Emergency Medical Services Providers Research Articles

The association between tree canopy cover over streets and elderly pedestrian falls: A health disparity study in urban areas

Older pedestrians are vulnerable to outdoor falling while walking on streets/sidewalks, but few studies have examined the role of the street environment and tree canopy cover over streets in relation to pedestrian falls among the elderly. We used spatial analysis to examine the association between tree canopy cover over streets and pedestrian falls reported to Emergency Medical Service (EMS) providers from March 2013 to February 2020 among adults aged 65 and older living in urban areas of Marin County, CA. Tree canopy cover over streets was measured using 1-m resolution of tree canopy within street polygons. After controlling for socioeconomic status and built environments, we found an inverse association between tree canopy cover over streets and elderly pedestrian fall rates at the census block level. Specifically, with a 10-percentage point increase in tree canopy cover over streets of a block, we expected to see about an 11.2% decrease in the elderly pedestrian fall rate. We found that the inverse relationship between tree canopy cover over streets and elderly pedestrian falls was only significant during the leaf-on season in the spring and summer. Finally, sub-analysis found that the relationship between tree canopy cover over streets and elderly pedestrian falls was stronger in low-income areas, compared to high-income areas. Planting street trees is a potential evidence-based intervention to prevent pedestrian falls. However, special attention must go beyond the quantity of tree canopy cover over streets to consider biophysical factors and social conditions.

Decreasing Peripheral Intravenous Catheter (PIV) Associated Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteremia

<h3>Background</h3> A 210-bed community hospital experienced 13 MRSA bacteremia events from July 2017 - June 2019. Among those infections, 46.2% were associated with the use of a PIV. Review of MRSA bacteremia infections identified a lack of standardized prevention measures in patients with PIVs. <h3>Methods</h3> A multidisciplinary team was assembled consisting of Infection Prevention (IP), nursing, anesthesia, and Emergency Medical Services (EMS) to create and implement a PIV bundle. The bundle included labeling, dating, and assessing intact, clean dressings. Following bundle development, education was conducted across the hospital via skills fair with hands-on training and roving in-services to ensure 90% of affected staff were reached. IP collected pre-intervention data and bundle audit data weekly to monitor improvement. During audits, the IP performed just-in time education and feedback on bundle non-compliance. PIV-bacteremia prevention education was incorporated into orientation for new nurses. Additional education was conducted with Anesthesia and EMS providers on PIV insertion technique and infection prevention processes. <h3>Results</h3> Baseline compliance with PIV-bundle components was 13.6% and increased to 69.0% in December of 2019 when the project ended. Dressing cleanliness increased from 66.0% in the baseline period to 88.7% Current data in December 2021 indicates an overall PIV bundle compliance rate of 80.6% demonstrating sustainability in the intervention. PIV-associated MRSA bacteremia decreased from 1.04 infections/10,000 patient days to 0 infections/10,000 patient days (p = 0.008). <h3>Conclusions</h3> PIV-associated bacteremia can be a major contributor to overall MRSA bacteremia. A comprehensive PIV bundle with stakeholder engagement is an effective intervention to reduce MRSA-bacteremia. Improving PIV maintenance practices reduces MRSA bacteremia.

A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services.

