Emergency Medical Services Activation Research Articles

Balancing Patient Care and Force Protection at Military Medical Treatment Facilities.

This study aimed to identify delays of care due to base access security protocols at a stateside military medical treatment facility (MTF) for patients with a time-sensitive medical condition who are seeking emergency medical care at the MTF. We retrospectively analyzed emergency medical services (EMS) run reports from January 1, 2017 to November 12, 2017 to hospital access points to assess patients who were initially denied access to the MTF. Time from EMS activation until patient delivery at the emergency department, number of time-sensitive complaints, number of time-sensitive conditions, and number of unauthorized access attempts are reported. During the 11-month period of review, 42 delays of care related to EMS activation by the sentry at hospital access points were identified. Of the 42, 14 were associated with a time-sensitive complaint, 2 with time-sensitive conditions, and none were unauthorized access attempts. We identify the potential for patient harm due to delays in care resulting from the security protocols at our MTF. A review of force protection requirements with consideration for their impact on patient safety, especially in cases of time-sensitive conditions, has been conducted.

A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting

Background: Hypoglycemia is a frequent cause of emergency medical services (EMS) activation; however, limited evidence exists to support optimal prehospital treatment. Objective: This study sought to compare the safety and efficacy of the administration of 10% dextrose (D10) intravenously (IV) versus 50% dextrose (D50) IV for the treatment of hypoglycemia in the prehospital setting. Methods: This was a retrospective cohort study of patients who received IV dextrose by EMS and were transported to an academic teaching hospital emergency department between 2014 and 2017. Results: Four hundred seventy-eight eligible patients were reviewed, with 161 patients receiving D10 and 150 patients receiving D50. There was no significant difference found regarding the need for dextrose retreatment prior to hospital arrival between the D10 and D50 groups (0.6% vs 2.0%; P = .565). The prehospital reassessment glucose in the D50 group was a significantly higher than the D10 group (151.9 vs 124.6 mg/dL, P = .001) and this difference was maintained on hospital arrival (129.5 vs 108.0 mg/dL, P = .011). No significant difference was found between groups with regard to hospital admission, length of stay, or in-hospital mortality. Conclusion: When comparing D10 with D50 for the treatment of hypoglycemia by EMS, there were no significant differences in the need for dextrose retreatment prior to hospital arrival. The use of D50 resulted in a significantly higher blood glucose concentrations both in the prehospital setting and upon hospital arrival. Further study is needed in larger patient populations to evaluate the use of D10, the need for dextrose readministration, and its impact on clinical outcomes.

Abstract 446: Availability and Quality of Cardiopulmonary Resuscitation Films Featuring a Female Victim on the Internet: A Cross-Sectional Study

Introduction: Bystander cardiopulmonary (CPR) improves survival following out-of-hospital cardiac arrest (OHCA). However, women are less likely than men to receive CPR in public locations. Female-specific issues such as fear of touching breasts have been identified as barriers to performing CPR on women. The purpose of this study was to quantify and evaluate online CPR instructional films featuring a female victim. Methods: Using the search query “how to do CPR” via Google and YouTube, 374 and 500 films (38 and 25 result pages), respectively, were reviewed in May 2019. Exclusion criteria included: non-English, non-instructional, pediatric or animal victim, duplicates, parity, or in-hospital cardiac arrest. We identified 11 films featuring a female victim. These films were scored on 6 key aspects of CPR education: scene safety, check responsiveness, activate Emergency Medical Services, proper hand position, accurate rate, and appropriate depth of compressions. Results: Of the 874 reviewed films, 11 featured a female victim. Just 5 films were high-quality (correctly addressing 5 or 6 key aspects of CPR training, Figure 1). Furthermore, 2 of the 5 high-quality instructional films taught rescue breathing, which is no longer a recommended component of bystander CPR in the U.S. The remaining 3 films were all created outside the U.S. (Australia, New Zealand, England). None of the films explicitly addressed barriers to performing CPR on a female, including fear of touching breasts or concerns about causing harm. Conclusion: Out of the billions of films available online, we identified only 3 high-quality instructional films teaching modern, hands-only CPR featuring a female victim, none of which addressed specific female-related CPR issues. This gender disparity can be addressed with high-quality CPR training films that feature a female victim and explicitly address previously-identified barriers to performing CPR on a female.

