Utilization of Heat‐Mapping Tools to Match a Resident Staffing Template to Emergency Department Arrival Patterns

2021 ◽  
Author(s):  
Abigail M. Schuh ◽  
Mark Nimmer ◽  
Amy L. Drendel
Keyword(s):  
Emergency Department ◽  
Emergency Department Arrival

scholarly journals Paramedic Global Impression of Change During Prehospital Evaluation and Transport for Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 784-791
Author(s):  
Kristina Shkirkova ◽  
Samuel Schuberg ◽  
Emma Balouzian ◽  
Sidney Starkman ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Los Angeles ◽  
Randomized Trial ◽  
Intracranial Hemorrhage ◽  
Prehospital Care ◽  
Early Period ◽  
Screening Tools ◽  
Neurological Deficits ◽  
Emergency Department Arrival ◽  
Global Impression Of Change

Background and Purpose— The prehospital setting is a promising site for therapeutic intervention in stroke, but current stroke screening tools do not account for the evolution of neurological symptoms in this early period. We developed and validated the Paramedic Global Impression of Change (PGIC) Scale in a large, prospective, randomized trial. Methods— In the prehospital FAST-MAG (Field Administration of Stroke Therapy-Magnesium) randomized trial conducted from 2005 to 2013, EMS providers were asked to complete the PGIC Scale (5-point Likert scale values: 1-much improved, 2-mildly improved, 3-unchanged, 4-mildly worsened, 5-much worsened) for neurological symptom change during transport for consecutive patients transported by ambulance within 2 hours of onset. We analyzed PGIC concurrent validity (compared with change in Glasgow Coma Scale, Los Angeles Motor Scale), convergent validity (compared with National Institutes of Health Stroke Scale severity measure performed in the emergency department), and predictive validity (of neurological deterioration after hospital arrival and of final 90-day functional outcome). We used PGIC to characterize differential prehospital course among stroke subtypes. Results— Paramedics completed the PGIC in 1691 of 1700 subjects (99.5%), among whom 635 (37.5%) had neurological deficit evolution (32% improvement, 5.5% worsening) during a median prehospital care period of 33 (IQR, 27–39) minutes. Improvement was associated with diagnosis of cerebral ischemia rather than intracranial hemorrhage, milder stroke deficits on emergency department arrival, and more frequent nondisabled and independent 3-month outcomes. Conversely, worsening on the PGIC was associated with intracranial hemorrhage, more severe neurological deficits on emergency department arrival, more frequent treatment with thrombolytic therapy, and poor disability outcome at 3 months. Conclusions— The PGIC scale is a simple, validated measure of prehospital patient course that has the potential to provide information useful to emergency department decision-making. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT00059332.

PREHOSPITAL END TIDAL CARBON DIOXIDE PREDICTS HEMORRHAGIC SHOCK UPON EMERGENCY DEPARTMENT ARRIVAL

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Natalie Bulger ◽  
Brenna Harrington ◽  
Josh Krieger ◽  
Andrew Latimer ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Emergency Department ◽  
Hemorrhagic Shock ◽  
Emergency Department Arrival ◽  
End Tidal Carbon Dioxide ◽  
End Tidal
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