ObjectiveCare of the critically ill child is a rare but stressful event for emergency medical services (EMS) providers. Simulation training can improve resuscitation care and prehospital outcomes but limited access to experts, simulation equipment, and cost have limited adoption by EMS systems. Our objective was to form a statewide collaboration to develop, deliver, and evaluate a pediatric critical care simulation curriculum for EMS providers.MethodsWe describe a statewide collaboration between five academic centers to develop a simulation curriculum and deliver it to EMS providers. Cases were developed by the collaborating PEM faculty, reviewed by EMS regional directors, and based on previously published EMS curricula, a statewide needs assessment, and updated state EMS protocols. The simulation curriculum was comprised of 3 scenarios requiring recognition and acute management of critically ill infants and children. The curriculum was implemented through 5 separate education sessions, led by a faculty lead at each site, over a 6 month time period. We evaluated curriculum effectiveness with a prospective, interventional, single-arm educational study using pre-post assessment design to assess the impact on EMS provider knowledge and confidence. To assess the intervention effect on knowledge scores while accounting for nested data, we estimated a mixed effects generalized regression model with random effects for region and participant. We assessed for knowledge retention and self-reported practice change at 6 months post-curriculum. Qualitative analysis of participants' written responses immediately following the curriculum and at 6 month follow-up was performed using the framework method.ResultsOverall, 78 emergency medical technicians (EMTs) and 109 paramedics participated in the curriculum over five separate sessions. Most participants were male (69%) and paramedics (58%). One third had over 15 years of clinical experience. In the regression analysis, mean pediatric knowledge scores increased by 9.8% (95% CI: 7.2%, 12.4%). Most (93% [95% CI: 87.2%, 96.5%]) participants reported improved confidence caring for pediatric patients. Though follow-up responses were limited, participants who completed follow up surveys reported they had used skills acquired during the curriculum in clinical practice.ConclusionThrough statewide collaboration, we delivered a pediatric critical care simulation curriculum for EMS providers that impacted participant knowledge and confidence caring for pediatric patients. Follow-up data suggest that knowledge and skills obtained as part of the curriculum was translated into practice. This strategy could be used in future efforts to integrate simulation into EMS practice.

Prehospital Epinephrine Use in Pediatric Anaphylaxis by Emergency Medical Services.

Anaphylaxis requires prompt assessment and management with epinephrine to reduce its morbidity and mortality. This study examined the prehospital management of pediatric anaphylactic reactions in Northeast Ohio. This is a retrospective chart review using emergency medical service (EMS) run charts of patients 18 years and younger from February 2015 to April 2019. Patient charts with the diagnosis of "anaphylaxis" or "allergic reaction" were reviewed and confirmed that symptoms met anaphylaxis criteria. Information regarding epinephrine administration before EMS arrival and medications given by EMS providers was collected. Analysis was performed using descriptive statistics. From 646 allergic/anaphylactic reaction EMS run charts, 150 (23%) met the guideline criteria for anaphylaxis. The median patient age was 12 years. Only 57% (86/150) of these patients received intramuscular epinephrine, and the majority received it before EMS arrival. Epinephrine was administered by EMS to 32% (30/94; 95% confidence interval [CI], 22.7% to 42.3%) of patients who had not already received epinephrine. The odds of receiving prehospital epinephrine were significantly lower for patients 5 years and younger (risk difference [RD], -0.23; 95% CI, -0.43 to -0.04), those with no history of allergic reaction (RD, -0.20; 95% CI, -0.38 to -0.03), those who presented with lethargy (RD, -0.43; 95% CI, -0.79 to -0.06), and those whose trigger was a medication or environmental allergen (RD, -0.47; 95% CI, -0.72 to -0.23 for each). Emergency medical service providers in this region demonstrated similar use of epinephrine as reported elsewhere. However, 43% (64/150) of pediatric patients meeting anaphylaxis criteria did not receive prehospital epinephrine, and 10% (15/150) received no treatment whatsoever. Efforts to improve EMS provider recognition and prompt epinephrine administration in pediatric cases of anaphylaxis seem necessary.