Workload and influencing factors in non-emergency medical transfers: a\xa0multiple linear regression analysis of a cross-sectional questionnaire study

BackgroundHuman workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics’ workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number.MethodsParamedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload.ResultsA total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient’s body weight and the transfer of patients with transmittable pathogens.ConclusionThe workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.

Effect of the Floor Level on the Probability of a Neurologically Favorable Discharge after Cardiac Arrest according to the Event Location.

As the number of people living in high-rise buildings increases, so does the incidence of cardiac arrest in these locations. Changes in cardiac arrest location affect the recognition of patients and emergency medical service (EMS) activation and response. This study aimed to compare the EMS response times and probability of a neurologically favorable discharge among patients who suffered an out-of-hospital cardiac arrest (OHCA) event while on a high or low floor at home or in a public place. This retrospective analysis was based on Smart Advanced Life Support registry data from January 2016 to December 2017. We included patients older than 18 years who suffered an OHCA due to medical causes. A high floor was defined as ≥3rd floor above ground. We compared the probability of a neurologically favorable discharge according to floor level and location (home vs. public place) of the OHCA event. Of the 6,335 included OHCA cases, 4,154 (65.6%) events occurred in homes. Rapid call-to-scene times were reported for high-floor events in both homes and public places. A longer call-to-patient time was observed for home events. The probability of a neurologically favorable discharge after a high-floor OHCA was significantly lower than that after a low-floor OHCA if the event occurred in a public place (adjusted odds ratio (aOR), 0.58; 95% confidence intervals (CI), 0.37–0.89) but was higher if the event occurred at home (aOR, 1.40; 95% CI, 0.96–2.03). Both the EMS response times to OHCA events in high-rise buildings and the probability of a neurologically favorable discharge differed between homes and public places. The results suggest that the prognosis of an OHCA patient is more likely to be affected by the building structure and use rather than the floor height.

Epidemiology, etiology, and outcomes of out-of-hospital cardiac arrest in young patients in lebanon.

The burden of out-of-hospital cardiac arrest (OHCA) on different population segments in developing countries is not well studied. Previous studies from Lebanon report poor survival to hospital discharge (4.8%-5.5%). This study describes characteristics and outcomes of young OHCA victims in Beirut, Lebanon METHODS: This retrospective observational study included young patients (<35 years of age) with OHCA admitted to the emergency department (ED) of a tertiary care center in Lebanon over a 10-year period. Fifty-four patients with OHCA were identified. Most were males (74.1%, n=40) and the mean age was 17.9±10.9 years. The most common arrest location was home (44.4%, n=24). The majority were witnessed (78.8%, n=41) with 15.4% (n=8) witnessed by emergency medical services (EMS). Prehospital cardiopulmonary resuscitation was done for 22 patients (41.5%) mostly by EMS (n=19, 86.4%), 9.1% (n=2) by a bystander, and 4.5% (n=1) by a family member. Prehospital automated external defibrillator use was documented in 13% (n=7) of cases. Most patients (n=48, 88.9%) were resuscitated in the ED where the most common rhythm was asystole (55.6%, n=30). Half of the patients (50%, n=27) survived to hospital admission. Overall survival to hospital discharge was 16.7% (n=9). Good neurologic outcome (cerebral performance category 1 or 2) was documented in seven patients (9.3%). Survival rate of young OHCA victims in Lebanon (16.7%) is higher than previously reported rates of OHCA in the overall population. Targeted community activities and medical oversight of EMS activities are needed to link EMS activities to clinical outcomes.

