scholarly journals Architecture and Functionality of the Advanced Life Support On-Line Project Information System

2004 ◽  
Author(s):  
John A. Hogan ◽  
Julie A. Levri ◽  
Rich Morrow ◽  
Jim Cavazzoni ◽  
Luis F. Rodriguez ◽  
...  
Keyword(s):  
Information System ◽  
Life Support ◽  
Advanced Life Support ◽  
On Line

scholarly journals An On-line Technology Information System (OTIS) for Advanced Life Support

2003 ◽  
Author(s):  
Julie A. Levri ◽  
Richard Boulanger ◽  
John A. Hogan ◽  
Luis Rodriguez
Keyword(s):  
Information System ◽  
Life Support ◽  
Advanced Life Support ◽  
On Line ◽  
Line Technology

Development Approach of the Advanced Life Support On-Line Project Information System

2005 ◽  
Author(s):  
Julie A. Levri ◽  
John A. Hogan ◽  
Rich Morrow ◽  
Michael C. Ho ◽  
Bob Kaehms ◽  
...  
Keyword(s):  
Information System ◽  
Life Support ◽  
Advanced Life Support ◽  
On Line ◽  
Development Approach

On-line Medical Direction: A Prospective Study

1995 ◽  
Vol 10 (3) ◽  
pp. 174-177 ◽  
Author(s):  
Richard C. Wuerz ◽  
Gregory E. Swope ◽  
C. James Holliman ◽  
Gaspar Vazquez-de Miguel
Keyword(s):  
Prospective Study ◽  
Life Support ◽  
Treatment Time ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Base Station ◽  
University Hospital ◽  
Time Interval ◽  
Prehospital Treatment ◽  
On Line

AbstractObjectives:To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.Methods:Blinded, prospective study.Setting:A university hospital base-station resource center.Participants:Ten emergency physicians, 50 advanced life support providers.Interventions:Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.Results:Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ± 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ± 439 sec). Mean transport time in this system was 13 minutes.Conclusion:Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

Patient-Initiated Refusals of Prehospital Care: Ambulance Call Report Documentation, Patient Outcome, and On-line Medical Command

1995 ◽  
Vol 10 (1) ◽  
pp. 3-9 ◽  
Author(s):  
David C. Cone ◽  
David T. Kim ◽  
Steven J. Davidson
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Support Service ◽  
Exact Test ◽  
On Line ◽  
Potential Impact

AbstractIntroduction:There is a growing interest in cases in which emergency medical services (EMS) providers evaluate a patient, but do not transport the patient to a hospital. A subset of these cases, the patient-initiated refusal (PIR) in which the patient refused care and transport, was studied and evaluated. The objectives of the study were to examine the adequacy of ambulance call report documentation in PIR, to examine the clinical outcome of these patients in one hospital-based, suburban EMS system, and to assess the potential impact of on-line medical command (OLMC) on cases of PIR.Methods:The system studied is a hospital-based, transport-capable, advanced life support service in a suburban EMS system, with an annual call volume of 4,200 runs. During the 6-month study period, all ambulance call reports completed by the paramedics and medical command control forms completed by medical command physicians were examined, and cases of PIR collected. Each ambulance call report was examined for adequacy of documentation. Patient outcome was determined from emergency department records and telephone follow-up.Results:Eighty-five PIRs were documented during the study period. Four cases were excluded because of a missing ambulance call reports and/or medical command control forms, leaving 81 PIRs for analysis. Despite policy requiring OLMC in cases of PIR, OLMC was established in only 23 PIRs (28%). Of these, two (9%) had inadequate ambulance call report documentation. Of the 58 PIR in which OLMC was not established, 25 (43%) had inadequate ambulance call report documentation (p <0.001, Fisher's exact test). Follow-up was obtained for 54 (67%) PIR. Of these, 37 (68%) did not subsequently see a physician, and all needed no further medical care. Seven (13%) saw their own physicians within a few days of the initial refusal of prehospital care, and had no further problems. Ten patients were seen in an emergency department within a few days. Three (6%) were discharged, and did well. Seven (13%) were admitted to the hospital, with four (7%) admitted to monitored beds, and three (6%) to unmonitored beds. There were no deaths.Conclusions:Ambulance call report documentation is better with OLMC than without. Patients who initially refuse care may be ill, and some ultimately will be hospitalized. Further research may elucidate a role for OLMC in preventing refusals by incompetent patients, convincing patients who are competent but appear ill to accept transport, and assisting paramedics with other difficult or unusual circumstances.

Medical Control of Mass Gatherings: Can Paramedics Perform Without Physicians On-site?

