Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Benzodiazepines are the primary antiseizure medication used by Emergency Medical Services (EMS) for seizures. Available literature in the United States and internationally shows 30% to 40% of seizures do not terminate with benzodiazepines called benzodiazepine refractory status epilepticus (BRSE). Ketamine is a potential treatment for BRSE due to its unique pharmacology. However, its application in the prehospital setting is mostly documented in case reports. Little is known about its use by EMS professionals for seizure management, whether as initial treatment or for BRSE, creating an opportunity to describe its current use and inform future research. ⋯ In this retrospective review of the ESO Data Collaborative, ketamine administration for seizure encounters without an airway procedure increased over the study period, both as a single agent and with another ASM. Most ketamine administrations were for adult patients in the south and in urban areas. The frequency of BRSE, the need for effective treatment, and the growth in ketamine use warrant prospective prehospital research to evaluate the value of ketamine in prehospital seizure management.
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The American Board of Emergency Medicine (ABEM) Emergency Medical Services Medicine (EMS) subspecialty was approved by the American Board of Medical Specialties on September 23, 2010. Subspecialty certification in EMS was contingent on two key elements-completing Accreditation Council for Graduate Medical Education (ACGME)-accredited EMS training and passing the subspecialty certification examination developed by ABEM. The first EMS certification examination was offered in October 2013. Meaningful certification requires rigorous assessment. In this instance, the EMS certification examination sought to embrace the tenets of validity, reliability, and fairness. For the purposes of this report, the sources of validity evidence were anchored on the EMS core content, the examination development process, and the association between fellowship training and passing the certification examination. ⋯ There is substantial and varied validity evidence to support the use of the EMS certifying examination in making summative decisions to award certification in EMS. Of note, there was a statistically significant association between ACGME-accredited fellowship training and passing the examination.
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Non-ST segment elevation myocardial infarction (NSTEMI) is a relatively unknown complication of injecting sublingual Suboxone (buprenorphine/naloxone). Buprenorphine/naloxone should be taken as a sublingual tablet or a buccal film and not injected, so its effects from this mode of administration are not well known. While the differential diagnosis for chest pain is very broad, many practitioners do not associate chest pain with the use of buprenorphine/naloxone. We recommend considering serial electrocardiograms (ECGs) and high-sensitivity troponins for a patient who presents with chest pain after buprenorphine/naloxone use.
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This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google's Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate identification of areas requiring improvement, thereby potentially enhancing patient care outcomes. ⋯ Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their current value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.
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Prehospital electrocardiogram (ECG) and administration of aspirin are evidence-based strategies for patients with acute coronary syndrome (ACS). However, emergency medical services (EMS) compliance in patients with suspected ACS varies widely. We sought to understand the barriers to prehospital ECG acquisition and aspirin administration for patients with suspected ACS. ⋯ Multiple, interrelated themes underscored the complexities of delivering evidence-based care to prehospital patients with ACS. Education in ECG interpretation, resource allocation, bias, and enhancing feedback may serve as strategies to address the identified barriers.