Naloxone: sixty years of an essential antidote in emergency and prehospital care.

The Relationship Between Ski Patrols and Emergency Medical Services Systems

Emergency medical services (EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records (EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care.

Objective To guide the improvement and construction of Emergency Medical Service System, and investigate the epidemiological information of patients in pre-hospital emergency care in Huaihua city and probe the patients, characteristic. Methods The data were exported from the computer databases of Huaihua city, emergency medical center between 9-21, 2013 and 9-20, 2016.The thorough records of data from 12 744 aid patients were conducted to statistical analysis.The 7 033 male and 5 711 female between 1 month to 94 years old in that, the average ages is 51.8±22.6 . Specificly analyse different results of treatment [Pre-hospital care non-death, pre-hospital death (Pre-hospital cardiac death and Pre-hospital non-cardiac death)], that patients accepted pre-hospital emergency care of the time of deployment, arrival, spot, returning, drawing-out, and rescuing radius, quarterly distribution, types of diseases, the distribution of sexs and ages; this analyses the situation of ages of the different types of diseases about Pre-hospital medical care patients. Results (1) The scheduling time, running time, returning time and service radius about patients receiving pre-hospital care in the death group were less than those of the non-death group, and the rescue time and total time of the former were more than those of the latter respectively (P 0.05), but running time, returning time, total time and service radius of the sudden cardiac death groups were more than those of the non- sudden cardiac death groups, and returning time of the former was less than that of Pre-hospital care group of non-sudden cardiac death (P<0.01 or P<0.05). (2)The patients, amount in Pre-hospital medical care group, the non-death group, the death group, the non- sudden cardiac death group and the sudden cardiac death group were common in the first season of the year. (3)In 12 744 cases of pre-hospital medical care patients group, the patients, amount of trauma was at most, the percentage of the trauma group to the pre-hospital medical care group was 32.99%(4 204/12 744), whose age grades was by far among 21~50, which the patients, amount of traffic accident was at the most, and the others with a high incidence of the disease in sequence were circulatory system, nervous system, digestive system, poisoning group and respiratory system, whose age grades in circulatory system, nervous system, digestive system, respiratory system was by far above 51, the patients, age grades in poisoning group was patients by far among 21~50, which the patients, amount of acute alcoholism was at the most, the percentage of the acute alcoholism group to the poisoning group was 76.52%. (4)In 657 cases of aid death patients group, the death amount of trauma and poisoning group ranked at the 1th, 5th respectively, whose age grades was by far among 21~50.The death amount of diseases of circulatory system, nervous system, respiratory system and digestive system ranked at the 2th, 3th, 4th, 6th respectively, those patient’ age grades was by far above 51, in the further analysis, the amount of patients with pre-hospital of sudden cardiac death was at most in the death amount of diseases in circulatory system.(5) The total amount, the death amount and the sudden cardiac death amount of cases of male patients were more than those of female patients. (6) The percentage of the death group to the pre-hospital medical care group cases was 5.15%(657/12 744), and the percentage of the sudden cardiac death group to the pre-hospital medical care group cases was 1.11%(141/12 744), and the percentage of the sudden cardiac death patients group to the death group was 21.46%(141/657). Conclusions Trauma, especially in traffic accident injury, is the main cause of death of pre-hospital care in Huaihua city in recent years. The measures benefit to reduce icidence, mrtality in pre-hospital emergency medical care in the local aera by strengthening emergency first aid network construction, the rational preparation schedule settings, or the evidence for the existence of sudden cardiac death risk factors in patients with increased vigilance, making preventions plans for a particular season, disease and people, promoting the knowledge and skills of pre-hospital popularity, focusiong on cardio-cerebral vascular disease and respiratory disease prevention and control, improving the masses of the common early identification of critical capacity and other targeted initiatives. Key words: Pre-hospital emergency care; Pre-hospital death; Sudden cardiac death; Epidemiological study

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

BackgroundDelivering pre-hospital emergency care has the potential to be hazardous. Despite this, little is known about the factors that precipitate human errors and influence patient safety in the pre-hospital care setting, in contrast to in-hospital care. Similarly, limited report on patient safety and human error issues in the pre-hospital emergency care setting exist in South Africa.AimThis study investigated the perspectives of emergency care personnel (ECP) in South Africa on the types of human errors and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa.SettingThis study was conducted in the pre-hospital emergency care environment in South Africa.MethodsThis research was designed as an exploratory study that made use of a semi-structured questionnaire administered to 2,000 emergency care personnel.ResultsA response rate of 76% was obtained. According to the participants, errors relating to poor judgement, poor skill or knowledge, fatigue, and communication, and individual error are common during pre-hospital care. Inadequate equipment, environmental factors, and personal safety concerns were reported as some of the factors that influence patient safety in the pre-hospital emergency care setting.ConclusionImplementation of strategies that enhances education and training, clinical skill development, teamwork skills, fatigue management, and leadership skills can help prevent some of the errors identified in this study.ContributionThis study identifies the types of human errors, and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa.

