scholarly journals P008: Care of palliative patients by paramedics in the 911 system

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S67-S67
Author(s):  
C. Wallner ◽  
M. Welsford ◽  
K. Lutz-Graul ◽  
K. Winter
Keyword(s):  
Palliative Care ◽  
Emergency Medical Services ◽  
Retrospective Chart Review ◽  
Care Physician ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Emergency Medical ◽  
Circle Of Care ◽  
Lift Assist ◽  
Palliative Patients

Introduction: Palliative Care aims to relieve suffering and improve the quality of living and dying in patients with life-limiting, progressive conditions. Many patients and families prefer to stay at home at end of life. Despite this, many access 911 in times of apparent crisis. It has been noted in the literature that a well functioning palliative care system includes considering Emergency Medical Services as part of the patients’ circle of care. Training in palliative care is traditionally limited or absent for prehospital clinicians, including Paramedics and Emergency Medical Services Physicians. Furthermore, in our region, there are currently no medical directives available to Paramedics within the 911 system specifically addressing the needs of palliative care patients. Methods: A feasibility study (Expanding Care by Paramedics for Palliative Patients – EC3P) was designed to evaluate implementation of a new palliative care medical directive with trained teams of Paramedics available to respond to 911 calls. As part of this study, a pre-implementation retrospective chart review was performed. Patient care records were screened for “palliative” within the past medical history and text fields. Information about dispatch and scene times, patient demographics, details of patient encounter, and disposition of the patient were recorded. Descriptive statics were used. Results: Data was reviewed for all calls in 2018. Call data was reviewed to exclude those that were pediatric (<18yo) and those whose palliative status was unknown or unclear. There was a total of 318 calls. The majority of the calls (83%) were between 7am and 8pm, with peaks at 10 am and 6pm. The majority were transported to hospital (74%), 16% were transferred to hospital initiated by their palliative care physician, 20% “refused” transport, and 6% were declared dead and not transported. The most common reasons for calling 911 were new symptoms or a sudden worsening of chronic symptoms, followed by needs exceeding caregiver capacity; the third most common was lift assist without apparent injury. Conclusion: Much is unknown about the palliative patient population as it intersects with prehospital emergency care. This study will help provide information needed to guide further research and implementation.

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

Utilizing Advanced Telecommunication Strategies to Enhance the Response of Emergency Medical Services Volunteers

2020 ◽  
pp. 1-6 ◽  
Author(s):  
Ziv Dadon ◽  
Evan Avraham Alpert ◽  
Eli Jaffe
Keyword(s):  
High School Students ◽  
Emergency Medical Services ◽  
Critical Role ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
School Students ◽  
Software Applications ◽  
Emergency Medical ◽  
International College ◽  
And Control

ABSTRACT Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with advanced telecommunication strategies to activate and direct them in order to improve these processes. The volunteers include local high school students, international college students, emergency medical technicians, on-call volunteers, motorcyclists, and Life Guardian first responders. The telecommunication strategies include pagers, push-to-talk over cellular, and sophisticated smartphone-based software applications. These are monitored and directed via a central command and control station. Such processes, both on an organizational as well as technical level, can be adapted to improve prehospital emergency care.

The Surgeon and Emergency Medical Services for Chi

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 184-188
Author(s):  
Arthur Cooper ◽  
Barbara Barlow
Keyword(s):  
Emergency Medical Services ◽  
Life Support ◽  
Pediatric Trauma ◽  
Care Physician ◽  
Medical Services ◽  
Injured Child ◽  
Mortality And Morbidity ◽  
Emergency Medical ◽  
American Children ◽  
Unnecessary Death

A central focus of emergency medical services for chi is the critically injured child, whose potential for recovery is great. Yet trauma remains the leading cause of mortality and morbidity among American children 1-14 years of age. Much unnecessary death and disability can be avoided through aggressive professional and public education in pediatric advanced life support and injury prevention. As the primary-care physician of the critically injured child, the surgeon plays a leading role in ensuring that trauma and emergency medical services systems are optimally prepared to meet the dual challenges of providing optimal pediatric trauma care and obviating the need for such treatment through all means possible.

The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation

2006 ◽  
Vol 21 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Luis Mauricio Pinet Peralta
Keyword(s):  
Emergency Medical Services ◽  
System Design ◽  
Mexico City ◽  
Emergency Care ◽  
Response Times ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
High Quality ◽  
Emergency Medical ◽  
Prehospital Emergency

AbstractIntroduction:Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.Objective:The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.Methods:This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.Results:The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.Conclusions:Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Janett Rothhardt ◽  
Enno Swart ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Logistic Models ◽  
Patient Survey ◽  
Insurance Companies ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Emergency Medical

Abstract Introduction Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. Methods The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). Results The majority of respondents indicated that their EMS use was due to an emergency or someone else’s decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians’ opening hours) and insecurity/anxiety about one’s state of health (>45% of the respondents). “Social factors” were similarly important (e. g., 42% affirming, “No one could give me a ride to the emergency department or doctor’s office.”). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. Conclusion The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients’ insecurity.

Emergency Medical Services in India: The Present and Future

2014 ◽  
Vol 29 (3) ◽  
pp. 307-310 ◽  
Author(s):  
Mohit Sharma ◽  
Ethan S. Brandler
Keyword(s):  
Emergency Medical Services ◽  
Emergency Services ◽  
Prehospital Care ◽  
Emergency Medical Technician ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Publication Type ◽  
Emergency Medical ◽  
Trauma Service ◽  
Care System

AbstractIndia is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.SharmaM, BrandlerES. Emergency Medical Services in India: the present and future. Prehosp Disaster Med. 2014;29(3):1-4.

scholarly journals Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study

2020 ◽  
Vol 9 (2) ◽  
pp. e000946
Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Lee Wallis ◽  
Maaret Castrén ◽  
Veronica Lindström
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Quality Systems ◽  
Exploratory Case Study ◽  
Private Service ◽  
Emergency Medical ◽  
Prehospital Emergency

IntroductionIn South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development.MethodsA multiple exploratory case study design was used that employed the Institute for Healthcare Improvement’s 18-point Quality Program Assessment Tool as both a formative assessment and semistructured interview guide using four provincial government EMS and one national private service.ResultsServices generally scored higher for structure and planning. Measurement and improvement were found to be more dependent on utilisation and perceived mandate. There was a relatively strong focus on clinical quality assessment within the private service, whereas in the provincial systems, measures were exclusively restricted to call times with little focus on clinical care. Staff engagement and programme evaluation were generally among the lowest scores. A multitude of contextual factors were identified that affected the effectiveness of quality systems, centred around leadership, vision and mission, and quality system infrastructure and capacity, guided by the need for comprehensive yet pragmatic strategic policies and standards.ConclusionUnderstanding and accounting for these factors will be key to ensuring both successful implementation and ongoing utilisation of healthcare quality systems in emergency care. The result will not only provide a more efficient and effective service, but also positively impact patient safety and quality of care of the services delivered.

Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments

2016 ◽  
Vol 31 (6) ◽  
pp. 675-679 ◽  
Author(s):  
Olindi Wijesekera ◽  
Amanda Reed ◽  
Parker S. Chastain ◽  
Shauna Biggs ◽  
Elizabeth G. Clark ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Emergency Medical Services ◽  
Emergency Departments ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Medical Services ◽  
Publication Type ◽  
Patient Demographics ◽  
Emergency Medical ◽  
Chief Complaints

AbstractIntroductionWithout a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) utilization in four Indian emergency departments. Prehosp Disaster Med. 2016;31(6):675–679.

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