Diurnal, weekly and seasonal variations of chest pain in patients transported by emergency medical services

ObjectivesChest pain is among the leading causes for emergency medical services (EMS) activation. Acute myocardial infarction (MI) is not only one of the most critical aetiologies of chest pain, but...

"Make the Call, Don't Miss a Beat" Campaign: Effect on Emergency Medical Services Use in Women with Heart Attack Signs.

Our objective was to evaluate the relationship between the "Make The Call, Don't Miss a Beat" national mass media campaign and emergency medical services (EMS) use among women with possible heart attack symptoms. We linked campaign TV public service advertisement data with national EMS activation data for 2010 to 2014. We identified EMS activations (i.e., responses) for possible heart attack symptoms and for unintentional injuries for both women and men. We estimated the impact of the campaign on the fraction of the 1.7 to 15.9 million activations of women with possible heart attack symptoms compared with 1.9 million female activations for unintentional injuries within each EMS agency and month using quasi-binomial logistic regression controlling for time and state. Of the 3,175 US. counties, 90% were exposed to the campaign. However, less than 2% of U.S. counties reached moderate TV exposure (≥300 gross rating points) during the entire campaign period. We did not observe an increase in the fraction of female activations for possible heart attack during periods or in counties with higher campaign exposure. This mass media campaign that relied heavily on TV public service advertisements was not associated with increased EMS use by women with possible heart attack symptoms, even among counties that were more highly exposed to the campaign advertisements.

Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

ObjectiveThe emergency medical service (EMS) provides rapid pre-hospital diagnosis and transportation in ST-elevation myocardial infarction (STEMI) systems of care. Aim of the study was to assess temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network.MethodsPatient call-to-arrival of EMS at site (call-to-site), transportation time from site to hospital (site-to-door), call-to-door, patient’s location, month, weekday, and hour of EMS activation were recorded in 4751 patients referred to a tertiary center with suspicion of STEMI.ResultsMedian call-to-site, site-to-door, and call-to-door times were 9 (7–12), 39 (31–48), and 49 (41–59) minutes, respectively. The shortest transportation times were noted between 08:00 and 16:00 and in general on Sundays. They were significantly prolonged between midnight and 04:00, whereby the longest difference did not exceed 4 min in median. Patient’s site of call had a major impact on transportation times, which were shorter in Central and Western districts as compared to Southern and Eastern districts of Vienna (p < 0.001 between-group difference for call-to-site, site-to-door, and call-to-door). After multivariable adjustment, patient’s site of call was an independent predictor of call-to-site delay (p < 0.001). Moreover, age and hour of EMS activation were the strongest predictors of call-to-site, site-to-door, and call-to-door delays (p < 0.05).ConclusionIn our Viennese STEMI network, the strongest determinants of pre-hospital EMS-related transportation delays were patient’s site of call, patient’s age, and hour of EMS activation. Due to the significant but small median time delays, which are within the guideline-recommended time intervals, no impact on clinical outcome can be expected.Graphic abstract

Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update.

In 2005, the American Stroke Association published recommendations for the establishment of stroke systems of care and in 2013 expanded on them with a statement on interactions within stroke systems of care. The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating stroke systems of care to date and to update the American Stroke Association recommendations on the basis of improvements in stroke systems of care. Over the past decade, stroke systems of care have seen vast improvements in endovascular therapy, neurocritical care, and stroke center certification, in addition to the advent of innovations, such as telestroke and mobile stroke units, in the context of significant changes in the organization of healthcare policy in the United States. This statement provides an update to prior publications to help guide policymakers and public healthcare agencies in continually updating their stroke systems of care in light of these changes. This statement and its recommendations span primordial and primary prevention, acute stroke recognition and activation of emergency medical services, triage to appropriate facilities, designation of and treatment at stroke centers, secondary prevention at hospital discharge, and rehabilitation and recovery.