Secondary Traumatic Stress in Emergency Services Systems Project: Quantifying the Effect of Personal Trauma Profiles on Lifetime Prevalence of Suicidality in Emergency Medical Services Personnel

ObjectiveWithin the last 20 years, there has been a 500% increase in public safety suicides, the exact cause of which is unknown. MethodsThis was a cross-sectional survey of emergency medical services (EMS) personnel. Nine EMS agencies were selected to participate based on geography and population. The survey assessed sociodemographic, occupational, and military factors. Childhood adversity and traumatic experiences were evaluated using the Adverse Childhood Experiences Questionnaire and the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, respectively. Using factors significant in univariate analyses, a logistic regression was conducted to determine predictors of suicidality while controlling for potential confounders. ResultsA total of 681 EMS providers participated; 56.1% were male, 12.6% were minorities, and 72.8% were paramedics. Nearly a quarter (24.4%) had considered suicide. Approximately twice as many had received counseling for a stress-related event, and 1.5 times as many identified as currently in counseling. Indigenous populations were 4.76 times more likely to have suicidality (odds ratio [OR] = 4.76; 95% confidence interval [CI], 1.22-18.62). Suicidality was 97% more likely in EMS professionals with prior military service (OR = 1.97; 95% CI, 1.08-3.57) and 2.22 times more likely in sexual minorities (OR = 2.22; 95% CI, 1.16-4.25). Emotional abuse (OR = 1.86; 95% CI, 1.08-3.21) and burnout (OR = 2.88; 95% CI, 1.78-4.66) were also predictive. ConclusionsSuicidality is an indisputable concern for the EMS profession and represents a multifaceted issue that must be addressed.

Redirecting emergency medical services patients with unmet primary care needs: the perspective of paramedics on feasibility and acceptance of an alternative care path in a qualitative investigation from Berlin, Germany

BackgroundAgainst the backdrop of emergency department (ED) overcrowding, patients’ potential redirection to outpatient care structures is a subject of current political debate in Germany. It was suggested in this context that suitable lower-urgency cases could be transported directly to primary care practices by emergency medical services (EMS), thus bypassing the ED. However, practicality is discussed controversially. This qualitative study aimed to capture the perspective of EMS personnel on potential patient redirection concepts.MethodsWe conducted qualitative, semi-structured phone interviews with 24 paramedics. Interviews were concluded after attainment of thematic saturation. Interviews were transcribed verbatim, and qualitative content analysis was performed.ResultsTechnical and organizational feasibility of patients’ redirection was predominantly seen as limited (theme: “feasible, but only under certain conditions”) or even impossible (theme: “actually not feasible”), based on a wide spectrum of potential barriers. Prominently voiced reasons were restrictions in personnel resources in both EMS and ambulatory care, as well as concerns for patient safety ascribed to a restricted diagnostic scope. Concerning logistics, alternative transport options were assessed as preferable. Regarding acceptance by stakeholders, the potential for releasing ED caseload was described as a factor potentially promoting adoption, while doubt was raised regarding acceptance by EMS personnel, as their workload was expected to conversely increase. Paramedics predominantly did not consider transporting lower-urgency cases as their responsibility, or even as necessary. Participants were markedly concerned of EMS being misused for taxi services in this context and worried about negative impact for critically ill patients, as to vehicles and personnel being potentially tied up in unnecessary transports. As to acceptance on the patients’ side, interview participants surmised a potential openness to redirection if this would be associated with benefits like shorter wait times and accompanied by proper explanation.ConclusionsInterviews with EMS staff highlighted considerable doubts about the general possibility of a direct redirection to primary care as to considerable logistic challenges in a situation of strained EMS resources, as well as patient safety concerns. Plans for redirection schemes should consider paramedics’ perspective and ensure a provision of EMS with the resources required to function in a changing care environment.

