Emergency Medical Services System Research Articles

Development and Feasibility of the Emergency Medical Services Hub for Northern Thai Older Adults: An Action Research Study

Most older adults have unique needs and are suffering from chronic diseases. It is important to have quick and easy access to emergency medical services. Three-phase action research aimed to develop and assess the feasibility of implementing the Emergency Medical Service Hub for Older Adults Model in Upper Northern Thailand was conducted. In phase I and phase II, 27 emergency healthcare providers and 10 older adults were purposively recruited, and in phase III 16 emergency healthcare providers evaluated the feasibility of the model. The framework guided the study was based on action research methodologyand six emergency medical services system functions. Data were collected via in-depth interviews, observation, and self-report of the implementation feasibility questionnaire. All research instruments were validated by three experts, yielded a content validity index of 0.80-1, and the reliability test of the implementation feasibility questionnaire revealed a Cronbach’s alpha coefficient of 0.81. Data were analyzed using descriptive statistics and content analysis.The final model consisted of six components: effective communication, registry and database, geographic information system, effective emergency medical service team, one-stop service emergency department for older adults, and continuum of care. Overall, the possibility of the model implementation was rated as high. The benefit and safety aspect of implementing the model was at the highest level, followed by its applicability. The use of the model is likely to benefit older adults. Effective implementation requires proper resource support and future study to examine the effectiveness of the model in a full-scale clinical trial is recommended.

The Effect of Sustained Poor Air Quality on EMS Call Volume and Characteristics: A Time-Stratified Case-Crossover Study.

As wildfires and air pollution become more common across the United States, it is increasingly important to understand the burden they place on public health. Previous studies have noted relationships between air quality and use of Emergency Medical Services (EMS), but until now, these studies have focused on day-to-day air quality. The goal of this study is to investigate the effect of sustained periods of poor air quality on EMS call characteristics and volume. Using a time-stratified case-crossover design, the effect of exposure to periods of poor air quality on number and type of EMS calls in California, USA from 2014-2019 was observed. Poor air quality periods greater than three days were identified at the United States Environmental Protection Agency's (EPA's) Air Quality Index (AQI) levels of Unhealthy for Sensitive Groups (AQI 100) and Unhealthy (AQI 150). Periods less than three days apart were combined. Each poor air quality period was matched with two one-week controls, the first being the closest preceding week that did not intersect a different case. The second control was the closest week at least three days after the case and not intersecting with a different case. Due to seasonal variation in EMS usage, from the initial cases, cases were used only if it was possible to identify controls within 28 days of the case. A conditional Poisson regression calculated risk ratios for EMS call volume. Comparing the case periods to the controls, significant increases were found at AQI >100 for total number of calls, and the primary impressions categories of emotional state or behavior, level of consciousness, no patient complaint, other, respiratory, and abdominal. At an AQI >150, significance was found for the primary impressions categories of other, pain, respiratory, and digestive. These data demonstrate increased EMS calls during sustained poor air quality, and that several EMS primary impression categories are disproportionately affected. This study is limited by the imprecision of the primary impression's classification provided by the EMS clinician responding to the EMS call. More research is needed to understand the effects of periods of poor air quality on the EMS system for more efficient deployment of resources.

Ambulance Service in Kathmandu, Nepal: Service Delivery Constraints, Challenges, and Achievements during the COVID-19 Pandemic.

