 0.2 and p = 0.349). Conclusions: We found Malay and Indian communities to be at higher risks of OHCA compared to Chinese, and additionally, the Malay community is at higher risk of subsequent mortality than the Chinese and Indian communities. These disparities were not explained by neighborhood SES.