Dynamic changes of emergency visits: a retrospective observational study

BackgroundWith more emergency visits, there is increasing pressure to provide emergency medical services globally and locally. This study aimed to investigate the epidemiological characteristics and the disease spectrum of patients presenting in the last three years to the Department of Emergency Medicine of Tianjin Medical University General Hospital, a tertiary hospital in Tianjin, China, to improve the services of the emergency medicine department.MethodsA retrospective study was conducted on all patients in the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59, including variables like medical record number, gender, age, date of admission, principal diagnosis. The data were analyzed by SPSS statistical software; statistical charts were prepared by GraphPad Prism9.0 and SPSS 20.0; statistical tables were made by Microsoft Excel.ResultsA total of 1,314,916 patients presented to the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59. In terms of gender distribution, the male–female ratio was 0.78∶1. As for age distribution, patients aged 60–69 were the most (23.47%), and patients younger than 20 years were the least (2.80%). Concerning monthly data, the number of visits peaked during January and December. The distribution of daily visits showed the feature of three highs and a low. The top three prevalence diseases in the emergency disease spectrum were respiratory, cardiovascular, and digestive diseases. The respiratory system was the most common in patients with infectious diseases (200,912, accounting for 86.97%). Among the patients suffering from infectious diseases, the number of patients with respiratory infections peaked in 2019 (73,530) and was the lowest in 2020 (20,078).ConclusionsFrom 2017 to 2019, the demand for emergency services in Tianjin Medical University General Hospital continued to increase, but it was greatly affected by COVID-19 in 2020. This emergency department is mainly for patients with respiratory system, circulatory system and digestive system diseases, and its treatment time is relatively centralized. The prevention of diseases for people of all ages, especially female patients and the elderly, should be strengthened, and emergency medical resources should be allocated reasonably according to the peak months and crowed periods of patients.

Success of prehospital tracheal intubation during cardiac arrest varies based on race/ethnicity and sex

IntroductionTracheal intubation is a high-risk procedure often performed in the prehospital setting by emergency medical services (EMS) on patients experiencing cardiac arrest. Because of the high potential for adverse consequences resulting from unsuccessful intubation, intubation success rates are a topic of significant concern. There has been little research examining whether cardiac arrest intubation success rates vary based on patient race/ethnicity and patient sex. MethodsWe examined a national registry of EMS calls in the United States. Inclusion criteria were tracheal intubations (2017–2021) performed on adult cardiac arrest patients where EMS providers documented the patient's race/ethnicity and patient sex and whether the intubation was successful. A total of 210,992 cardiac arrests met inclusion criteria. When considering patient sex, intubation was more common in male patients than female patients, but intubation success rates were significantly higher in female patients (p < .01). When considering patient race/ethnicity, intubation success rates were highest in White patients and significantly lower in patients of all other races/ethnicities (p < .01). ConclusionsIntubation success rates were higher in female patients and White patients. Further studies need to examine disparities and identify strategies to improve intubation success for all patients with cardiac arrest. Possible explanations for the obtained results are differences in patient health, in provider familiarity with intubation, and in the availability of assistive technologies that facilitate intubation (e.g. video laryngoscopy).

The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic.

BackgroundDuring the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic.MethodsWe surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model.ResultsOur final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse.ConclusionsWe found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.

The FAST VAN for Field Identification of Large Vessel Occlusion in Acute Stroke.

There is definitive evidence for effectiveness of thrombectomy for acute stroke with large vessel occlusion (LVO). A clinical tool to identify patients with LVO is therefore required for effective triage and prehospital decision making. We developed the FAST VAN tool, which follows from the Heart and Stroke Foundation FAST stroke screen, with the addition of cortical features of vision, aphasia, and neglect, to differentiate from lacunar syndromes. Consecutive acute stroke alerts initiated by emergency medical services (EMS) were prospectively analyzed from April 2017 to Jan 2021. FAST VAN signs were recorded by first responders who had received online education about the tool. These findings were compared to the presence or absence of LVO on CT angiography. Analysis was also performed by appropriateness for comprehensive stroke centers (CSC) transfer if no LVO was present. EMS providers were surveyed regarding ease of use in terms of learning the tool and using in real-world practice. Data from 1080 consecutive acute strokes included 440 patients considered to have VAN signs by EMS. Fifty-four percent of VAN-positive patients showed LVO on CTA. Sensitivity, specificity, and accuracy were 86%, 75%, and 77%, respectively. In 204 false-positive cases, 143 (70%) were considered appropriate for evaluation at the CSC. EMS providers reported high satisfaction with learning and using the tool. The FAST VAN tool for identification of LVO meets desired characteristics of an effective screening tool in ease of use, efficiency, and accuracy. Aphasia remains the most challenging cortical feature to identify accurately.