An Emergency Medical Service (EMS) is defined as a complete system that responds to public medical and surgical emergencies with prompt and adequate emergency care. Ambulance services are also classified as EMS in modern medical history. In the Nepalese context, prehospital care is very limited, and the EMS system is still a new concept in Nepal. In a study in the emergency room at Patan Hospital in Kathmandu, only 9.9% of patients came by ambulance, 53.6% by taxi, 11.4% by private car, 13.5% by bus, 5.4% by bicycle, and another 6.2% came with alternative routes. This study aims to investigate the constraints, challenges, and achievements made by ambulances services during the coronavirus disease 2019 (COVID-19) pandemic. The study design was phenomenological and the method was qualitative. In-depth interviews (IDIs) were conducted with six human resources working from the COVID-19 first wave pandemic in the ambulance service of Nepal Ambulance Service (NAS), Kathmandu. Four themes were generated from IDIs: (1) challenges in service delivery; (2) constraints on service delivery; (3) working experiences; and (4) achievements of ambulatory service providers during the COVID-19 pandemic. Under these four themes, 12 sub-themes were constructed. The new nature of disease (COVID-19) in the first wave led to fear and anxiety, which also forced them to think about quitting the job; however, later on with proper training and safety measures, it led to working for COVID-19 patient transfers from home to hospital, as well as hospital to hospital, and proper prehospital care services were provided. The major challenges faced by ambulatory service providers were long working hours, wearing a single personal protective equipment (PPE) for long hours, confusing locations to pick up patients, and both stigma and discrimination. From IDIs, it was concluded that although constraints and challenges arise during a pandemic, from proper guidance and support through NAS, they are able to provide proper prehospital care for the patient. Challenges like fear, heavy workload, PPE, and other material barriers do not hamper in service delivery.

Adopting a ‘System of Caring' as a leadership strategy toward professionalisation within South African emergency medical services: A grounded theory

Professionalization is a key agenda within South African prehospital care. Emergency Medical Services (EMS) agencies continue to grapple with operationalising the process of professionalising, with a number approaches described in literature. This research presents a System of Caring developed within the context of EMS as an approach to achieving professionalization. Methods: A qualitative research design in the form of constructivist grounded theory design was used. Participants were enrolled using purposive and theoretical sampling. Data were analysed using coding procedures in a constant comparative analysis approach supported by theoretical sensitivity. Analytical diagrams consistent with grounded theory methodology were also employed, primarily in the form of inter-relational diagraphs. Results: Six main categories were established with associated coding lists. Coding lists were used to develop groups of propositions that were then abstracted to construct final analytical labels that captured the elements of the System of Caring. These elements include caring for the leaders, caring for the team, caring for the patient, caring for each other (collegial) and caring for self. The components of each element were also abstracted, and the System of Caring developed. Conclusion: While there are various well-established definitions for the term care, within the context of the perceptions of the participants of this study, care (and caring) means a combination of constructed environmental conditions and people-process practices that recognises the well-being of the people within the processes. This 'System of Caring' offers a practicable way to operationalise caring into the workforce and move toward exploring how to promote professionalism within the workforce, through a 'System of Caring'. While this may have been reasonably extrapolated before, this research allows for a poignant insight into how EMS agencies can promote professionalization within EMS systems within South Africa, through the 'System of Caring'.

Paramedic Clinical Consults with a Paramedic or Nurse in an EMS Communications Center Compared to Traditional Online Physician Consults

Objectives In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD “peer to peer” consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures. Methods This retrospective cohort study analyzed 2 months before (September 1 to October 31, 2012) and 2 months after (September 1 to October 31, 2013) implementation of the CSD. In the before period, all clinical consults were fielded by the direct medical oversight physician. In the after period, consults were fielded by the physician, CSD or both. EMS databases were queried, and manual chart review and abstraction of audio recordings were done. Relapses back to EMS within 48 hours of non-transport were measured. Results 1621 consults were included, with 764 consults in the before period and 857 after (p = 0.02). The number of physician consults decreased from 764 before to 464 after (39.2%, p < 0.001), with the CSD taking 325 (37.9%) consults. The CSD was consulted more for police custody and trip destination. The physician was consulted more for cease resuscitation and clinical consults prior to medication administration. Overall non-transport rates were 595/764 before (77.9%), and 646/857 after (75.4%) (p = 0.2). Non-transports were 233/325 (71.7%) via the CSD, 364/464 (78.4%) via the physician, and 49/68 (72.1%) when both were involved (p = 0.07). Rate of relapse to EMS was similar before (25/524, 4.8%) and after (26/568, 4.6%) (p = 0.76), and between CSD (12/216, 5.5%) and physician consults (13/325, 4.0%) in the after period (p = 0.41). Conclusion The introduction of a novel “peer-to-peer” consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied.

Overview of Basic Criteria and Models Applicable to Emergency Medical Service System Optimization

Overview of Basic Criteria and Models Applicable to Emergency Medical Service System Optimization

Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care.

Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.

Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China.

