Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance. Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance. ⋯ Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92). Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.
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Objective: Emergency medical services (EMS) provide critical interventions for patients with acute illness and injury and are important in implementing prehospital emergency care research. Retrospective, manual patient record review, the current reference-standard for identifying patient cohorts, requires significant time and financial investment. We developed automated classification models to identify eligible patients for prehospital clinical trials using EMS clinical notes and compared model performance to manual review. ⋯ Compared to manual classification (N = 363 records), the automated method excluded 90.9% of records as ineligible and leaving only 33 records for manual review. Conclusions: Our ML derived approach demonstrates the feasibility of developing a high-performing, automated classification system using EMS clinical notes to streamline the identification of a specific cardiac patient cohort. This efficient approach can be leveraged to facilitate prehospital patient-trial matching, patient phenotyping (i.e. influenza-like illness), and create prehospital patient registries.
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Background: A standardized objective measure of prehospital patient risk of hospitalization or death is needed. The Rapid Emergency Medicine Score (REMS), a validated risk-stratification tool, has not been widely tested for prehospital use. This study's objective was to assess predictive characteristics of initial prehospital REMS for ED disposition and overall patient mortality. ⋯ A score 7 or lower was statistically optimal for predicting survival. Initial prehospital REMS of 7 or lower was associated with a five-fold increase in odds of overall survival (OR:5.41, 95%CI:5.15-5.69). Conclusion: Initial prehospital REMS was predictive of ED disposition and overall patient mortality, suggesting value as a risk-stratification measure for EMS agencies, systems and researchers.
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Introduction: Patients experiencing a large vessel occlusion stroke (LVOS) may require endovascular-capable centers and benefit from direct transport to such facilities, creating a need for an accurate prehospital assessment. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a secondary scale to identify LVOS. Currently, there is limited prospective evidence validating the use of the FAST-ED in the prehospital environment. ⋯ Agreement was substantial across provider certifications including paramedics and EMTS. Conclusion: This study demonstrated high inter-rater reliability of the FAST-ED scale when performed in the prehospital setting on patients suspected of having a stroke. There were minimal differences in reliability based on provider certification, and item level analysis indicated substantial inter-rater reliability.
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Background: The geographic distribution and access to paramedic education programs is unclear but often cited as a reason for emergency medical services (EMS) workforce shortages. Our aims were: 1) to examine the spatial distribution of accredited paramedic programs and 2) to compare characteristics of communities with and without existing programs. Methods: We performed a cross-sectional study of US paramedic education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of April 2020. ⋯ There were significantly higher odds of having a paramedic program for counties classified as metro compared to non-metro (OR 4.42, 95% CI 3.60-5.42) and with the presence of healthcare resources (e.g., emergency department in the county: OR 2.42, 95% CI 1.87-3.14). Conclusions: Approximately 73% of the US adult population lives within 30 miles of an existing paramedic education program; however, this decreases to 22% in rural areas. Geographic barriers to accessing paramedic education remain a challenge for ongoing efforts to address the rural EMS workforce shortage.