Emergency Medical Services Activation Research Articles

Medicaid Expansion and Emergency Medical Service Transports

The primary objective of this investigation was to determine if there was a change in emergency medical service (EMS) utilization following implementation of Medicaid expansion under the Affordable Care Act. The National Emergency Medical Service Information System (NEMSIS) data from 2010-2016 were evaluated in an interrupted time series analysis. Data were stratified by pediatric and adult EMS activations. No significant changes in level or trend were observed in adult EMS activations. A significant level change was observed in the pediatric EMS activations; however, the trend change reduced the impact of the level change over the study period. These results suggest that Medicaid expansion was not associated with a significant change in adult EMS use. Further investigation into pediatric EMS activations following Medicaid expansion is indicated, as these results suggest there may have been a temporary effect.

Impacts of Meteorological Factors on 119 Emergency Medical Services: Focused on Busan

This study aims to analyze the impacts of meteorological factors on 119 Emergency Medical Services (EMS). Busan in 2017 was set as the temporal and spatial subject. It identified the differences in the effects of each meteorological factor on the characteristics of the 119 EMS and investigated the degree of weakness in the provision of EMS due to weather abnormalities. The characteristics of EMS were defined by the number of dispatches, EMS time, distance to dispatch, and the ratio of dispatches outside the jurisdiction in the 119 EMS activity report of the Busan Fire Headquarter. Meteorological factors included temperature, wind speed, and precipitation data from the Korea Meteorological Administration's Automatic Weather System (AWS), and the meteorological abnormality was set as heavy rain that occurred in Busan on September 11, 2017. The results of the regression analysis on the relationship between weather and EMS reveal that the weather factors affect the characteristics of EMS, although it differs according to the first factor. In particular, an increase in temperature and rainfall tends to negatively affect the proper provision of EMS. Weather anomalies, such as the torrential downpour on September 11, 2017, acted as a factor that made the provision of emergency services more vulnerable.

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

BackgroundCoronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. Methods and resultsItaly was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases.The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001). ConclusionsReductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.

AN ANALYSIS OF BRAIN STROKE PREDICTION USING MACHINE LEARNING

A stroke, also known as a cerebrovascular accident or CVA, is when part of the brain loses its blood supply and the part of the body that the blood-deprived brain cells control stops working. This loss of blood supply can be ischemic because of lack of blood flow, or haemorrhagic because of bleeding into brain tissue. A stroke is a medical emergency because strokes can lead to death or permanent disability. There are opportunities to treat ischemic strokes, but that treatment needs to be started in the first few hours after the signs of a stroke begin. The patient, family, or bystanders should activate emergency medical services immediately should a stroke be suspected. A transient ischemic attack (TIA or mini stroke) describes an ischemic stroke that is short-lived where the symptoms resolve spontaneously. This situation also requires emergency assessment to try to minimize the risk of a future stroke. By definition, a stroke would be classified as TIA if all symptoms resolved within 24 hours. According to the World Health Organization (WHO) stroke is the 2nd leading cause of death globally, responsible to approximately 11% of total deaths. For survival prediction, our ML model uses dataset to predict whether a patient is likely to get stroke based on the input parameters like gender, age, various diseases, and smoking status. Unlike most of the datasets, our dataset focuses on attributes that would have a major risk factor of a Brain Stroke.&#x0D;

339 Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

AimsCoronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area.Methods and resultsItaly was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all P < 0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (P < 0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (P < 0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (P < 0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both P < 0.001).ConclusionReductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.

Delay in Emergency Medical Service Transportation Responsiveness during the COVID-19 Pandemic in a Minimally Affected Region.

Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March-May 2019 or March-May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient's first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

Abstract 137: Lack of Racial Diversity in Cardiopulmonary Resuscitation Training Films: A Cross-sectional Analysis