Acute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care. This study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China. This retrospective analysis was based on an integrated database of China's MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score-matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes. A total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen κ=0.918, P<.001) was higher than that of the before MPDS group (Cohen κ=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: -1.67, 95% CI -2.33 to -1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: -3.81, 95% CI -4.63 to -2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes. The optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis.

Private Health Information Legal Protections in Emergency Medical Services

Recent communications between counsel for an Emergency Medical Service (EMS) provider in New Jersey and the state Department of Health (DOH), Office of Emergency Medical Services (OEMS) claimed that the DOH was providing illicit access to private health information (PHI) based within the providers electronic patient care report (ePCR). While the response from the DOH indicated that the information sharing was completed in accordance with all state and federal laws, the concerns raised by the law firm are not novel concerns. EMS systems are often trusted by their patients to protect their PHI that is obtained as a necessity in the course of their lifesaving operations. The collection and use of data from EMS systems nationwide is crucial to the improvement of operations, provider safety, and patient care, however there is the competing interest of protecting the privacy of patients and respecting their Constitutionally protected rights. There are important legal and policy perspectives that should guide the prospect of personally identifiable EMS data sharing to law enforcement.

Abstract 232: The Association Between Amplitude Spectrum Area And An Automated External Defibrillator Algorithm’s Detection Of Ventricular Fibrillation During Cardiopulmonary Resuscitation

Introduction: Prior studies have reported the performance of a Philips analysis-through-CPR (ATC) shock determination algorithm during chest compressions (CCs). Amplitude spectrum area (AMSA), calculated for ventricular fibrillation (VF) rhythms, has also been reported as a predictor of defibrillation success. This study evaluated how AMSA scores for VF rhythms are associated with the performance of the shock determination ATC algorithm. Methods: A total of 838 VF rhythms were extracted from 304 adult patients recorded by Philips FR3 AEDs and Philips MRx defibrillators from multiple Emergency Medical Service (EMS) systems. Each extracted VF rhythm contained at least 11 seconds (s) of data recorded during CCs, followed by at least 2 s of CPR-free ECG data used to retrospectively calculate an AMSA score for the rhythm before the onset of a shock. VF rhythms were split into three groups according to their AMSA score: Low (&lt;6 mV*Hz), Medium (6-15 mV*Hz), High (&gt;15 mV*Hz). We evaluated the sensitivity of the ATC algorithm during CCs for each AMSA range. Results: During the 11s period with active CCs, 77.8% (Table 1) of all VF rhythms were identified by the ATC algorithm. The remaining unidentified VF rhythms (22.2%) would require a pause in CPR for a hands-off analysis. The median AMSA score for identified VF rhythms was significantly greater than the unidentified VF rhythms (7.8 vs. 6.1 [mV*Hz], p &lt; .001). The sensitivities during CCs for VF rhythms in the Low, Medium, and High AMSA score ranges were 66.4%, 82.6%, and 88.1%, respectively. Conclusions: The present study has shown the association between Philips ATC algorithm’s sensitivity of identifying VF during CCs and the corresponding AMSA score. Such results suggest that when the ATC algorithm identifies a shockable rhythm during CCs, this rhythm’s AMSA score is likely to be high resulting in a higher likelihood of shock success.

Abstract 330: Effect Of Covid-19 Mitigation On Resource Utilization And Rates Of Acute Myocardial Infarction In Areas Of Higher And Lower Socioeconomic Vulnerability