Termination-of-resuscitation rule in the emergency department for patients with refractory out-of-hospital cardiac arrest: a nationwide, population-based observational study

BackgroundIn Japan, emergency medical service (EMS) providers are prohibited from field termination-of-resuscitation (TOR) in out-of-hospital cardiac arrest (OHCA) patients. In 2013, we developed a TOR rule for emergency department physicians (Goto’s TOR rule) immediately after hospital arrival. However, this rule is subject to flaws, and there is a need for revision owing to its relatively low specificity for predicting mortality compared with other TOR rules in the emergency department. Therefore, this study aimed to develop and validate a modified Goto’s TOR rule by considering prehospital EMS cardiopulmonary resuscitation (CPR) duration.MethodsWe analysed the records of 465,657 adult patients with OHCA from the All-Japan Utstein registry from 2016 to 2019 and divided them into two groups: development (n = 231,363) and validation (n = 234,294). The primary outcome measures were specificity, false-positive rate (FPR), and positive predictive value (PPV) of the revised TOR rule in the emergency department for predicting 1-month mortality.ResultsRecursive partitioning analysis for the development group in predicting 1-month mortality revealed that a modified Goto’s TOR rule could be defined if patients with OHCA met the following four criteria: (1) initial asystole, (2) unwitnessed arrest by any laypersons, (3) EMS-CPR duration > 20 min, and (4) no prehospital return of spontaneous circulation (ROSC). The specificity, FPR, and PPV of the rule for predicting 1-month mortality were 99.2% (95% confidence interval [CI], 99.0–99.4%), 0.8% (0.6–1.0%), and 99.8% (99.8–99.9%), respectively. The proportion of patients who fulfilled the rule and the area under the receiver operating curve (AUC) was 27.5% (95% CI 27.3–27.7%) and 0.904 (0.902–0.905), respectively. In the validation group, the specificity, FPR, PPV, proportion of patients who met the rule, and AUC were 99.1% (95% CI 98.9–99.2%), 0.9% (0.8–1.1%), 99.8% (99.8–99.8%), 27.8% (27.6–28.0%), and 0.889 (0.887–0.891), respectively.ConclusionThe modified Goto’s TOR rule (which includes the following four criteria: initial asystole, unwitnessed arrest, EMS-CPR duration > 20 min, and no prehospital ROSC) with a > 99% predictor of 1-month mortality is a reliable tool for physicians treating refractory OHCAs immediately after hospital arrival.

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review.

This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.

National EMS Memorial Service: Honoring the Emergency Medical Services and Air Medical Fallen

It was 30 years ago that Emergency Medical Technician (EMT) Kevin Dillard and a group from the Virginia Association of Volunteer Rescue Squads who founded the volunteer-based National EMS Memorial Service (NEMSMS) to honor and recognize emergency medical services (EMS) and air medical providers who died in the line of duty, held the first service. They realized that although there were memorial services for police and fire professionals, there was no formal recognition of EMS and air medical providers who made the ultimate sacrifice in the service to others.

Emergency Transport Crew: Post-Traumatic Stress Disorder Prevention Program

Background: The incidences of post-traumatic stress disorder (PTSD) among critical care nurses, emergency room nurses, and paramedics range from 20 to 33%. PTSD is associated with a lower quality of life (QOL), occupational impairments, physical health decline, and increases the risk of premature death. Research supports prevention and surveillance measures for post-traumatic stress disorder in emergency medical service providers, but the practice is not routinely done.&#x0D; Methods: A multi-purpose quality improvement project focused on educating transport crew members about PTSD. Other interventions emphasized anti-stigma lessons, resiliency assistance, and coping skills training. The pilot provided surveillance efforts, employed an early organizational PTSD recognition, and immediate debriefing for at-risk personnel at three Air Evac Lifeteam bases.&#x0D; Results: After the QI interventions, most crew members’ overall post-test PCL-5 scores were lowered by 12.5%. Another measure of the QI success was the Professional Quality of Life score improvement. Specially, the compassion satisfaction average level increased by 14% and the average burnout level decreased by of 15%.&#x0D; Conclusions: The QI project demonstrated the transport crew members’ well-being can be positively influenced by a PTSD prevention and surveillance program. These interventions offer a promising reduction in the prevalence of stress and PTSD. A nationwide practice change with these project interventions could improve the mental health of helicopter emergency medical personnel.