Impact of Emergency Medical Services Activation of the Cardiac Catheterization Laboratory and a 24-Hour/Day In-Hospital Interventional Cardiology Team on Treatment Times (Door to Balloon and Medical Contact to Balloon) for ST-Elevation Myocardial Infarction

The incremental benefit of emergency medical services (EMS) activation of the cardiac catheterization laboratory (CCL) for ST-elevation myocardial infarction (STEMI) in the setting of an established in-house interventional team (IHIT) is uncertain. We evaluated the impact of EMS activation on door-to-balloon (D2B) time and first medical contact-to-balloon (FMC2B) time for STEMI when coupled with a 24-hour/day IHIT. All patients presenting with STEMI to Loyola University Medical Center had demographic, procedural, and outcome data consecutively entered in a STEMI Data Registry. From 223 consecutive patients presenting between April 2009 and December 2015, a retrospective analysis was performed on 190 patients. Patients were divided into 2 groups depending on CCL activation mode (EMS activation or emergency department activation) and STEMI treatment process times were compared. The primary end point was D2B process times. The secondary end point was FMC2B process times in a subgroup analysis of EMS-transported patients. D2B times were shorter (37 ± 14 minutes vs 57 ± 27 minutes, p < 0.001) with EMS activation. Subgroup analysis of EMS-transported patients demonstrated shorter FMC2B times with EMS activation (52 ± 17 minutes vs 67 ± 32 minutes, p = 0.002). EMS activation was the only predictor of D2B ≤60 minutes in multivariable analysis of EMS-transported patients (odds ratio 9.4; 95% confidence interval 2.1 to 43.0; p = 0.04). In conclusion, EMS activation of the CCL in STEMI was associated with significant improvements in already excellent D2B and FMC2B times even in the setting of a 24-hour/day IHIT.

Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke.

Background and Purpose- Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods- We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates' balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results- Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95-2.20] for onset-to-door time ≤2 hours, 2.32 [2.18-2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88-3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62-1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70-1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions- Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.

Comparison of Outcomes and Characteristics of Emergency Medical Services (EMS)-Witnessed, Bystander-Witnessed, and Unwitnessed Out-of-Hospital Cardiac Arrests in Singapore

Objectives: The objective was to compare the survival outcomes of emergency medical services (EMS)-witnessed to bystander-witnessed, and unwitnessed out-of-hospital cardiac arrests (OHCA) in Singapore. Secondary aims are to describe the 5-year trend in survival rates of EMS-witnessed arrests. Methods: This was a retrospective analysis of the Singapore’s OHCA registry data from 2011 to 2015. Excluded from the analysis were patients younger than 18 years old, arrests of traumatic etiology, resuscitation not attempted, and cases not conveyed by EMS. The primary outcome was survival to hospital discharge or 30 days post-arrest. Secondary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Results: 8,394 cases were analyzed, with 650 (7.7%) EMS-witnessed arrests, 4480 (53.4%) bystander-witnessed arrests, and 3264 (38.9%) unwitnessed arrests. Among EMS-witnessed arrests, the majority were presumed to be of cardiac etiology (62.8%) and the most common presenting rhythm was pulseless electrical activity (PEA; 57.2%). Survival to discharge or 30th day post-arrest was higher in EMS-witnessed arrests compared to bystander-witnessed and unwitnessed arrests (11.2% vs. 5.3% and 1.3%, p < 0.001). Survival to discharge for EMS-witnessed cases increased from 2011 (13.2%) to 2015 (18.9%). Conclusions: EMS-witnessed OHCAs were more likely to have favorable outcomes compared to bystander-witnessed and unwitnessed OHCAs. High PEA rates in EMS-witnessed arrests were associated with older patients with underlying preexisting medical conditions. Increasing public awareness on recognition of prodromal symptoms and early activation of EMS could improve post-arrest survival and neurological outcomes of OHCA.