Introduction: Minorities are less likely to be CPR-trained, and less likely to receive bystander CPR compared to whites. Hypothesis: We hypothesized that modern CPR training films demonstrate poor racial diversity and therefore poor relevance to minority communities. Methods: Using the query “how to do CPR” in Google and YouTube, 350 and 500 films were reviewed. Exclusion criteria included: pre-2015, non-English, non-instructional, pediatric or animal victims, duplicates, parity, or in-hospital cardiac arrest. For each film, 4 racially-diverse evaluators identified the race of the instructor, rescuer, victim, and manikin as “white” or “non-white.” Films were scored on 6 aspects of CPR instruction: scene safety, check responsiveness, activate Emergency Medical Services, proper hand position, accurate rate, and appropriate depth of compressions. Similarly, the race of characters in CPR training films from the American Heart Association (AHA) and American Red Cross (ARC) were analyzed by one self-identified non-white evaluator. Results: Of 72 online films meeting the criteria, 50 used a human instructor (76% white); 19 showed a human victim (84% white); 70 depicted a human rescuer (74% white); and 58 featured a manikin (95% white) (p&lt;0.0001 for all, white v. non-white). Only 10 of 72 films (14%) taught hands-only CPR, featured AT LEAST ONE non-white character, and were of high-quality ( &gt; 5 aspects of CPR instruction). Inter-rater reliability was high (&gt;0.775). We also reviewed 7 ARC and 7 AHA adult CPR training films (2015 or later). Four of 7 AHA films (57%) and 2 of 7 ARC films (29%) featured at least one non-white character (Figure 1). Conclusion: We identified only 10 online high-quality films teaching hands-only CPR which feature at least one non-white character. CPR instructional films from the AHA and ARC showed greater racial diversity. Improved racial representation in CPR training films is important to increase relevance to under-trained minority communities.

Paramedic Identification of Pediatric Seizures: A Prospective Cohort Study

Objective Pediatric seizures commonly trigger emergency medical services (EMS) activation and account for approximately 5–15% of all pediatric 911-EMS calls. More than 50% of children with active seizure activity do not receive prehospital antiepileptic drugs, potentially because they are not recognized by EMS. The purpose of this study is to evaluate specificity and sensitivity of paramedic identification of pediatric seizures and to describe the characteristics of unrecognized seizures. Methods This is an 18-month prospective cohort study at a single, pediatric emergency department (ED). EMS patients ≤15 years old with a prehospital provider impression of seizure were included. Upon ED arrival, a data collection form, which included the EMS verbal report and patient’s clinical status, was completed by the attending emergency physician. The primary outcome was sensitivity and specificity of paramedic identification of active seizure. Secondary outcomes included characteristics of missed seizures, ED interventions, and disposition. Descriptive statistics, sensitivity, and specificity were computed. Patient characteristics and clinical outcomes were compared. Results Surveys were completed for 349 patients (Median 3, IQR = 3.4). Fifty-two of the patients (15%) were actively seizing upon arrival at the ED. Sensitivity was 54% and specificity was 96% for paramedic identification of active seizure. Common features of missed cases were abnormal vital signs (75%), gaze deviation (50%) and clenched jaw (33%). Of these, 37% required intubation and 53% were admitted to the intensive care unit. Conclusion Paramedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation.

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

BackgroundThe poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. MethodsThis study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. ResultsOut of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31–6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26–4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23–4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25–4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04–3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18–0.55). ConclusionsDelay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.

Language preference does not influence stroke patients' symptom recognition or emergency care time metrics

Our objective was to determine whether acute ischemic stroke (AIS) patients' language preference is associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. We identified consecutive AIS patients presenting to a single urban, tertiary, academic center between 01/2003-05/2014 for whom language preference was available. Data were abstracted from the institution's Research Patient Data Registry and Get with the Guidelines-Stroke Registry. Bivariate and regression models evaluated the relationship between language preference and: 1) time from symptom onset to hospital arrival, 2) use of EMS, 3) DTI, and 4) DTN time. Of 3190 AIS patients, 300 (9.4%) were non-English preferring (NEP). Comparing NEP to English preferring (EP) patients in unadjusted or adjusted analyses, time from symptom discovery to arrival and rate of EMS utilization were not significantly different (overall median time 157min, IQR 55-420; EMS utilization: 65% vs. 61.3% p=0.21). There was also no significant differences in DTI or in likelihood of guideline-recommended DTI≤25min (overall median 59min, IQR 29-127; DTI≤25min 24.3% vs. 21.3% p=0.29) or DTN time or in likelihood of guideline-recommended DTN≤60min (overall median 53min, IQR 36-73; DTN≤60min 62.5% vs. 58.2% p=0.60). Consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics. Reassuringly, NEP and EP patients also had similar speed of symptom recognition and EMS utilization.