Multilevel analysis of sleep quality and anger in emergency medical service workers

ObjectivePoor sleep quality characterizes the emergency medical service (EMS) profession. Anger is particularly affected by sleep disturbance and may be related to sleep quality at both between- and within-person levels, yet this has never been examined. The current study performed a multilevel analysis of the relationship between sleep quality and anger among EMS workers. DesignEcological momentary assessment ParticipantsSeventy-nine EMS workers employed at an emergency medical service provider in Central New York. MeasurementsParticipants completed 8 daily assessments that inquired about sleep quality and anger. ResultsEMS workers who typically experienced poorer sleep quality reported greater anger levels; for instance, workers who routinely experienced poor sleep quality reported anger levels that were 18%-35% higher compared to workers receiving fair sleep quality. Regardless of their typical sleep quality, days when workers experienced poorer sleep than usual was characterized by higher levels of anger: on a day when a worker experienced poorer sleep quality than usual for them, their anger levels were 5% higher on that day regardless of their typical sleep quality. ConclusionsEMS workers regularly experiencing poor sleep quality experience more anger. However, even workers who typically have better sleep quality experience anger elevations following poor sleep. These findings suggest that interventions targeting both between- and within-person factors impacting sleep may be important for addressing sleep quality's influence on anger in the EMS profession.

Outcomes of Pediatric Patients in Secondary Transport to Tertiary Hospital: A Retrospective Observational Study.

Emergency medical service (EMS) providers play an important role in determining which hospital to choose. To date, there is no evidence-based guideline to support their decisions, except for major trauma cases. Secondary transport is considered when a patient needs further investigation or treatment after primary transport, but this can delay treatment and put patients at unnecessary risk. The objective of this study was to investigate the outcomes of pediatric secondary transport patients to tertiary hospitals. This was a citywide population-based observational study conducted in Kobe, Japan. We reviewed the EMS registry to identify secondary transport patients younger than 19 years and investigated their clinical characteristics. We excluded cases of unknown hospital destinations, nontransported cases, and major trauma patients who followed a different protocol for a hospital destination. The primary endpoint was the hospital outcome 12 hours after transport. Because there was no link between the EMS patient transport data and the hospital medical records, a probabilistic linkage was performed to obtain the hospital outcomes. Patients who required secondary transport were compared with patients transported directly to tertiary hospitals. A total of 13,720 pediatric patients were transported from the field by Kobe EMS between January 2013 and December 2015. Among them, 81 pediatric patients (0.6%) required secondary transport to tertiary hospitals within 24 hours of the primary transport, whereas a total of 3673 patients (27%) were transported directly to tertiary hospitals. Despite no apparent difference in prehospital severity, secondary transport patients were associated with higher hospitalization rates and a need for critical care compared with those who had direct transport. Seizure was the most common reason for the use of secondary transport, and 89% of the seizure patients were hospitalized after undergoing secondary transport; minor trauma was the second most common reason for the use of secondary transport, and 53% of the patients were hospitalized. In this study, the characteristics of the secondary transport patients and hospital outcomes revealed a heterogeneity in pediatric prehospital transport. It is recommended that the development of pediatric EMS destination guidelines cover children's diverse conditions. Further studies are required, and linkages between prehospital and hospital data will help promote a better understanding of appropriate hospital destinations.

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time.