Abstract P130: Disparities in Out-of-hospital Cardiac Arrest Rates Among Adults, Aged ≥18 Years Old, With 9-1-1 Emergency Medical Service Activation’s in the United States, 2016

Introduction: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Hypothesis: This study aims to assess whether patients’ age, sex, race/ethnicity, and urban/non-urban status are associated with the rate of OHCA events among adults who accessed 9-1-1 emergency medical services (EMS) in 2016. Methods: We conducted a cross-sectional analysis using the 2016 National Emergency Medical Services Information System (NEMSIS), a national EMS database. OHCA events among adults aged ≥18 years were extracted by sex, age group, race/ethnicity, urban and non-Urban categories. Those with unknown race/ethnicity (45.8%) or of other race (1.3%) were excluded. Rates of OHCA events were calculated and Chi-square tests were used to assess associations. Results: We identified 205,461 OHCA events with EMS activations among non-Hispanic (NH) whites (68.1%), NH blacks (23.2%), and Hispanics (8.7%) in the 2016 NEMSIS dataset. Of the OHCA events, 59.5% were among males, 81.1% among urban residents, and 15.4% among non-urban residents. The overall OHCA rate was 19.6 per 1,000 EMS activations. OHCA rates per 1,000 EMS activations increased with age for adults until age 74, ranging from 11.2 (18-34 years) to 25.1 (65-74 years), then decreased with age for older adults ≥75 ranging from 22.3 (75-84 years) to 20.8 (≥85 years) ( p &lt;.0001). OHCA rates were higher among males 25.3, Hispanics 20.9, and urban residents 21.7 than females 15.6, other race ethnicities (NH whites 19.8 and NH blacks 18.7), and non-urban residents 17.6 ( p &lt;.0001) respectively. Conlusions: OHCA incidence rates among EMS activations increased with age until age 74. Adult males, Hispanics, and urban patients had statistically significant higher EMS activations for OHCA rates. Findings can be incorporated in community planning for improving EMS services.

Abstract WP393: Usage of Emergency Medical Services Among Ischemic Stroke Patients: Data From China Stroke Center Alliance

Background and Purpose: Emergency medical services (EMSs) is critical for the early treatment of ischemic stroke patients, yet data regarding EMSs utilization and its association with timely treatment are still limited in China. Methods: We examined the data from Chinese Stroke Center Alliance (CSCA) recording consecutive ischemic stroke patients from 2015 June to 2017 November. The absolute standardized difference was used for covariates balance assessments. We used multivariable logistic models to identify factors associated with EMSs usage and to evaluate the effect of EMSs on timely treatment. Results: Of the 326,534 analyzed ischemic patients, only 42,293 (13.0%) were transported by EMSs. Multivariable-adjusted results indicated that younger age, less education, non-urban employ medial insurance, lower income level, less stroke severity, smoking, history of stroke/transient ischemic attack, carotid stenosis, hypertension, diabetes and peripheral vascular disease were associated with decreased risk of EMSs usage. However, coronary heart disease or myocardial infarction, atrial fibrillation and heart failure were associated with increased risk of EMSs usage. Compared to self-transportation, EMS-transported patients were associated with significantly shorter onset-to-door time (Median (IQR): 210 (105-586) vs. 1020 (290-2250) minutes, P&lt;0.0001), higher chance of arrival at hospitals within 2 hours (32.0% vs 9.4%, OR=3.77, 95% CI: 3.53-4.02) or within 3.5 hours (50.1% vs 19.0%, OR=3.60, 95% CI, 3.35-3.86) after symptom onset, and treated with IV tPA (13.8% vs 3.6%, OR=3.06, 95% CI:2.75-3.41). Conclusions: EMSs utilization is far from optimal among Chinse ischemic stroke patients. Nevertheless, use of EMSs transportation is associated with substantial reductions in prehospital delay and improved chance of timely treatment. Therefore, community education efforts are needed to improve EMSs activation.

Impact of prehospital mechanical ventilation: A retrospective matched cohort study of 911 calls in the United States.

