scholarly journals P048: Listening to care partners: a feasible method to screen for frailty in emergency medical services?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S94-S95
Author(s):  
J. Goldstein ◽  
K. Rockwood
Keyword(s):  
Emergency Medical Services ◽  
Frailty Index ◽  
Outcome Data ◽  
Medical Services ◽  
Future Research ◽  
Clinical Frailty Scale ◽  
Emergency Medical ◽  
Care Partners ◽  
One Year

Introduction: Frailty is a state of vulnerability, and may go unrecognized in emergency medical services (EMS). Identifying frailty earlier may allow for services to be offered proactively to maintain function and prevent further health deterioration. The Clinical Frailty Scale (CFS) can be used to screen for frailty, but has only been validated when used by physicians. Our objective was to evaluate the feasibility and validity of a Care Partner-completed CFS, facilitated by a paramedic or nurse. Methods: A prospective sample of older adults (age ≥ 70 years) presenting in two settings (to EMS, following a 911 call, and to Geriatric Ambulatory Care) between February 2009 and March 2010 were included. Care partners completed a survey that included the nine-point CFS, which grades from 1 (very fit) to 9 (terminally ill). Demographic, clinical and outcome data were collected from the health care record, with one year follow-up. Based on clinical evaluations a frailty index was calculated for each patient. In each setting, descriptive statistics were used to compare fitter patients (CFS scores <5) to frailer ones (CFS scores >4). Results: The mean age was 82.2 ± 5.9 years (n=198) and most were women (n = 118, 62.1%). The Care Partner-CFS was incomplete for 3 surveys. The median CFS score in both the clinic and EMS groups was 5 (interquartile range = 4-6). The Care Partner-CFS correlated moderately with their independently assessed frailty index (0.64; p<0.01; n=195). Most patients (n=125; 64%) had frailty scores > 4. Frail patients were older and had worse health outcomes than the patients with score <5. More EMS patients were severely frail or very severely frail compared to the geriatric clinic patients (n = 19, 19% vs. n =5, 5%). Conclusion: The Care Partner-CFS is a feasible and valid method for evaluating frailty in the EMS and medical clinic settings where frailty was common. It may be a useful EMS screening tool to identify those that could benefit from comprehensive assessment and follow-up after emergency care. Future research will evaluate this approach in multiple populations with community based follow-up intervention for those at higher risk.

The Effect of the Familiarity of a Survey Sender on Response Outcomes in a Large-Scale Survey of Emergency Medical Services Agencies

2021 ◽  
Vol 44 (3) ◽  
pp. 260-267
Author(s):  
Morgan M. Millar ◽  
Hilary A. Hewes ◽  
Andrea L. Genovesi ◽  
Michael Ely ◽  
Braden Green ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Large Scale ◽  
Nationwide Survey ◽  
Survey Response ◽  
Medical Services ◽  
Healthcare Organizations ◽  
Emergency Medical ◽  
Established Relationship ◽  
To Receive

Survey response is higher when the request comes from a familiar entity compared to an unknown sender. Little is known about how sender influences response to surveys of organizations. We assessed whether familiarity of the sender influences response outcomes in a survey of emergency medical services agencies. Emergency medical services agencies in one U.S. state were randomly assigned to receive survey emails from either a familiar or unfamiliar sender. Both deployment approaches were subsequently used nationwide, with each state selecting one of the two contact methods. Experimental results showed that requests from the familiar sender achieved higher survey response (54.3%) compared to requests from the unfamiliar sender (36.9%; OR: 2.03; 95% CI: 1.23, 3.33). Similar results were observed in the subsequent nationwide survey; in states where the familiar sender deployed the survey, 62.0% of agencies responded, compared to 51.0% when the survey was sent by the unfamiliar sender (OR: 1.57; 95% CI: 1.47, 1.67). The response difference resulted in nearly 60 additional hours of staff time needed to perform telephone follow-up to nonrespondents. When surveying healthcare organizations, surveyors should recognize that it is more challenging to obtain responses without a pre-established relationship with the organizations.