Background and PurposeAcute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania.MethodsWe conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas.ResultsIn total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1–2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1–2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621).ConclusionsThe interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.

Novel Negative Pressure Procedural Tent Reduces Aerosolized Particles in a Simulated Prehospital Setting.

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization. Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]). For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms. Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.

The COVID-19 vaccine concerns scale: Development and validation of a new measure

ABSTRACT Reasons for COVID-19 hesitancy are multi-faceted and tend to differ from those for general vaccine hesitancy. We developed the COVID-19 Vaccine Concerns Scale (CVCS), a self-report measure intended to better understand individuals’ concerns about COVID-19 vaccines. We validated the scale using data from a convenience sample of 2,281 emergency medical services providers, a group of professionals with high occupational COVID-19 risk. Measures included the CVCS items, an adapted Oxford COVID-19 vaccine hesitancy scale, a general vaccine hesitancy scale, demographics, and self-reported COVID-19 vaccination status. The CVCS had high internal consistency reliability (α = .89). A one-factor structure was determined by exploratory and confirmatory factor analyses (EFA and CFA), resulting in a seven-item scale. The model had good fit (X2[14] = 189.26, p < .001; CFI = .95, RMSEA = .11 [.09, .12], NNFI = .93, SRMR = .03). Moderate Pearson correlations with validated scales of general vaccine hesitancy (r = .71 , p < .001; n = 2144) and COVID-19 vaccine hesitancy (r = .82; p < .001; n = 2279) indicated construct validity. The CVCS predicted COVID-19 vaccination status (B = −2.21, Exp(B) = .11 [95% CI = .09, .13], Nagelkerke R2 = .55), indicating criterion-related validity. In sum, the 7-item CVCS is a reliable and valid self-report measure to examine fears and concerns about COVID-19 vaccines. The scale predicts COVID-19 vaccination status and can be used to inform efforts to reduce COVID-19 vaccine hesitancy.

Adverse Health Effects Related to Shift Work Patterns and Work Schedule Tolerance in Emergency Medical Services Personnel: A Scoping Review.

Paramedicine as a profession is continually evolving in clinical practice, responsibilities, and workload. Changes over time in both population demographics and distribution have altered the demand for, and availability of, prehospital emergency medical services (EMS). These factors may also affect scheduling policies in many EMS organizations. However, there is little evidence that suggests optimal shift scheduling patterns to reduce adverse health events such as increased stress or fatigue in prehospital emergency health care providers. Our objective was to describe associations between variations in shift scheduling patterns and EMS provider health outcomes, such as fatigue, stress, sleep quality, and general mental and physiological health. We also sought to identify knowledge gaps. We performed searches of PubMed, CINAHL, Embase, and Cochrane databases for primary studies, systematic reviews, and meta-analyses published between January 2000 and December 2020. Studies reporting measurable health care outcomes in prehospital personnel with defined shift schedule patterns in land-based ambulance systems were included. Our search strategy yielded 188 studies, of which 11 met eligibility criteria (eight cross-sectional surveys, one single case report, one retrospective cohort study, one prospective cohort study, and one systematic review), with one additional study found through reference list screening, leaving 12 studies for review. All publications contained a description of shift schedule characteristics and shared similar outcomes of interest, although there was variation in comparators and assessment of outcomes. Most studies showed high rates of fatigue, stress, mental health concerns, and negative general health outcomes in paramedic shift worker populations. The case study reported improved fatigue, alertness, and sleep quality levels following a switch from a 24-hour shift pattern to an eight-hour shift. We did not complete an in-depth risk of bias assessment for any of the studies. Melnyk evidence ratings varied from IV to VI, indicating a low quality of evidence evaluating the impacts of shift schedule patterns in paramedics, with the retrospective cohort study design, ranked as IV, systematic review as a V, and prospective cohort study, case report and surveys ranked as VI. The low quality and quantity of evidence indicate the need for further research to definitively assess relationships between specific schedule patterns and health outcomes.