Prehospital use of ventilators by emergency medical services (EMS) during 911 calls is increasing. This study described the impact of prehospital mechanical ventilation on prehospital time intervals and on mortality.This retrospective matched-cohort study used 4 consecutive public releases of the US National Emergency Medical Services Information System dataset (2011–2014). EMS activations with recorded ventilator use were randomly matched with activations without ventilator use (1 to 1) on age (range ± 2 years), gender, provider's primary impression, urbanicity, and level of service.A total of 5740 EMS activations were included (2870 patients per group). Patients in the ventilator group had a mean age of 69.1 (±17.3) years with 49.4% males, similar to the non-ventilator group. Activations were mostly in urban settings (83.8%) with an advanced life support level of care (94.5%). Respiratory distress (77.8%) and cardiac arrest (6.8%) were the most common provider's primary impressions. Continuous positive airway pressure was the most common mode of ventilation used (79.2%).Mortality was higher at hospital discharge (29.0% vs 21.1%, P = .01) but not at emergency department (ED) discharge (8.4% vs 7.4%, P = .19) with prehospital ventilator use. Both total on-scene time and total prehospital time intervals increased with reported ventilator use (4.10 minutes (95% confidence interval [CI]: 2.71–5.49) and 3.59 minutes (95% CI: 3.04–4.14), respectively).Ventilator use by EMS agencies in 911 calls in the US is associated with higher prehospital time intervals without observed impact on survival to ED discharge. More EMS outcome research is needed to provide evidence-based prehospital care guidelines and targeted resource utilization.

Emergency Medical Services Experience With Barb Removal After Taser Use By Law Enforcement: A Descriptive National Study.

Conducted electrical weapons (CEWs), including Thomas A. Swift Electric Rifles (TASERs), are increasingly used by law enforcement officers (LEOs) in the US and world-wide. Little is known about the experience of Emergency Medical Service (EMS) providers with these incidents. This study describes EMS encounters with documented TASER use and barb removal, characteristics of resulting injuries, and treatment provided. This retrospective study used five combined, consecutive National Emergency Medical Services Information System (NEMSIS; Salt Lake City, Utah USA) public-release datasets (2011-2015). All EMS activations with documented TASER barb removal were included. Descriptive analyses were carried out. The study included 648 EMS activations with documented TASER barb removal, yielding a prevalence rate of 4.55 per 1,000,000 EMS activations. Patients had a mean age of 35.9 years (SD=18.2). The majority were males (80.2%) and mainly white (71.3%). Included EMS activations were mostly in urban or suburban areas (78.3%). Over one-half received Advanced Life Support (ALS)-level of service (58.2%). The most common chief complaint reported by dispatch were burns (29.9%), followed by traumatic injury (16.1%). Patients had pain (45.6%) or wound (17.2%) as a primary symptom, with most having possible injury (77.8%). Reported causes of injury were mainly fire and flames (29.8%) or excessive heat (16.7%). The provider's primary impressions were traumatic injury (66.3%) and behavioral/psychiatric disorder (16.8%). Only one cardiac arrest (0.2%) was reported. Over one-half of activations resulted in patient transports (56.3%), mainly to a hospital (91.2%). These encounters required routine EMS care (procedures and medications). An increase in the prevalence of EMS activations with documented TASER barb removal over the study period was not significant (P=.27). At present, EMS activations with documented TASER barb removal are rare. Routine care by EMS is expected, and life-threatening emergencies are not common. All EMS providers should be familiar with local policies and procedures related to TASER use and barb removal.El SayedM, El TawilC, TamimH, MailhacA, MannNC. Emergency Medical Services experience with barb removal after TASER use by law enforcement: a descriptive national study. Prehosp Disaster Med. 2019;34(1):38-45.

Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation.

IntroductionMost medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR.MethodsThis was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual.ResultsStudents in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30–4.82]) for SIM and 3.89 cm (95% CI [3.50–4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699–0.751]) for SIM group and 0.679 (95% CI [0.655–0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7–40.8]) for SIM group and 79.5 s (95% CI [44.8–119.6]) for STD group, p=0.007.ConclusionHigh-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.

