Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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We present the case of a 30-year-old man with a subcutaneous implantable cardioverter defibrillator (S-ICD) who suffered sudden out-of-hospital cardiac arrest. During resuscitation, the patient received inappropriate shocks due to oversensing by the S-ICD of chest compression induced artifact. ⋯ Placement of a magnet over the S-ICD generator failed to inhibit the delivery of S-ICD shocks. Information regarding inappropriate S-ICD shocks may be useful during resuscitation of patients with sudden cardiac arrest.
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Observational Study
How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults?
Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. ⋯ Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0-80.0%; specificity 35.3%, 95% CI 31.6-38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.
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Background: To evaluate a new strategy for identifying sepsis in Emergency Department (ED) patients that combines administrative diagnosis codes with clinical information from the point of first contact. Methods: This study linked clinical data from adult patients transported by a provincial Emergency Medical Services (EMS) system to ED and inpatient administrative databases. Sepsis cases were identified by searching ED databases for diagnosis codes consistent with infection and organ dysfunction. ⋯ The novel strategy requiring the presence of an infection code and either an organ dysfunction code or 2 or more SOFA points from EMS clinical information identified 1,379 more ED patients as having sepsis than the inpatient algorithm. These patients had high mortality supporting construct validity. Conclusions: Incorporation of a broader range of diagnostic codes and linking to an electronic database to obtain initial clinical information for the assessment of organ dysfunction improves reliability, criterion, and construct validity for identifying sepsis in ED patients.
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Introduction: Hypothermia in severe trauma patients can increase mortality by 25%. Active warming practices decrease mortality and are recommended in the Advanced Trauma Life Support (ATLS) guidelines. Despite this, many emergency medical services (EMS) vehicles do not carry equipment necessary to perform active warming. ⋯ Factors associated with higher risk of hypothermia include pre-MTC intubation, high ISS, multiple comorbidities, low SBP, non-penetrating mechanism of injury, and being transferred directly to MTC, and colder outdoor temperature. Avoidance of hypothermia is imperative to the management of major trauma patients. Prospective studies are required to determine if prehospital warming in these high-risk patients decreases the rate of hypothermia in major trauma and improves patient outcomes.
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Objective: To describe the process, benefits, and challenges of linking Arizona's prehospital registry to hospital discharge data. Methods: Data were queried from the Arizona Prehospital Information and Emergency Medical Services Registry System (AZ-PIERS) and the Arizona Hospital Discharge Database (HDD) for the calendar year 2015. To maximize the number of matched records, the databases were deterministically linked in 17 steps using different combinations/variations of patient personal identifiers. ⋯ The 2 steps with the highest false positive match rates were Step 16 (43.02%, n = 77) and Step 17 (31.43%, n = 11). Conclusion: It is feasible to link prehospital and hospital data using stepwise deterministic linkage; this method returns a high linkage rate with a low false positive error rate. Data linkage is vital to identifying and bridging gaps in the continuum of care and is a useful tool in statewide and agency-specific research and quality improvement.