Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Observational Study
Secondary Public Safety Answering Points Delay the Response to Out of Hospital Cardiac Arrest.
Background: National guidelines recommend that high-performing systems process 9-1-1 calls within 60 s and deliver the first telecommunicator cardiopulmonary resuscitation compression within 90 s. The inability of systems employing secondary public safety answering points (PSAPs) to capture the call arrival timestamp at the primary PSAP is a challenge in out-of-hospital cardiac arrest response time research. Objective: We sought to measure the interval from call receipt at primary PSAPs to call answer at secondary PSAPs in metropolitan areas. ⋯ The median interval required to transfer a 9-1-1 caller from primary to secondary PSAPs was 41 s (IQR 31, 59), and 86 s at the 90th percentile. The 90th percentile performance level at individual agencies ranged from 63 s to 117 s. Conclusions: The primary to secondary PSAP transfer interval lengths observed in this study preclude these EMS agencies from meeting out-of-hospital cardiac arrest performance recommendations at the 90% percentile performance level.
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Almost half of pediatric EMS calls may be for low-acuity problems. Many EMS agencies have implemented alternative disposition programs for low-acuity patients, including transportation to clinics, substituting taxis for ambulances, and treatment in place without transport to an emergency department. Including children in such programs poses specific challenges, with one concern being potential caregiver opposition. Limited published evidence addresses caregiver perspectives on including children in alternative disposition programs. Our objective was to describe caregiver perspectives of alternative EMS disposition systems for low-acuity pediatric patients. ⋯ Caregivers in our study generally supported alternative EMS dispositions for some children and identified multiple potential benefits of such programs for both children and the health care system. Caregivers were concerned about the safety and logistical details of how such programs would be implemented and wanted to retain final decision-making authority. Caregiver perspectives should be considered when designing and implementing alternative EMS disposition programs for children.
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Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs. ⋯ Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals. Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.
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Emergency airway management is a common and critical task EMS clinicians perform in the prehospital setting. A new set of evidence-based guidelines (EBG) was developed to assist in prehospital airway management decision-making. We aim to describe the methods used to develop these EBGs. ⋯ The EBGs for prehospital airway management were developed by leveraging validated techniques, including the GRADE methodology and a rigorous systematic approach to consensus building to identify treatment recommendations. This process allowed the mitigation of many virtual and electronic communication confounders while managing several PICO questions to be evaluated consistently. Recognizing the increased need for rigorous evidence evaluation and recommendation development, this approach allows for transparency in the development processes and may inform future guideline development.
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This study aims to demonstrate the feasibility of quantifying the off-balancing vectors experienced during ambulance transport and comparing them to high-quality cardiopulmonary resuscitation (HQ-CPR) metrics. ⋯ Off-balancing vector data can be successfully quantified during ambulance transport and compared with HQ-CPR performance parameters. Increasing off-balancing vectors experienced during ambulance transport are associated with worse HQ-CPR metrics and increased perceived physical exertion. These data may help guide future drive styles, ambulance design, or use of mechanical CPR devices to improve HQ-CPR delivery during selected patient transport scenarios.