Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The National Emergency Medical Services Information System (NEMSIS) provides a robust set of data to evaluate prehospital care. However, a major limitation is that the vast majority of the records lack a definitive outcome. This study aimed to evaluate the performance of a recently proposed method ("MLB" method) to impute missing end-of-EMS-event outcomes ("dead" or "alive") for patient care reports in the NEMSIS public research dataset. ⋯ This study found that the recently published MLB method produced reasonably good "dead" or "alive" indicators. We recommend reporting of True Positive Rate ("dead" prediction accuracy) and True Negative Rate ("alive" prediction accuracy) when applying the imputation method for analyses of NEMSIS data. More attention by EMS clinicians to complete documentation of target NEMSIS elements can further improve the method's performance.
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Implementing prehospital blood products for treating hemorrhagic shock has been utilized globally in military and civilian settings. This review aims to compare various guidelines for using blood products, including the types of blood products, injuries, biomarkers (hemodynamic measurement) to indicate use, associated treatments and risks, and the logistical concerns of storage and wastage in the prehospital setting. Furthermore, it explores whether prehospital blood transfusions are beneficial and a safe treatment option. ⋯ Prehospital blood was used in medical, trauma, and maternity-related hemorrhage. Many types of blood products are in use, ranging from component therapy to whole blood, with each protocol having different indications of use and treatment guidelines aimed at improving hemodynamic stability.
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Large vessel occlusion (LVO) strokes may be eligible for treatment with intravenous thrombolysis (IVT) and endovascular therapy (EVT). Patients selected for treatment have better neurologic outcomes with EVT, and delays in this therapy lead to worse outcomes. However, EVT is offered at a limited number of hospitals, referred to as endovascular stroke centers (ESC). This poses a difficult decision for EMS: to take potential stroke patients to the closest primary stroke center (PSC) or longer transport time to a more distant ESC. We hypothesized that patients with LVO stroke undergoing EVT transported directly to an ESC would have more favorable outcomes as measured by the modified Rankin scale (mRS) at 90 days, compared to transport to a PSC followed by transfer to an ESC. ⋯ In patients with LVO stroke who undergo thrombectomy, EMS transport directly to an ESC results in shorter time thrombectomy, although we did not observe a difference in 90-day functional outcomes. Additionally, bypass to reach a more capable endovascular stroke center does not delay administration of IVT from time of LKW.
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The use of machine learning to identify patient 'clusters' using post-return of spontaneous circulation (ROSC) vital signs may facilitate the identification of patient subgroups at high risk of rearrest and mortality. Our objective was to use k-means clustering to identify post-ROSC vital sign clusters and determine whether these clusters were associated with rearrest and mortality. ⋯ Unsupervised k-means clustering yielded 5 post-ROSC vital sign clusters that were associated with rearrest and mortality.
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Airway management is a fundamental skill that Emergency Medical Services (EMS) clinicians must be prepared to perform on patients of any age. We performed one of the first epidemiological studies of out-of-hospital pediatric airway management utilizing the ESO data set. ⋯ In the ESO cohort, advanced airway management of children occurred in only 5.9 in 10,000 911 emergency encounters. Overall and first pass success rates for TI were low. These data provide contemporary perspectives of pediatric prehospital airway management in the United States.