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

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 86-94
Author(s):  
John M. Tallon ◽  
Lu Zheng ◽  
Julie Wei ◽  
William Dick ◽  
George Papadopoulos ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Time Series ◽  
Time Series Analysis ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
Mortality Trend ◽  
Series Analysis ◽  
Emergency Medical ◽  
Life Threatening

ABSTRACTBackgroundResource allocation planning for emergency medical services (EMS) systems determines appropriate resources including what paramedic qualification and how rapidly to respond to patients for optimal outcomes. The British Columbia Emergency Health Services implemented a revised response plan in 2013.MethodsA pre- and post-methodology was used to evaluate the effect of the resource allocation plan revision on 24-hour mortality. All adult cases with evaluable outcome data (obtained through linked provincial health administrative data) were analyzed. Multivariable logistic regression was used to adjust for variations in other significant associated factors. Interrupted time series analysis was used to estimate immediate changes in level or trend of outcome after the start of the revised resource allocation plan implementation, while simultaneously controlling for pre-existing trends.ResultsThe derived cohort comprised 562,546 cases (April 2012–March 2015). When adjusted for age, sex, urban/metro region, season, day, hour, and dispatch determinant, the probability of dying within 24 hours of an EMS call was 7% lower in the post-resource allocation plan-revision cohort (OR = 0.936; 95% CI: 0.886–0.989; p = 0.018). A subgroup analysis of immediately life-threatening cases demonstrated similar effect (OR = 0.890; 95% CI: 0.808–0.981; p = 0.019). Using time series analysis, the descending changes in overall 24-hour mortality trend and the 24-hour mortality trend in immediately life-threatening cases, were both statistically significant (p < 0.001).ConclusionComprehensive, evidence-informed reconstruction of a provincial EMS resource allocation plan is feasible. Despite change in crew level response and resource allocation, there was significant decrease in 24-hour mortality in this pan-provincial population-based cohort.

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.

03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

2021 ◽  
Vol 38 (9) ◽  
pp. A2.1-A2
Author(s):  
Tom Quinn ◽  
Timothy Driscoll ◽  
Lucia Gavalova ◽  
Mary Halter ◽  
Chris P Gale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
St Segment ◽  
Coronary Syndromes ◽  
Audit Project

BackgroundUse of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS).ObjectivesTo investigate differences in mortality between those who did/did not receive PHECG.MethodsPopulation-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017.ResultsOf 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30-day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001).ConclusionPHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients.

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.

scholarly journals Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population‐based time–series analysis

Addiction ◽  
2021 ◽  
Author(s):  
Tony Antoniou ◽  
Diana Martins ◽  
Tonya Campbell ◽  
Mina Tadrous ◽  
Charlotte Munro ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Population Based ◽  
Policy Changes ◽  
Series Analysis

Population-Based Study of Hypoglycemia in Patients with Type 1 Diabetes Mellitus Requiring Emergency Medical Services

2012 ◽  
Vol 18 (6) ◽  
pp. 834-841 ◽  
Author(s):  
Ajay Parsaik ◽  
Rickey Carter ◽  
Lucas Myers ◽  
Jennifer Geske ◽  
Steven Smith ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
Population Based Study ◽  
Emergency Medical
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