Background: Multiple reports demonstrate decreased emergency department (ED) utilization for cardiovascular emergencies during COVID-19. It is possible this decrease had downstream effects on the later severity of cardiovascular disease, especially in patients with higher social vulnerability. The purpose of this study was to determine the effect of early COVID-19 mitigation strategies on hospital resource utilization and acute myocardial infarction (AMI) admissions by social vulnerability. Methods: We retrospectively analyzed patients transported by emergency medical services (EMS) with a diagnosis of chest pain and/or AMI from a large urban Midwest EMS and single hospital system from Jan 1-Dec 31, 2020. Hospital office, telehealth, ED visits for chest pain, and hospital admissions for AMI were identified using the electronic health record. The 3 phases of COVID-19 mitigation were compared (pre-mitigation-Jan 1 st to Feb 28 th , mitigation-March 1 st to April 30 th , and post-mitigation-May 1 st -December 31 st ). The socioeconomic status theme of the Social Vulnerability Index (SVI) was determined. The primary outcome was rate of AMI per ED chest pain visit, which was compared between the highest and lowest SVI quartiles. Statistical comparisons were made using binary logistic regression and Chi-squared tests. Results: Overall, there was a similar increase in telehealth visits and a decrease in office visits during mitigation in both highest and lowest SVI quartiles. In the post-mitigation phase, patients with the highest social vulnerability had a 30% relative increase rate of AMI per ED chest pain visit (7.3% vs 5.5%, p=0.048) compared to patients with lower social vulnerability. This increase was not seen in the pre-mitigation (5.8% vs 6.1%) or mitigation (4.9% vs 5.4%, each p=ns) phases. Conclusions: After initial COVID-19 mitigation strategies were implemented patients with higher socioeconomic vulnerability presented to the ED with AMI at a higher rate than patients with a lower socioeconomic vulnerability, despite no differences in office, telehealth, or EMS transport. Understanding the complex effect of pandemic mitigation strategies on vulnerable populations can provide guidance for resource management in future crises.

Emergency medical service location problem based on physical bounds using chance-constrained programming approach

This paper studies a location and sizing problem for an emergency medical service system using distributionally robust chance-constrained programming approach. The medical demands are uncertain and described in an ambiguity set, which is constructed based on Wasserstein-metric. The location problem is modelled through minimising the total expected costs, including construction costs of facilities, purchase of ambulances and maintenance costs. The chance constraints are introduced to guarantee the service level of geographical areas. For the chance constraints, three reformulations such as CVaR-approximation, the mixed integer linear programme exact reformulation and the physically bounded bilinear reformulation are studied. A numerical study is conducted to illustrate the computational performance and objective values.

Abstract 258: Age, Sex And Survival Of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: The Influence Of Electrocardiogram Waveform Measures

Background: Studies of sex-based outcome in out-of-hospital cardiac arrest (OHCA) have produced mixed results that may depend on age. Menopause produces a range of effects that may influence resuscitation. We used quantitative measures of the presenting OHCA ventricular fibrillation (VF) waveform - a surrogate of the myocardium’s acute physiology - to assess whether outcome differences according to sex and age group may be mediated via a biologic mechanism. Methods: We conducted a retrospective cohort study of adults with non-traumatic VF-OHCA in a metropolitan Emergency Medical Services system between 2008-2020. We used multivariable logistic regression to assess the association of outcome (survival to hospital discharge, favorable neurological outcome (Cerebral Performance Category (CPC) 1 or 2), with sex and age group (&lt;55, &gt; 55 yrs). We then determined the proportion of the outcome difference mediated by the waveform measure by incorporating previously described quantitative VF waveform measures - an estimated probability of survival (P Survival ) and amplitude spectrum area (AMSA - into the model individually. Results: Of 1526 VF-OHCA patients, average age was 62 years, and 29% were female. Overall, younger women were more likely to survive than younger men (survival 67% vs 54%, p=0.02 with CPC 1-2 61% vs 51%, p=0.07), while older women and older men had similar worse outcomes. After adjusting for Utstein characteristics, women &lt;55 compared to men &lt;55 was associated with greater odds of survival to hospital discharge (OR 1.93, 95% CI 1.23-3.09, p=0.005) and CPC 1-2 survival (OR 1.72, 95% CI 1.10-2.71, p=0.02), whereas no associated sex-based differences in these outcomes were observed between the older groups. Each waveform measure mediated some of the beneficial association between sex and age group with survival: 47% for P Survival and 25% AMSA. Conclusions: Women &lt;55 years were more likely to survive to hospital discharge and with favorable neurological status compared to men &lt;55 years, a sex-associated outcome difference not observed in the older age group. The biologic mechanism represented by VF waveform measures mediated some (47% at most), though not all, of the outcome differences.

