scholarly journals Are emergency medical services offload delay patients at increased risk of adverse outcomes?

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 505-512 ◽  
Author(s):  
Dana Stewart ◽  
Eddy Lang ◽  
Dongmei Wang ◽  
Grant Innes
Keyword(s):  
Emergency Medical Services ◽  
Care Delivery ◽  
Hospital Length ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Medical Services ◽  
Emergency Medical ◽  
Increased Risk ◽  
High Acuity ◽  
Offload Delay

ABSTRACTObjectiveEmergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied.MethodsWe used administrative data to study all high-acuity Canadian Triage Acuity Scale 2–3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered “delayed.” Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality.ResultsOf 162,002 high-acuity arrivals, 70,711 had offload delays <15 minutes and 41,032 had delays > 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates.ConclusionIn this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

scholarly journals The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

CJEM ◽  
2015 ◽  
Vol 18 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Judah Goldstein ◽  
Jennifer McVey ◽  
Stacy Ackroyd-Stolarz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Emergency Medical Services ◽  
Acute Care ◽  
Functional Independence ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Care Needs ◽  
Frail Older Adults ◽  
Emergency Medical

AbstractCaring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

Rationale, development and implementation of the ReACanROC registry for out-of-hospital cardiac arrests in France and Canada

2021 ◽  
pp. emermed-2020-211073
Author(s):  
Matthieu Heidet ◽  
Hervé Hubert ◽  
Brian E Grunau ◽  
Sheldon Cheskes ◽  
Valentine Baert ◽  
...  
Keyword(s):  
North America ◽  
Emergency Medical Services ◽  
Care Delivery ◽  
Steering Committee ◽  
Population Based ◽  
Research Network ◽  
Medical Services ◽  
Emergency Medical ◽  
Utstein Style ◽  
Wide Population

France and Canada prehospital systems and care delivery in out-of-hospital cardiac arrests (OHCAs) show substantial differences. This article aims to describe the rationale, design, implementation and expected research implications of the international, population-based, France-Canada registry for OHCAs, namely ReACanROC, which is built from the merging of two nation-wide, population-based, Utstein-style prospectively implemented registries for OHCAs attended to by emergency medical services. Under the supervision of an international steering committee and research network, the ReACanROC dataset will be used to run in-depth analyses on the differences in organisational, practical and geographic predictors of survival after OHCA between France and Canada. ReACanROC is the first Europe-North America registry ever created to meet this goal. To date, it covers close to 80 million people over the two countries, and includes approximately 200 000 cases over a 10-year period.

Patient Outcome Using Medical Protocol to Limit “Lights and Siren” Transport

1994 ◽  
Vol 9 (4) ◽  
pp. 226-229 ◽  
Author(s):  
Douglas F. Kupas ◽  
David J. Dula ◽  
Bruno J. Pino
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Emergency Medical Services ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Vehicle Collisions ◽  
Patient Transport ◽  
Emergency Medical ◽  
Warning Lights

AbstractIntroduction:Emergency medical services vehicle collisions (EMVCs) associated with the use of warning “lights and siren” (L&S) are responsible for injuries and death to emergency medical services (EMS) personnel and patients. This study examines patient outcome when medical protocol directs L&S transport.Design:During four months, all EMS calls initiated as an emergency request for service and culminating in transport to an emergency department (ED) were included. Medical criteria determined emergent (L&S) versus non-emergent transport. Patients with worsened conditions, as reported by EMS providers, were reviewed.Setting:Countywide suburban/rural EMS system.Results:Ninety-two percent (1,495 of 1,625) of patients were transported non-emergently. Thirteen (1%) of these were reported to have worsened during transport, and none of them suffered any worsened outcome related to the non-L&S transport.Conclusion:This medical protocol directing the use of warning L&S during patient transport results in infrequent L&S transport. In this study, no adverse outcomes were found related to non-L&S transports.

scholarly journals Frequency and severity of prehospital obstetric events encountered by emergency medical services in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca E. Cash ◽  
Robert A. Swor ◽  
Margaret Samuels-Kalow ◽  
David Eisenbrey ◽  
Anjali J. Kaimal ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Prehospital Care ◽  
The United States ◽  
Medical Services ◽  
Patient Acuity ◽  
Cohen’S Kappa ◽  
Specific Patient ◽  
Cohen's Kappa ◽  
Emergency Medical ◽  
High Acuity

