Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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With Canada's growing opioid crisis, many communities are attempting to monitor cases in real-time. Paramedic Naloxone Administration (PNA) has become a common metric for monitoring overdoses. We evaluate whether the use of naloxone administration counts represents an effective monitoring tool for community opioid overdoses. ⋯ PNA calls did not account for a significant percentage of opioid overdoses attended to by paramedics. The strong association between PNA and call location being a residence, along with increasing use of community naloxone kits, may cause certain populations to be under-represent if PNA is used as a standalone metric. The decreasing association with time may also lead to a falsely improving metric further reducing its effectiveness. Thus, PNA when used alone may no longer be a suitable metric for opioid overdose tracking.
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Hemorrhage is responsible for up to 40% of all traumatic deaths. The seminal CRASH-2 trial demonstrated a reduction in overall mortality following early tranexamic acid (TXA) administration to bleeding trauma patients. Following publication of the trial results, TXA has been incorporated into many prehospital trauma protocols. However, the cost-effectiveness of widespread TXA adoption by EMS is unknown. ⋯ Previous studies have demonstrated the clinical effectiveness of early TXA administration to patients with hemorrhage. Our modeling of the financial implications and clinical benefits of implementing a statewide TXA protocol suggests that prehospital TXA is a cost-effective treatment.
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Inequities have been described in areas of prehospital care ranging from pain medication administration and scene time, to stroke and cardiac arrest management. Though a critical element in understanding inequity, race and ethnicity information are often missing from the prehospital patient care report. This study aimed to characterize and understand demographic trends among records with missing race and ethnicity information. ⋯ When compared to data after the implementation of mandated race and ethnicity fields, missing race and ethnicity data were found to be more common in patients of color, younger patients, males, and those transported non-emergently. Inconsistent completion of race and ethnicity documentation may lead to a poor understanding of equity issues within a system, suggesting a need for mandatory race and ethnicity fields.
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We report the initial six pediatric patients treated with ketamine for benzodiazepine-resistant status epilepticus in an urban, ground-based emergency medical services (EMS) system. Evidence for ketamine as a second-line agent for both adult and pediatric refractory seizure activity in the hospital setting has increased over the past decade. The availability of an inexpensive and familiar second-line prehospital anti-epileptic drug option is extremely desirable. We believe these initial data demonstrate promising seizure control effects without significant respiratory depression, indicating a potential role for ketamine in the EMS treatment of pediatric benzodiazepine-refractory seizures.
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Like other public safety professions, paramedicine has historically been a male-dominated occupation. Although women are increasingly choosing paramedicine as a career, participation in leadership roles remains limited. Drawing on data from a comprehensive mental health survey, we describe the proportion of women in leadership in a single, large, urban paramedic service in Ontario, Canada. ⋯ Although paramedicine is witnessing an encouraging shift in the demography of its workforce, our results point to a potential under-representation of women in leadership roles. Future research should focus on identifying and ameliorating barriers to career advancement among women and other historically underrepresented people.