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: With the emergence of the 2019 novel coronavirus disease (COVID-19), appropriate training for emergency medical services (EMS) personnel on personal protective equipment (PPE) is essential. We aimed: 1) to examine the change in proportions of EMS personnel reporting awareness of and training in PPE during the COVID-19 pandemic; and 2) to determine factors associated with reporting these outcomes. We conducted a cross-sectional analysis of data collected from October 1, 2019 to June 30, 2020 from currently working, nationally certified EMS personnel (n = 15,339), assessing N95 respirator fit testing; training in air purified respirators (APR) or powered APR (PAPR) use; and training on PPE use for chemical, biological, and nuclear (CBN) threats. ⋯ Factors consistently associated with lower odds of awareness/training included part-time employment, providing 9-1-1 response service, working at a non-fire-based EMS agency, and working in a rural setting. Conclusions: CDC guidance on COVID-19 for EMS may have increased N95 fit testing and training, but there remain substantial gaps in training on PPE use among EMS personnel. As the pandemic continues in our communities, EMS agencies should be supported in efforts to adequately prepare their staff.
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Background: The United States is currently facing 2 epidemics: sustained morbidity and mortality from substance use and the more recent COVID-19 pandemic. We tested the hypothesis that the pandemic has disproportionately affected individuals with substance use disorder by evaluating average daily 9-1-1 ambulance calls for substance use-related issues compared with all other calls. Methods: This was a retrospective cross-sectional analysis of 9-1-1 ambulance calls before and after the start of COVID-19 in Massachusetts. ⋯ Refusal of transport for substance-related calls increased from 5.0% before the statewide emergency to 7.5% after the declaration (p < 0.001). Conclusions: After an initial decline in substance-related ambulance calls following a statewide declaration of emergency, calls for substance use increased to pre-COVID-19 levels, while those for other reasons remained at a lower rate. The results suggest that COVID-19 is disproportionately affecting individuals with substance use disorder.
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Case Reports
Acute myocardial infarction identified by paramedics using the Smith-modified Sgarbossa criteria: a case report.
Identifying acute MI in the setting of left bundle branch block (LBBB) is challenging because ST-segment elevation is often found at baseline. When faced with LBBB and ischemic symptoms, identifying which patients require urgent reperfusion therapy is critical. ⋯ We present a case of LBBB meeting the Smith-modified Sgarbossa criteria, recognized by paramedics and used to activate the catheterization laboratory after normal business hours. The patient was found with 95% stenosis of the left anterior descending artery and received stenting.
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Objective: We sought to determine if Emergency Medical Services (EMS) identified Persons Under Investigation (PUI) for COVID-19 are associated with hospitalizations for COVID-19 disease for the purposes of serving as a potential early indicator of hospital surge. Methods: A retrospective analysis was conducted using data from the Maryland statewide EMS electronic medical records and daily COVID-19 hospitalizations from March 13, 2020 through July 31, 2020. All unique EMS patients who were identified as COVID-19 PUIs during the study period were included. ⋯ Conclusions: A strong correlation between EMS PUIs and COVID-19 hospitalizations was noted in this state-wide analysis. These findings demonstrate the potential value of incorporating EMS clinical information into the development of a robust syndromic surveillance system for COVID-19. This correlation has important utility in the development of predictive tools and models that seek to provide indicators of an impending surge on the healthcare system at large.
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Needle decompression of tension pneumothorax in children is a rarely encountered but potentially life-saving procedure, that is accompanied by a certain risk of injury. We evaluated the nipple as a landmark for an alternative anterior insertion site and as an aid in localizing lateral insertion sites, as well as its influence on the safety profile of the procedure. ⋯ When performing anterior needle decompression in children, we recommend inserting the needle at the more lateral insertion site at the 2nd intercostal space at the nipple line. At the lateral decompression sites, the nipple can be used as a marker for localizing the correct intercostal space for insertion and thereby ensuring enough caudad distance to the diaphragm to avoid abdominal injury.