Prehospital medicine learning experience for pharmacy residents

AbstractPharmacist collaboration with medical directors and practitioners operating in the emergency medical services (EMS) system can improve overall care, optimize the medication formulary, and decrease medication‐related risk. However, to achieve this, pharmacists must have a fundamental understanding of the prehospital medicine environment. We describe a comprehensive prehospital medicine postgraduate training experience for postgraduate year two (PGY2) emergency medicine (EM) pharmacy residents. A detailed description of the prehospital medicine learning experience (LE) is provided that includes an immersive schedule with diverse EMS exposure, attendance at dedicated EMS‐specific medical resident conferences, didactic and self‐learning requirements, and a scholarly EMS project. Information regarding how this LE is organized and evaluated, as well as challenges and future directions are provided. Program success is highlighted with the reporting of 20 scholarly projects completed by PGY2 EM pharmacy residents from 2006 through 2022 in collaboration with EMS and the Division of Prehospital Medicine. A collaborative and immersive prehospital medicine LE for PGY2 EM pharmacy residents can be mutually beneficial for the training of the pharmacy resident, scholarly productivity supporting regional and statewide change, and EMS personnel.

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia.

Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers. This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients. Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score -3.26; P value <.01) or as an EMS physician (z-score -2.76; P value <.01) as well as being at least 30 years old (z-score -2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%). Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Background/Introduction:Emergency Medical Services (EMS) is a critical part of Disaster Medicine (DM) and can limit morbidity and mortality with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training available to EMS physicians. The Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War arose during the SARS-CoV-2 (COVID-19) pandemic.Objectives:This study assessed the state of disaster preparedness of the Armenian EMS system and effects of the simultaneous pandemic and war on EMS providers.Method/Description:This was a cross-sectional study by anonymous survey of Yerevan EMS physicians who provided care to war casualties and COVID-19 patients.Results/Outcomes:Most participants had been a physician for ≤three years (52.1%). Many were in residency (64.6%).Battlefield medicine experience was limited prior to the war. The majority reported no experience treating mass casualties (52.1%), explosives wounds (52.1%), or performing surgical procedures (52.1%). Greater battlefield medicine experience was found with ≥three years of experience as a physician (z-score -3.26; P value &lt;.01) or EMS physician (z-score -2.76; P value &lt;.01), and being ≥30 years old (z-score -2.11; P value = .03). Most participants felt in danger during the war at least sometimes (89.6%).Conclusion:EMS physicians in Armenia had limited training and experience in DM prior to the 2020 Nagorno-Karabakh War, but practiced in a setting requiring extensive DM knowledge as evidenced by the simultaneous response to the COVID-19 pandemic and war. There is a strong need for DM training within the Armenian EMS system.

Prehospital Pediatric Asthma Care during COVID-19: Changes to EMS Treatment Protocols and Downstream Clinical Effects

Introduction During the COVID-19 pandemic, many emergency medical services (EMS) agencies modified treatment guidelines for clinical care and standard operating procedures. For the prehospital care of pediatric asthma exacerbations, modifications included changes to bronchodilator administration, systemic corticosteroid administration, and introduction of alternative medications. Since timely administration of bronchodilators and systemic corticosteroids has been shown to improve pediatric asthma clinical outcomes, we investigated the association of COVID-19 protocol modifications in the prehospital management of pediatric asthma on hospital admission rates and emergency department (ED) length-of-stay. Methods This is a multicenter, retrospective, observational cohort study comparing prehospital pediatric asthma patients treated by EMS clinicians from four EMS systems before and after implementation of COVID-19 interim EMS protocol modifications. We included children ages 2–18 years who were treated and transported by ground EMS for respiratory-related prehospital primary complaints, and who also had asthma-related ED discharge diagnoses. Patient data and outcomes were compared from 12 months prior to and 12 months after the implementation of interim COVID-19 prehospital protocol modifications using univariate and multivariable statistics. Results A total of 430 patients met inclusion criteria with a median age of 8 years. There was a slight male predominance (57.9%) and the majority of patients were African American (78.4%). There were twice as many patients treated prior to the COVID-19 protocol modifications (N = 287) compared to after (N = 143). There was a significant decrease in EMS bronchodilator administration from 76% to 59.4% of patients after COVID-19 protocol guidelines were implemented (p < 0.0001). Mixed effects models for hospital admission (to both pediatric inpatient units and pediatric intensive care units) as well as ED length-of-stay did not show any significant effect after the COVID-19 protocol change period (p = 0.18 and p = 0.55, respectively). Conclusions Despite a decrease in prehospital bronchodilator administration after COVID-19 changes to prehospital pediatric asthma management protocols, hospital admission rates and ED length-of-stay did not significantly increase. However, this finding is tempered by the marked decrease in study patients treated after COVID-19 prehospital protocol modifications. Given the potential for future waves of COVID-19 variants, further studies with larger patient populations are warranted.

