Abstract
BackgroundPrevious studies have shown that prehospital insertion of peripheral vascular access is highly variable. The aim of this study is to establish the proportion of peripheral vascular access placement and its use with regard to both the severity of cases and the main problem suspected by the paramedics involved. Over-triage was considered to have taken place where peripheral vascular access was placed but unused and these cases were specifically analysed in order to evaluate the possibility of improving current practice.MethodsThis is a one-year (2017) retrospective study conducted throughout one State of Switzerland. Data were extracted from the state’s public health service database, collected electronically by paramedics on RescueNet® from Siemens. The following data were collected and analyzed: sex, age, main diagnosis suspected by paramedics and the National Advisory Committee for Aeronautics score (NACA) to classify the severity of cases.ResultsA total of 33,055 missions were included, 29,309 (88.7%) with a low severity. A peripheral vascular access was placed in 8603 (26.0%) cases. Among those, 3948 (45.9%) were unused and 2626 (66.5%) of these patients had a low severity score. Opiates represent 48.3% of all medications given. The most frequent diagnosis among unused peripheral vascular access were: respiratory distress (12.7%), neurological deficit without coma or trauma (9.6%), cardiac condition with thoracic pain and without trauma or loss of consciousness (9.6%) and decreased general condition of the patient (8.5%).ConclusionsPeripheral vascular access was set in 26% of patients, nearly half of which were unused. To reduce over-triage, special attention should be dedicated to cases defined by EMS on site as low severity, as they do not require placement of a peripheral vascular access as a precautionary measure. Alternative routes, such as the intra-nasal route, should be promoted, particularly for analgesia, whose efficiency is well documented. Emergency medical services medical directors may also consider modifying protocols of acute clinical situations when data show that mandatory peripheral vascular access, in stroke cases for example, is almost never used.
Highlights
Previous studies have shown that prehospital insertion of peripheral vascular access is highly variable
There are no guidelines for its use in the prehospital setting and a lack of evidence supporting the efficacy of such a measure, especially in non-trauma or non-cardiac arrest patients
Once in place, prehospitalinserted peripheral vascular access (PVA) were used in 17% [1] to 67% [2] of cases, with other PVAs being considered as a precautionary measure
Summary
Previous studies have shown that prehospital insertion of peripheral vascular access is highly variable. The aim of this study is to establish the proportion of peripheral vascular access placement and its use with regard to both the severity of cases and the main problem suspected by the paramedics involved. Once in place, prehospitalinserted PVAs were used in 17% [1] to 67% [2] of cases, with other PVAs being considered as a precautionary measure. The placement of PVA in the prehospital setting is motivated by the immediate need to give IV or IO medication or fluid therapy [3]. Paramedics are taught to establish PVA as a precautionary measure because they might need to quickly administer medication or fluid, and inserting a catheter while the patient is stable might be easier than in an emergency situation [4]. The circumstances in which a paramedic finds it appropriate to insert a catheter in the field are determined by each individual, so a large amount of inconsistency exists [4]
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