Gender Differences in the Quality of EMS Care Nationwide for Chest Pain and Out-of-Hospital Cardiac Arrest.

We sought to determine whether gender disparities exist in the prehospital management of chest pain (CP) or out-of-hospital cardiac arrest (OHCA) among patients who accessed the emergency medical services (EMS) system. We obtained 2010-2013 data from the National Emergency Medical Services Information System and identified all EMS activations for CP or OHCA by adults 40years of age or older. We selected American Heart Association medications and procedures to manage cardiovascular events. We stratified women and men by age (<65years vs. ≥65years), race (White vs. Black), clinical condition (CP vs. OHCA), same EMS agency, and calendar year. We determined the gender-specific treatment proportions for each stratum and calculated the weighted percentage difference in treatment between women and men. Approximately 2.4 million CP and 284,000 OHCA activations were analyzed. Women with CP received a lower percentage of recommended treatments than men. For every 100 EMS activations by women with CP, 2.8 fewer received aspirin (95% CI, -4.8 to -0.8). The greatest gap in CP care was that women were significantly less likely to be transported using lights and sirens than men (-4.6%; 95% CI, -8.7% to -0.5%). More than 90% of OHCA activations were resuscitated; however, women were significantly less likely to be resuscitated compared with men (-1.3%; 95% CI, -2.4% to -0.2%). Small to modest disparities between otherwise similar women and men in the EMS treatment of CP and OHCA suggest the need for further evaluation and research with detailed contextual and outcome data.

Abstract 140: Utilization of Mechanical CPR Is Highly Variable Within the National EMS Information System Dataset

Background: Randomized controlled trials have demonstrated neither survival benefit nor harm from use of mechanical CPR (mCPR). Retrospective analyses have shown an association between mCPR and worse survival outcomes, even when controlling for differences in patient mix and arrest duration. Nonetheless, studies have suggested mCPR use increased from 2013 to 2016. Objective: We sought to quantify the proportion of out-of-hospital cardiac arrest (OHCA) cases in the US with utilization of mCPR and use in conjunction with other procedures. Methods: Using Emergency Medical Services (EMS) call data from the National EMS Information System (NEMSIS) Dataset, we identified non-traumatic OHCA with EMS resuscitation. Procedure codes were classified as “Mechanical CPR”, “Advanced Airway”, “IO”, “IV”, “Defibrillation”, “Other” and “No Procedures”. The NEMSIS Dataset includes US Census Region, Division, and urbanicity for each call. Results: In 2016, there were 29,919,652 EMS activations reported, 151,333 met inclusion criteria and 138,555 included procedure codes. Of the OHCA cohort, the mean age was 63±20 yrs, 39% were female, 86% occurred prior to EMS arrival, 62% occurred in a home/residence, 18% in public, and 14% in healthcare facilities. mCPR was used in 10% of all cases. Reported regional utilization varied from 4.8% in the Northeast to 14.9% in the South (p&lt;0.001). mCPR did not vary significantly based on urbanicity (range: 10.4% to 11.4%, p=0.34). In multiple logistic regression controlling for age, gender, location of arrest, race and ethnicity, and region, mCPR utilization was more likely if an advanced airway was placed (OR: 1.74, CI: 1.58-1.91), and less likely if an IV or IO was placed (IV: OR 0.75, CI 0.71 - 0.79; IO: OR 0.37, CI 0.28 - 0.48). 4,928 cases contained information on survival to admission. Of these, overall survival to admission was 27%, with no significant difference between mCPR and no mCPR groups. Survival to discharge data was available for 2,476 subjects (1.8% of OHCA cohort). Survival to discharge was higher among the non-mCPR group (13.8% vs. 10.3%, p = 0.011). Conclusion: In NEMSIS, reported mCPR utilization is highly variable across the US. The overall proportion of cases receiving mCPR is lower than previous registry-based studies.