Survey of Iowa Emergency Medical Services on the Effects of the 1993 Floods

1997 ◽  
Vol 12 (3) ◽  
pp. 37-41 ◽  
Author(s):  
Stanley E. Chartoff ◽  
Joann M. Gren
Keyword(s):  
Emergency Medical Services ◽  
Missouri River ◽  
Medical Services ◽  
Cross Sectional ◽  
Emergency Medical ◽  
First Response ◽  
Service Areas ◽  
The Government ◽  
Survey Questionnaires

AbstractIntroduction:From June through August 1993, extensive flooding in the Mississippi and Missouri River basins resulted in 50 deaths and 12 billion dollars [U.S.] in damages in nine Midwestern states. In Iowa (1990 population 2,777,000), the government declared all 99 counties Federal Disaster Areas. This study examines how this event impacted local emergency medical services (EMS).Methods:All 797 registered prehospital ambulance, rescue, and first-response companies in Iowa received survey questionnaires. Two follow-up mailings were provided for non-responders.Results:A total of 468 EMS companies (59%) returned completed questionnaires. The geographic distribution ofresponders and non-responders was similar. Of the companies responding, 132 (28%) reported an impact on their operations from the flood disaster. The most frequently reported operational changes included the use of non-traditional vehicles, providing aid to regions outside usual service areas, and involvement in non-medical rescue operations.Conclusion:A major flood provides unique challenges for emergency medical services. Cross-sectional surveys can identify areas of improvement for prehospital systems located in flood-prone areas. Results from this study provide a basis for constructing a more refined instrument to study future flood disasters.

scholarly journals P016: Evaluating the impact of a novel mobile care team (MCT) on the prevalence of ambulatory care sensitive conditions presenting to emergency medical services in Nova Scotia

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S83-S83 ◽  
Author(s):  
D.R. Brown ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
A. Travers ◽  
...  
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Emergency Medical Services ◽  
Care Provider ◽  
Primary Care Provider ◽  
Care Team ◽  
Medical Services ◽  
Ambulatory Care Sensitive Conditions ◽  
Emergency Medical ◽  
One Year

Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency medical services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to bookings from EMS, emergency and primary care and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT. Methods: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol and medical history) one year pre- and one year post-MCT implementation was conducted for the period Oct. 1, 2012 to Sept. 30, 2014. Demographics were described. Predictors of ACSC were identified via logistic regression. Prevalence was compared with chi-squared analysis. Results: There were 975 calls pre- and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre vs post, GA calls differed by sex (p=0.007) but not age (65.38 ± 15.12 vs. 62.51 ± 20.48; p=0.16). Post-MCT, prevalence of specific ACSC increased for GA: hypertension (p<0.001) and congestive heart failure (p=0.04). MCT patients with ACSC were less likely to have a primary care provider compared to GA (90.2% and 87.6% vs. 63.2%; p=0.003, p=0.004). Conclusion: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call or are referred to EMS for the new MCT service. Given that MCT patients were less likely to have a primary care provider this may represent an increase in access to care, or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.

scholarly journals Psychological Resilience towards COVID-19 amongst Emergency Medical Professionals in Pune (India)

2021 ◽  
pp. 17-24
Author(s):  
Parag Rishipathak ◽  
Shrimathy Vijayraghavan ◽  
Anand Hinduja
Keyword(s):  
Emergency Medical Services ◽  
Well Being ◽  
Medical Services ◽  
Medical Professionals ◽  
Psychological Resilience ◽  
Breaking Bad ◽  
Stressful Environment ◽  
Emergency Medical ◽  
Work Routine ◽  
One Year

Aim: The surge of COVID 19 infection across the globe has put tremendous pressure on Healthcare Professionals worldwide. Emergency Medical Professionals are first responders and hence bear the brunt of exposure to the virus as well as dealing with critically ill patients. The aim of the study is to assess psychological resilience towards COVID 19 amongst Emergency Medical Professionals. Study Design: Descriptive Study. Place and Duration of Study: Symbiosis Centre for Health Skills, Pune in April 2021. Methodology: The study was conducted amongst 120 Emergency Medical Professionals in Pune, India. The data was collected during the month of April 2021. Professionals who have completed Post Graduate Diploma in Emergency Medical Services and working in COVID centres for at least one year were included in the study. A 38-item questionnaire was developed for frontline Emergency Medical Professionals and included questions adapted from the tools which are available in public domain. Results and Discussion: Working in a stressful environment along with continuous fear of self-exposure and risk of transmission to family members affects the efficacy and productivity of Emergency Medical Services Professionals. Debriefing, training for effective ‘breaking bad news’ stress management workshops and counselling sessions should be integrated into their work routine to enhance their psychological capacity. Conclusion: The findings indicate that even after a year of serving COVID 19 patients, Emergency Medical Professionals demonstrate a high degree of resilience. Yet there are areas requiring improvement which need to be focussed upon immediately in the interest of the mental well-being of Emergency Medical Professionals.