1993 ◽  
Vol 8 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Cary C. McDonald ◽  
Max D. Koenigsberg ◽  
Sharon Ward
Keyword(s):  
Rock Music ◽  
Life Support ◽  
Prehospital Care ◽  
Vital Signs ◽  
Advanced Life Support ◽  
First Aid ◽  
Adverse Outcomes ◽  
Mass Gatherings ◽  
Medical Control ◽  
On Line

AbstractObjective:Evaluate the experience of paramedic personnel at mass gatherings in the absence of on-site physicians.Design:Retrospective review of patients evaluated by paramedics with emergency medical services (EMS) medical control.Setting:First-aid facility operated by paramedics at an outdoor amphitheater involving 32 (predominantly rock music) concerts in accordance with the Chicago EMS System, June through September 1990.Participants:A total of 438 patients (≤0.1% on-site population) were evaluated.Interventions:Presentations to the first-aid facility were viewed as if the patient was presenting to an ambulance. Transportation to an emergency department was strongly recommended for all encounters. Time from presentation to the first-aid facility until disposition was limited to 30 minutes in the absence of on-line [direct] medical control. Refusal of care was accepted. On-line [direct] medical control with the EMS resource hospital was initiated as needed. Off-line [indirect] medical control consisted of weekly reviews of all patient records and periodic site visits.Results:Of the 438 patients, 366 (84%) refused further care, including 31 patients (7%) who refused advanced life support (ALS) level care. Seventy-two patients (16%) were transported; 37 by ALS and 35 by basic life support (BLS) units. On-line [direct] medical control was initiated in all ALS patients that were transported as well as for those who refused care. No known deaths or adverse outcomes occurred, based on lack of inquiries or complaints from the local EMS system, emergency departments receiving transported patients, law enforcement agencies, 9-1-1 emergency response providers, venue management, or security. No request for medical records from law firms have occurred. Problems noted initially were poor documentation and a tendency not to document all encounters (e.g., dispensing band-aids, tampons, earplugs, etc.). Concerns noted included: initial and subsequent vital signs, times of arrival, interventions, dispositions, and patient conditions of refusal. Specific problems with documentation of refusals at disposition included: appropriate mental status, speech, and gait; release with an accompanying family member or friend; and parental notification and approval of care for minors. There also was an initial tendency not to establish on-line [direct] medical control for ALS refusal or BLS medicolegal issues.Conclusions:The medical system configuration modeled after practices of prehospital care, demonstrates physicians did not need to be onsite when adequate EMS medical control existed with less than 30 minutes on-scene time.

Adenosine for the Treatment of PSVT in the Prehospital Arena: Efficacy of an Initial 6 mg Dosing Regimen

1997 ◽  
Vol 12 (3) ◽  
pp. 64-66 ◽  
Author(s):  
Lynn K. Wittwer ◽  
Marc D. Muhr
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Dosing Regimen ◽  
Clark County ◽  
Medical Control ◽  
On Line ◽  
Adenosine Administration ◽  
Total Maximum ◽  
Initial Bolus

AbstractObjective:To confirm the efficacy of pre-hospital administration of adenosine, using a 6 milligram (mg) initial dosing regimen, for the treatment of paroxysmal supraventricular tachycardia (PSVT).Methods:Urban, suburban, rural emergency medical services (EMS) system in Clark County, Washington with advanced life support (ALS) patient transports. Concurrent, paramedic Medical Incident Report (MIR) review was conducted for 102 patients receiving prehospital adenosine during a 42-month period. Patients were administered 6 mg of adenosine using an intravenous (IV) bolus followed by 10 ml of balanced salt solution flush. If the patient's rhythm remained unchanged, the dosing regimen was increased to 12 mg followed by a 10 ml flush. This was repeated once more if the rhythm remained unchanged, to a total maximum dose of 30 mg. Medical direction for administration of adenosine was in the form of standing orders rather than direct (on-line) medical control.Results:Seventy-four of 102 patients had PSVT as determined by physician analysis of the initial six-second electrocardiographic rhythm strip (ECG) recording. Sixty-six of these patients converted their cardiac rhythm from PSVT using adenosine; 46 (70%) converted with the initial 6 mg bolus. Fifteen patients converted after receiving the second dose (12 mg); and five patients required 30 mg.Conclusion:These results show that for paramedics, adenosine is an effective treatment for PSVT. An initial bolus of 6 mg converts the majority of cases. Eighty-nine percent of cases of confirmed PSVT converted with adenosine administration.

Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

Circulation ◽  
1995 ◽  
Vol 92 (7) ◽  
pp. 2006-2020 ◽  
Author(s):  
Arno Zaritsky ◽  
Vinay Nadkarni ◽  
Mary Fran Hazinski ◽  
George Foltin ◽  
Linda Quan ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Recommended Guidelines ◽  
Utstein Style
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