Abstract Background Prehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality. The frequency of prehospital obstetric events is unclear because existing descriptions have reported obstetric and gynecological conditions together, without delineating specific patient presentations. Our objective was to identify the types, frequency, and acuity of prehospital obstetric events treated by EMS personnel in the US. Methods We conducted a cross-sectional analysis of EMS patient care records in the 2018 National EMS Information System dataset (n=22,532,890). We focused on EMS activations (i.e., calls for service) for an emergency scene response for patients aged 12-50 years with evidence of an obstetric event. Type of obstetric event was determined by examining patient symptoms, the treating EMS provider’s impression (i.e., field diagnosis), and procedures performed. High patient acuity was ascertained by EMS documentation of patient status and application of the modified early obstetric warning system (MEOWS) criteria, with concordance assessed using Cohen’s kappa. Descriptive statistics were calculated to describe the primary symptoms, impressions, and frequency of each type of obstetric event among these activations. Results A total of 107,771 (0.6%) of EMS emergency activations were identified as involving an obstetric event. The most common presentation was early or threatened labor (15%). Abdominal complaints, including pain and other digestive/abdomen signs and symptoms, was the most common primary symptom (29%) and primary impression (18%). We identified 3,489 (3%) out-of-hospital deliveries, of which 1,504 were preterm. Overall, EMS providers documented 34% of patients as being high acuity, similar to the MEOWS criteria (35%); however, there were high rates of missing data for EMS documented acuity (19%), poor concordance between the two measures (Cohen’s kappa=0.12), and acuity differences for specific conditions (e.g., high acuity of non-cephalic presentations, 77% in EMS documentation versus 53% identified by MEOWS). Conclusion Prehospital obstetric events were infrequently encountered by EMS personnel, and about one-third were high acuity. Additional work to understand the epidemiology and clinical care of these patients by EMS would help to optimize prehospital care and outcomes.

scholarly journals Emergency Medical Services vs. Police: Impact of Pre-Hospital Transportation Method on Outcomes of Trauma Patients with Firearm Injuries

2020 ◽  
Author(s):  
Christina Wohler ◽  
Rachel Denneny ◽  
Allegra Bermudez ◽  
Robert Wilson ◽  
Douglas Gouchoe ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Medical Services ◽  
Hospital Treatment ◽  
Firearm Injuries ◽  
Patient Demographics ◽  
Emergency Medical ◽  
Significant Difference ◽  
The Impact

Abstract Background Firearms are a significant cause of morbidity and mortality in the United States. Few studies exist to investigate the impact of pre-hospital transportation methods on trauma patient outcomes. Methods Patients with firearm injuries were identified using an institutional trauma registry (2008 to 2017). Data on patient demographics, hospital transportation, treatments, and outcomes was collected and analyzed. Patient characteristics between Emergency Medical Services (EMS) vs. police transport groups were compared using Kruskal-Wallis, chi-square, or Fisher’s exact tests as appropriate. Results Of 224 patients identified, 147 (66%) were transported by EMS and 77 (34%) were transported by police. There was no significant difference in patient demographics between groups. Most patients were male (94.2%) and African American (69.2%), with a mean age of 27.1 years. 84.4% of patients suffered from an externally-inflicted gunshot wound, while 9.4% of patients had inflicted the wound themselves. Handguns were the weapon most commonly used. There was no significant difference in in-hospital treatments or mortality between patients transported by EMS vs. police. 44.1% of patients underwent surgery, and 34.8% required specialist consultation. The mean hospital length of stay for all patients was 1 day, and 27.7% of all patients expired during admission. Conclusions There is no difference in hospital treatment or mortality between firearm victims transported by EMS vs. police.

Gunshot Injuries in Children Served by Emergency Services

2017 ◽  
pp. 127-137
Author(s):  
Craig D. Newgard ◽  
Nathan Kuppermann ◽  
James F. Holmes ◽  
Jason S. Haukoos ◽  
Brian Wetzel ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Injury Severity ◽  
Emergency Services ◽  
Population Based ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Major Surgery ◽  
Gunshot Injuries ◽  
Emergency Medical ◽  
Injury Mechanisms

OBJECTIVE To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs ($28 510 per patient, 95% CI 22 193–34 827). CONCLUSIONS Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.

scholarly journals Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

CJEM ◽  
2011 ◽  
Vol 13 (01) ◽  
pp. 13-18 ◽  
Author(s):  
Blair L. Bigham ◽  
Ellen Bull ◽  
Merideth Morrison ◽  
Rob Burgess ◽  
Janet Maher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Emergency Medical Services ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Medical Services ◽  
Executive Summary ◽  
Emergency Medical ◽  
Increased Risk

ABSTRACT Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.