Web-based training on weapons of mass destruction response for emergency medical services personnel

2009 ◽  
Vol 4 (3) ◽  
pp. 153-161 ◽  
Author(s):  
Robyn R. M. Gershon, MHS, DrPH ◽  
Allison N. Canton, BA ◽  
Lori A. Magda, MA ◽  
Charles DiMaggio, PhD ◽  
Dario Gonzalez, MD, FACEP ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Training Program ◽  
New York State ◽  
Weapons Of Mass Destruction ◽  
Medical Services ◽  
Mass Destruction ◽  
Web Based ◽  
Emergency Medical ◽  
Post Test

Objective: To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks.Design: The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program.Setting: New York State EMS.Participants: Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate).Main Outcome Variables: The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests.Results: Assessment scores for overall knowledge increased from the pretest (mean 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p = 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs.Conclusions: This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.

Drones in Emergency Medical Services: A Systematic Literature Review with Bibliometric Analysis

2020 ◽  
pp. 2097001
Author(s):  
Nonthapat Pulsiri ◽  
Ronald Vatananan-Thesenvitz
Keyword(s):  
Literature Review ◽  
Emergency Medical Services ◽  
Bibliometric Analysis ◽  
Systematic Literature Review ◽  
Academic Community ◽  
Medical Services ◽  
Future Research ◽  
Emergency Medical ◽  
Future Research Directions ◽  
Entrepreneurial Activities

This paper conducts a systematic literature review with bibliometric analysis for drone-related research in Emergency Medical Services (EMS). Forty publications were extracted from the SCOPUS database during 2015–2019 for further analysis. The results show the current research landscape and guide future research directions. Interestingly, the occurrence of the COVID-19 pandemic made the use of drones necessary to assist EMSs lifesaving tasks to reduce fatality, which has also attracted more attention from the academic community. It was found that the co-evolution of drone technologies and entrepreneurial activities in the EMS ecosystem offers drone uses beyond medical applications.

scholarly journals LO09: Population-based analysis of the effect of a comprehensive, systematic change in an emergency medical services resource allocation plan on 24 hour mortality

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S9-S9
Author(s):  
J. Tallon ◽  
L. Zheng ◽  
O. Djurdjev ◽  
J. Wei ◽  
G. Papadopoulos ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Emergency Medical Services ◽  
Group Analysis ◽  
Interrupted Time Series ◽  
Population Based ◽  
Outcome Data ◽  
Considerable Change ◽  
Medical Services ◽  
Systematic Change ◽  
Emergency Medical

Introduction: Resource allocation planning (RAP) for emergency medical services (EMS) systems determines optimal resources for patient needs in order to minimize morbidity and mortality. The British Columbia Emergency Health Services developed a new RAP using an evidenced informed methodology, statistical analysis of outcomes and with further clinical input from EMS physicians, paramedics and allied EMS providers. The revised RAP was implemented on a pan provincial basis in fall of 2013. It is unknown how the modifications will affect outcomes of EMS cases. Population-based analysis was used to determine the effect of a comprehensive RAP changes by comparing 24-hour mortality before and after province-wide implementation of the revised RAP. Methods: The primary outcome, 24-hour mortality, was obtained through linked provincial health administrative data. All adult cases with evaluable outcome data were included in the analysis. A pre and post methodology was used to evaluate the effect of post-RAP revision (post-RAP-revision) on 24-hour mortality compared to pre-RAP revision (pre-RAP-revision). Multivariable logistic regression was used to adjust for variations in other significant factors associated with 24-hour mortality. The interrupted time series (ITS) estimated any immediate changes in the level or trend of outcome after the start of the revised RAP implementation (fall of 2013), while simultaneously controlling for pre-existing trends. Results: The cohort is comprised of 562,546 cases (April 2012 March 2015). In the multivariate model, adjusted for age, sex, urban/metro region, season, day hour, and MPDS determinant, the probability of dying within 24 hours of EMS call was 7% lower in the post-RAP-revision cohort (OR=0.936; 95% CI: 0.886 - 0.989; P=0.018). A sub-group analysis of immediately life-threatening cases demonstrated similar effect (OR=0.890; 95% CI: 0.808 - 0.981; P=0.019) Conclusion: Our results demonstrate that a comprehensive, evidence informed reconstruction of a provincial EMS RAP is feasible. Despite considerable change in crew level response and resource allocation, there was significant decrease in 24 hour mortality in a large pan-provincial population based patient cohort.

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