Patient Demographics are Associated with Differences in Prehospital Pain Management Among Trauma Patients

Objective: Disparities have been observed in the treatment of pain in emergency department patients. However, few studies have evaluated such disparities in emergency medical services (EMS). We describe pain medication administration for trauma indications in an urban EMS system and how it varies with patient demographics. Methods: We performed a retrospective review of the electronic medical records of adult patients transported for isolated trauma (without accompanying medical complaint) from 1/1/18 to 6/30/2020 by a third service EMS agency in a major United States metropolitan area. We performed descriptive statistics on epidemiology, type of pain medications administered, and pain scores. Kruskall-Wallis and chi-square or Fisher’s exact tests were used to compare continuous and categorical variables, respectively. We constructed a logistic regression model to estimate the odds of nontreatment of pain by age, race, sex, transport interval, pain score, and Glasgow Coma Scale (GCS) score for patients with pain scores of at least four on a one to ten scale, the threshold for pain treatment per the EMS protocol. Results: Of 32,463 EMS patients with traumatic injuries included in the analysis, 40% (12,881/32,463) were African American, 50% (16,284/32,463) were female, the median age was 27 years (IQR 45-64), and the median initial pain score was 5 (IQR 2-8). Fifteen percent (4,989/32,463) received any analgesic. Initial pain scores were significantly higher for African American and female patients. African American patients were less likely to receive analgesia compared to White and Hispanic patients (19% versus 25% and 23%, respectively, p < 0.0001). Adjusting for age, pain score, transport interval, and GCS, African American compared to White, and female compared to male patients were less likely to be treated for pain, OR 1.59 (95% CI 1.47-1.72) and OR 1.20 (95% CI 1.11-1.28), respectively. Conclusion: Among patients with isolated traumatic injuries treated in a single, urban EMS system, African American and female patients were less likely to receive analgesia than White or male patients. Analgesics were given to a small percentage of patients who were eligible for treatment by protocol, and intravenous opioids were used in the vast majority patients who received treatment.

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

Modeling and Optimization for Emergency Medical Services Network

Ambulance offload delays have become a challenging concern for emergency healthcare service providers. These delays often occur when the number of patients in the emergency department (ED) exceed the designed capacity such that ED cannot accept an incoming patient immediately, thereby forcing the ambulance and crew to wait with the patient until a bed becomes available. In this paper, we analyze and optimize the emergency medical services network, including ambulance stations and EDs. The objective is to reduce ambulance offload delays and lessen the congestion of EDs. To this end, we first build a continuous-time Markov chain to characterize this network analytically. Next, from the perspectives of both ambulance stations and EDs, we develop resource configuration and optimization models for this network. We investigate the reasons for ED overcapacity and ambulance offload delays. Finally, we design an effective approach to reconfigure the resources in the emergency medical services network, leading to a new and better equilibrium. Note to Practitioners—This article is motivated by our collaborations with the Emergency Medical Service Center (also called 120 Center) and several hospitals in Shanghai, China. The Emergency Medical Service Center and ED of hospitals are the frontlines of healthcare services in Shanghai. They provide medical treatment services for acutely ill and injured patients, so the operation of this system is critical to the health of such patients. Today, the ambulance offloading delay poses a challenge to the Emergency Medical Service Center, as it reduces the usage of ambulances and crews, as well as putting patients at risk. Meanwhile, the EDs sometimes suffer from bed shortages and overcrowding. Emergency Medical Service Centers and hospitals are both striving to improve the performance of this system. We analyze the network, including both the ambulance station (AS) and ED, and formulate a continuous-time Markov chain model to describe the network states. Then, we propose two optimization models from both AS and ED perspectives with a series of approximation methods to overcome computational difficulties. We obtain the equilibrium through joint optimization of AS and ED and demonstrate some valuable insights for managing ambulances and beds in the ED. Methods presented in this article may help decision-makers in emergency medical services systems.