Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process. ⋯ This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negative impacts on receiving hospitals and EMS operations. Our findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.
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Multicenter Study
Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes.
Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. ⋯ In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.
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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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Recent studies have shown inconsistent results regarding the association between QRS characteristics and survival outcomes in patients with cardiac arrest and pulseless electrical activity (PEA) rhythms. This meta-analysis aimed to identify the usefulness of QRS width and frequency as prognostic tools for outcomes in patients with cardiac arrest and PEA rhythm. ⋯ Wide QRS width or low QRS frequency is associated with increased odds of mortality in patients with PEA cardiac arrest. These findings may be beneficial to guide the disposition of cardiac arrest patients with PEA during resuscitation.
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Randomized Controlled Trial
Drone-facilitated real-time video-guided feedback helps to improve the quality of lay bystander basic life support. A randomized controlled simulation trial.
Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR. ⋯ Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.