scholarly journals Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

2015 ◽  
Vol 123 (6) ◽  
pp. 1301-1311 ◽  
Author(s):  
Felix Kork ◽  
Felix Balzer ◽  
Claudia D. Spies ◽  
Klaus-Dieter Wernecke ◽  
Adit A. Ginde ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Hospital Length ◽  
Noncardiac Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Risk Of Death ◽  
Postoperative Changes ◽  
Increased Risk

Abstract Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P &lt; 0.001) and a longer HLOS of 5 days (P &lt; 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but &lt; 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P &lt; 0.001) and 2 days longer HLOS (P &lt; 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P &lt; 0.05) and a 3-day longer HLOS (P &lt; 0.01) when undergoing noncardiac surgery. Conclusions Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.

scholarly journals The Development of Consensus-Based Descriptors for Low-Acuity Emergency Medical Services Cases for the South African Setting

2021 ◽  
Vol 36 (3) ◽  
pp. 287-294
Author(s):  
Faisal Binks ◽  
Lee Alan Wallis ◽  
Willem Stassen
Keyword(s):  
Emergency Medical Services ◽  
Online Survey ◽  
Medical Services ◽  
Free Text ◽  
Snowball Sampling ◽  
Survey Tool ◽  
Modified Delphi ◽  
Emergency Medical ◽  
High Acuity ◽  
Binary Options

AbstractIntroduction:Emergency Medical Services (EMS) are designed to respond to and manage patients experiencing life-threatening emergencies; however, not all emergency calls are necessarily emergent and of high acuity. Emergency responses to low-acuity patients affect not only EMS, but other areas of the health care system. However, definitions of low-acuity calls are vague and subjective; therefore, it was necessary to provide a clear description of the low-acuity patient in EMS.Aim:The goal of this study was to develop descriptors for “low-acuity EMS patients” through expert consensus within the EMS environment.Methods:A Modified Delphi survey was used to develop call-out categories and descriptors of low acuity through expert opinion of practitioners within EMS. Purposive, snowball sampling was used to recruit 60 participants, of which 29 completed all three rounds. An online survey tool was used and offered both binary and free-text options to participants. Consensus of 75% was accepted on the binary options while free text offered further proposals for consideration during the survey.Results:On completion of round two, consensus was obtained on 45% (70/155) of the descriptors, and a further 30% (46/155) consensus was obtained in round three. Experts felt that respiratory distress, unconsciousness, chest pain, and severe hemorrhage cannot be considered low acuity. For other emergency response categories, specific descriptors were offered to denote a case as low acuity.Conclusion:Descriptors of low acuity in EMS are provided in both medical and trauma cases. These descriptors may not only assist in the reduction of unnecessary response and transport of patients, but also assist in identifying the most appropriate response of EMS resources to call-outs. Further development and validation are required of these descriptors in order to improve accuracy and effectiveness within the EMS dispatch environment.

scholarly journals Retrospective chart review and survey to identify adverse safety events in the emergency medical services care of children with out-of-hospital cardiac arrest in the USA: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039215
Author(s):  
Carl Eriksson ◽  
Amanda Schoonover ◽  
Tabria Harrod ◽  
Garth Meckler ◽  
Matt Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Detection System ◽  
Prehospital Care ◽  
Medical Services ◽  
Emergency Medical ◽  
Increased Risk ◽  
Study Results ◽  
The Usa ◽  
Hospital Cardiac Arrest

IntroductionEfforts to improve the quality of emergency medical services (EMS) care for adults with out-of-hospital cardiac arrest (OHCA) have led to improved survival over time. Similar improvements have not been observed for children with OHCA, who may be at increased risk for preventable adverse safety events during prehospital care. The purpose of this study is to identify patient and organisational factors that are associated with adverse safety events during the EMS care of paediatric OHCA.Methods and analysisThis is a large multisite EMS study in the USA consisting of chart reviews and agency surveys to measure, characterise and evaluate predictors of our primary outcome severe adverse safety events in paediatric OHCA. Using the previously validated Paediatric prehospital adverse Event Detection System tool, we will review EMS charts for 1500 children with OHCA from 2013 to 2019 to collect details of each case and identify severe adverse safety events (ASEs). Cases will be drawn from over 40 EMS agencies in at least five states in geographically diverse areas of the USA. EMS agencies providing charts will also be invited to complete an agency survey to capture organisational characteristics. We will describe the frequency and proportion of severe ASEs in paediatric OHCA across geographic regions and clinical domains, and identify patient and EMS organisational characteristics associated with severe ASEs using logistic regression.Ethics and disseminationThis study has been approved by the Oregon Health & Science University Institutional Review Board (IRB Approval# 00018748). Study results will be disseminated through scientific publications and presentations, and to EMS leaders and staff through local EMS medical directors, quality and training officers and community engagement activities.

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