Patterns of Emergency Medical Transport for Suspected Acute Stroke, Acute Myocardial Infarction, and Other Diagnoses During the COVID‐19 Pandemic: A Retrospective Analysis of a Large Hospital‐Based Emergency Medical Services Agency

Governance and legal considerations supporting prehospital emergency care in low and middle-income countries—For the Special Series on Prehospital Care in LMICs

In reply:

Suburban sprawl: Where does emergency medicine fit on the map?

Utilization of Emergency Medical Transports and Hospital Admissions Among Persons With Behavioral Health Conditions

Commentary

Pediatric cervical spine injury is rare. As a result, evidence-based guidance for prehospital triage of children with suspected cervical spine injuries is limited. The effects of transport time and secondary transfer for specialty care have not previously been examined in the subset of children with cervical spine injuries. The primary objective was to determine if prehospital destination choice affects outcomes for children with cervical spine injuries. The secondary objectives were to describe prehospital and local hospital interventions for children ultimately transferred to pediatric trauma centers for definitive care of cervical spine injuries. The authors searched the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury data set for children transported by emergency medical services (EMS) from scene of injury. Neurologic outcomes in children with cervical spine injuries transported directly to pediatric trauma centers were compared with those transported to local hospitals and later transferred to pediatric trauma centers, adjusting for injury severity, indicated by altered mental status, focal neurologic deficits, and substantial comorbid injuries. In addition, transport times and interventions provided in the prehospital, local hospital, and pediatric trauma center settings were compared. Multiple imputation was used to handle missing data. The PECARN cervical spine injury cohort contains 364 patients transported from scene of injury by EMS. A total of 321 met our inclusion criteria. Of these, 180 were transported directly to pediatric trauma centers, and 141 were transported to local hospitals and later transferred. After adjustments for injury severity, odds of a normal outcome versus death or persistent neurologic deficit were higher for patients transported directly to pediatric trauma centers (odds ratio [OR]= 1.89, 95% confidence interval [CI]=1.03 to 3.47). EMS transport times to first hospital did not differ and did not affect outcomes. Prehospital analgesia was very infrequent. Initial destination from scene (pediatric trauma center vs. local hospital) appears to be associated with neurologic outcome of children with cervical spine injuries. Markers of injury severity (altered mental status and focal neurologic findings) are important predictors of poor outcome in children with cervical spine injuries and should remain the primary guide for prehospital triage to designated trauma centers.

Introduction The aim of our study was to investigate challenges faced by emergency physicians (EPs) who provide prehospital emergency care to patients with advanced incurable diseases and family caregivers in their familiar home environment. Methods Qualitative study using semistructured interviews with open-ended questions to collect data from 24 EPs. Data were analyzed using qualitative content analysis. Results We identified nine categories of challenges: structural conditions of prehospital emergency care, medical documentation and orders, finding optimal patient-centered therapy, uncertainty about legal consequences, challenges at the individual (EP) level, challenges at the emergency team level, family caregiver's emotions, coping and understanding of patient's illness, patient's wishes, coping and understanding of patient's illness, and social, cultural, and religious background of patients and families. EPs strengthened that the integrations of specialized prehospital palliative care services improved emergency care by providing resources to patients and family caregivers, enhancing the quality and availability of medical documentation and accessibility of aftercare in emergencies. Areas of improvement that were identified were to promote emergency physicians' knowledge and skills in palliative care, communication, and family caregiver support by education and training. Furthermore, structures for better care on-site, thorough medical documentation, and specialized palliative care emergency facilities in hospital and prehospital care were requested. Conclusion Prehospital emergency care in patients with advanced incurable diseases in their familiar home environment may be improved by training EPs in palliative care, communication, and caregiver support competences. Results underline the importance of collaborative specialized palliative care and prehospital emergency care.

EMS and Information Sharing: Challenges and Innovations in Getting Patient Data From the Ambulance to the Emergency Department and Back

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.