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

BackgroundOrganizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district.MethodsAll primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable.ResultsWe included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001).ConclusionAfter relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

Mapping Spatiotemporal Diffusion of COVID-19 in Lombardy (Italy) on the Base of Emergency Medical Services Activities

The epidemic of coronavirus-disease-2019 (COVID-19) started in Italy with the first official diagnosis on 21 February 2020; However, it is not known how many cases were already present in earlier days and weeks, thus limiting the possibilities of conducting any retrospective analysis. We hypothesized that an unbiased representation of COVID-19 diffusion in these early phases could be inferred by the georeferenced calls to the emergency number relevant to respiratory problems and by the following emergency medical services (EMS) interventions. Accordingly, the aim of this study was to identify the beginning of anomalous trends (change in the data morphology) in emergency calls and EMS ambulances dispatches and reconstruct COVID-19 spatiotemporal evolution on the territory of Lombardy region. Accordingly, a signal processing method, previously used to find morphological features on the electrocardiographic signal, was applied on a time series representative of territorial clusters of about 100,000 citizens. Both emergency calls and age- and gender-weighted ambulance dispatches resulted strongly correlated to COVID-19 casualties on a provincial level, and the identified local starting days anticipated the official diagnoses and casualties, thus demonstrating how these parameters could be effectively used as early indicators for the spatiotemporal evolution of the epidemic on a certain territory.

2020 American Heart Association and American Red Cross Focused Update for First Aid.

2020 American Heart Association and American Red Cross Focused Update for First Aid.

Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction

The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011-January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17-176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10-11.83; and 8.02; 3.65-17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient's decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.

Geospatial analysis of emergency services use for public health assessment and intervention

Abstract The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants. We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses. We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p &amp;lt; 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p &amp;lt; 0.001). There was no correlation between the density of primary care providers and EMS activity by population. EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care. Key messages The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.

Knowledge of stroke and attitude to activate emergency medical services: a cross-sectional study

Abstract Introduction Acute brain stroke is one of the leading causes of death in the world. Translating knowledge of stroke warning signs into appropriate actions is critical to decrease prehospital delay, meaning that the population has a key role in reducing the hospitalization time of affected people. Objectives The aim is to understand in which percentage adults (318, without healthcare formation) would react properly by calling emergency medical services (EMS) when presented with hypothetical stroke-related scenarios and how the knowledge of warning signs is related to different factors. Methods a population-based online survey was carried out in a random sample of Italian adults in June-July 2019. The STAT (Stroke Action Test) questionnaire included 21 close-ended questions focused on stroke symptoms. The prevalence and distribution of stroke knowledge was examined. Results 445 subjects were enrolled; the mean age was 36 years. The average score was 10,9/21, and only 21% had an optimal performance. Higher scores are associated with female gender and older age (p &amp;lt; 0,01). When a situation described a single stroke sign, only the 15% recognized the importance to call EMS. The sign/symptom mainly recognized (57%) was “trouble speaking”. Conclusions this study provides data describing stroke knowledge among Italian adults; despite its limitations, the study shows that people hesitate to call EMS when stroke signs and symptoms are presented. The knowledge of stroke signs/symptoms remains lower than the heart attack ones. As expected, it would be 'useful to give proper information and training on stroke signs/symptoms' but also it is fundamental to emphasize that stroke is a medical emergency and needs a fast hospital admission. Key messages There is a lack of knowledge in stroke emergency shall raise community awareness about the need of education campaigns. It is important to improve stroke's signs and symptoms in order to have better prognosis.

Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on the U.S. Emergency Medical Services System: A Preliminary Report.

BackgroundOur objective was to quantify trends in emergency medical services (EMS) incidents as the effects of the COVID‐19 pandemic spread across the United States and to determine if there was an increase in EMS‐attended deaths.MethodsWe conducted a 3‐year comparative retrospective cohort analysis of data from the National EMS Information System. Data were included if care was provided between the 40th and 21st weeks of the next year and compared over 3 years. We included incidents identified through 9‐1‐1 where patient contact was made. The total number of EMS incidents per week was used as the denominator to calculate the rate of patient deaths and possible injury. We assessed for temporal and seasonal trends.ResultsStarting in the 10th week of 2020 there was a decrease in the number of EMS activations in the United States compared to the prior weeks and the same time period in previous years. The number of activations between week 10 and week 16 decreased by 140,292 or 26.1%. The portion of EMS activations reporting a patient disposition of death nearly doubled between the 11th and 15th weeks of 2020 (1.49%–2.77% of all activations). The number of EMS activations documenting a possible injury decreased from 18.43% to 15.27% between weeks 10 and 13.ConclusionWe found that early in the COVID‐19 outbreak there was a significant decrease in the number of EMS responses across the United States. Simultaneously the rate of EMS‐attended death doubled, while the rate of injuries decreased.

Characteristics of paediatric out-of-hospital cardiac arrest in the United States

BackgroundThe absence of nationwide surveillance data on out-of-hospital cardiac arrest (OHCA) in the United States (US) limits understanding of the epidemiology of paediatric OHCA. We investigated the national characteristics of paediatric OHCA using the National Emergency Medical Services Information System (NEMSIS). MethodsWe conducted a cross-sectional study using the 2016 NEMSIS dataset, a national registry of emergency medical services (EMS) activations at 46 states in the US. We included paediatric patients (age <18 years) with “9-1-1” EMS responses to OHCA. We defined OHCA as (a) presence of cardiac arrest; (b) EMS reported initiation of cardiac arrest resuscitation; (c) performance of chest compressions; or (d) performance of defibrillation. We reported the incidence and characteristics of paediatric OHCA, stratified by age group: <1 year: infants, 1–5 years: young children, 6–12 years: older children, and 13–17 years: adolescents. ResultsAmong 1,531,469 paediatric EMS responses, we identified a total of 23,514 EMS responses to paediatric OHCA (95% confidence interval [CI], 23,217–23,814), incidence of 15.4 per 1000 paediatric EMS responses (95% CI, 15.2–15.5), and estimated national incidence of 37.9 per 100,000 child-years (95% CI, 37.4–38.4). Among 23,514 EMS responses to paediatric OHCA, we observed 4515 (19.2%) of EMS responses in infants, 5588 (23.8%) in young children, 4976 (21.2%) in older children, and 8435 (35.9%) in adolescents. ConclusionUsing data from the NEMSIS, we estimate that there are over 23,000 annual paediatric OHCA in the US. These data provide key insights of paediatric OHCA in the US.

Abstract TP247: A Comparison of Time to Treatment Between an Emergency Department-Focused Stroke Protocol and Mobile Stroke Units

Background: San Francisco is a relatively compact city with a population of 884,000 and nine stroke centers within a 47 square mile area. Emergency medical services (EMS) transport distances and times are short and there are currently no mobile stroke units (MSUs). Methods: We evaluated EMS activation to CT (EMS-CT) and EMS activation to thrombolysis (EMS-TPA) times for acute stroke in the first two years after implementation of an emergency department (ED)-focused, direct EMS-to-CT protocol entitled “Mission Protocol” (MP) at a safety net hospital in San Francisco and compared our performance to published reports from MSUs. EMS times were abstracted from ambulance records. Geometric means were calculated for MP data and pooled means were similarly calculated from published MSU data. Results: From July 2017 through June 2019, a total of 423 patients with suspected stroke were evaluated under the MP, and 166 of these patients were ultimately diagnosed with ischemic stroke. EMS and treatment time data were available for 129 of these patients with 60 patients (47%) receiving IV-tPA with mean EMS-CT and EMS-TPA times of 41 minutes (95% CI 39-43) and 64 minutes (95% CI 58-70), respectively. The pooled estimates for MSUs suggested a mean EMS-CT time of 35 minutes (95% CI 27-45) and a mean EMS-TPA time of 48 minutes (95% CI 39-60). MSUs achieved faster EMS-CT and EMS-TPA times (p&lt;0.0001 for both). Conclusions: In moderate-sized, urban settings with high population densities, our protocol was able to achieve EMS activation to treatment times that were comparable but ultimately slightly slower than published performance data from MSUs.

Out-of-Hospital Seizures in Children: A Population-Based Study.

Seizures seem to represent a frequent cause for pediatric emergency medical (EM) and emergency room (ER) contacts, but few population-based data are available. Our aim was to study the incidence, prehospital and ER treatment, and outcomes of pediatric seizures necessitating out-of-hospital care. We studied the out-of-hospital evaluation procedures, ER treatment, diagnostics and 2-year prognosis of all cases of pediatric (0-16 years) seizures encountered by the emergency medical services (EMS) in Helsinki, Finland, in 2012 (population 603,968, pediatric population 92,742); 251 patients were encountered by the EMS, of which 220 seen at the ER. The yearly incidence of pediatric seizures necessitating EMS activation was 2.8/1000 in the pediatric population. Febrile seizures were responsible for 97 (44.1%) of the cases transported to the ER. Only a minority of patients required advanced life support measures out-of-hospital or complex diagnostics in the ER. Still, of the 220 patients seen at ER, 68 (30.9%) were hospitalized, and 106 (48.2%) had follow-up contacts scheduled. Pediatric seizures were a common cause for EM and ER contacts. Advanced life support measures were seldom needed, and the prognosis was good, but seizures still required considerable resources. They often resulted in urgent EM dispatch and transport, hospitalization, follow-up visits, new medication, and complementary studies. This emphasizes the role the EMS plays in recognizing and terminating pediatric seizures and in referring these children to appropriate care.