Emergency Medical Services Research Research Articles

Development of a Computable Phenotype for Prehospital Pediatric Asthma Encounters

Introduction Asthma exacerbations are a common cause of pediatric Emergency Medical Services (EMS) encounters. Accordingly, prehospital management of pediatric asthma exacerbations has been designated an EMS research priority. However, accurate identification of pediatric asthma exacerbations from the prehospital record is nuanced and difficult due to the heterogeneity of asthma symptoms, especially in children. Therefore, this study’s objective was to develop a prehospital-specific pediatric asthma computable phenotype (CP) that could accurately identify prehospital encounters for pediatric asthma exacerbations. Methods This is a retrospective observational study of patient encounters for ages 2–18 years from the ESO Data Collaborative between 2018 and 2021. We modified two existing rule-based pediatric asthma CPs and created three new CPs (one rule-based and two machine learning-based). Two pediatric emergency medicine physicians independently reviewed encounters to assign labels of asthma exacerbation or not. Taking that labeled encounter data, a 50/50 train/test split was used to create training and test sets from the labeled data. A 90/10 split was used to create a small validation set from the training set. We used specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and macro F1 to compare performance across all CP models. Results After applying the inclusion and exclusion criteria, 24,283 patient encounters remained. The machine-learning models exhibited the best performance for the identification of pediatric asthma exacerbations. A multi-layer perceptron-based model had the best performance in all metrics, with an F1 score of 0.95, specificity of 1.00, sensitivity of 0.91, negative predictive value of 0.98, and positive predictive value of 1.00. Conclusion We modified existing and developed new pediatric asthma CPs to retrospectively identify prehospital pediatric asthma exacerbation encounters. We found that machine learning-based models greatly outperformed rule-based models. Given the high performance of the machine-learning models, the development and application of machine learning-based CPs for other conditions and diseases could help accelerate EMS research and ultimately enhance clinical care by accurately identifying patients with conditions of interest.

Twenty Years After the EMS Research Agenda: Trends in Emergency Medical Services Publications and Research Funding.

Since its publication in 2001, the National EMS Research Agenda has brought attention to a relative paucity of emergency medical services (EMS)-specific research and has called for an increase in funding and infrastructure to support EMS research. We investigated the trends in EMS-specific publications and National Institutes of Health (NIH)-funded research grants in the 20 years since this landmark publication. We performed a structured PubMed search of English-language citations from 2001 to 2020 to identify publications with populations, settings, or topics related to EMS care, education, or operations. Publications in trade journals and studies not involving humans were excluded. We also queried NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) using a similar structured search. Titles, keywords, and abstracts were reviewed. Descriptive statistics were calculated, and nonlinear trends were described using segmented regression models. A total of 183,307 references met the search criteria in PubMed, and 4,281 grants were identified in NIH RePORTER. After removing duplicates, 152,408 titles were screened, with 17,314 (11.5%) included. EMS-related publications increased from 419 in 2001 to 1,788 in 2020, a 327% increase, compared with a 197% increase in total PubMed publications. There was a statistically significant nonlinear (J-shaped) increase in EMS publications after 2007. There were 1,166 funded EMS-related NIH grants, with a 469% increase from 2001 to 2020 compared with an 18% increase in overall NIH awards. Although total publications have doubled in the United States over the past 20 years, EMS-specific research has more than tripled and the number of funded EMS research grants has increased nearly 5-fold. Future evaluation should examine the quality of this research and its application to clinical practice.

Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study

IntroductionQuality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands.MethodsThis mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement.ResultsForty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data.ConclusionBarriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.

Ambulance Transport Destinations In The US Differ By Patient Race And Ethnicity.

Patients in the US belonging to racial or ethnic minority groups often receive medical care in different hospitals than White patients, which contributes to health care disparities. We explored whether ambulance transport destinations contribute to this phenomenon. Using a national emergency medical services research data set for calendar year 2020, we made within-ZIP code comparisons of the transport destinations for White patients and non-White patients transported by ambulance from emergency scenes. We used the dissimilarity index to measure transport destination discordances and decided a priori that a more than 5percent difference in transport destinations (that is, dissimilarity index >0.05) would be practically meaningful. We found meaningful differences in the destination hospitals for White and non-White patients transported by ambulance from locations in the same ZIP code. The median ZIP code dissimilarity index was 0.08, 64percent of ZIP codes had a dissimilarity index above 0.05, and 61percent of patients were transported from ZIP codes with a dissimilarity index above 0.05. Forty-one percent of ZIP codes had a dissimilarity index above 0.10, and one-third of the patients were transported from those ZIP codes. These data indicate that ambulance transport destinations contribute to discordances in where White and non-White patients receive medical care.

Fifteen Years of Sustainable Development in Emergency Medical Services under the Emergency Medicine Act of Thailand

BACKGROUND: Thailand’s emergency medical services (EMSs) are constantly evolving both in terms of personnel and technology in pre-hospital care. While sustainable development goals (SDGs) are used in part as a catalyst for development in all countries, there are currently no studies regarding the relationship between EMS research and SDGs in Thailand. AIM: This study aims to analyze how Thailand’s EMS research was affected after the National Institute for Emergency Medicine (NIEM) was established and how SDGs are related. METHODS: This was an analytical cross-sectional database study. Data were collected in the Scopus database with Thailand’s EMS records between 2008 and 2022. Three experienced emergency physicians were enrolled independently in this study for the purpose of giving opinions and feedback on the research. RESULTS: The three experts of this study are qualified emergency physicians in Thailand. The greatest number of the expert’s publications from the Scopus database was 117 articles. The greatest number of citations was 3994. The 175 documents were analyzed with three experts reviewing all documents and then narrowing it down to 25 documents. The most common SDG found in documents was Goal 3: GOOD HEALTH AND WELL-BEING. CONCLUSIONS: The development of Thailand’s EMS after the establishment of NIEM varied in aspects ranging from triage systems and care in ambulances to vehicle selection and technology. Goal 3: GOOD HEALTH AND WELL-BEING occurred most frequently in publications regarding SDGs in EMS studies.

Linkage of Emergency Medical Services and Hospital Data: A Necessary Precursor to Improve Understanding of Outcomes of Prehospital Care

Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an existing linkage process, improved the linkage rate and reduced selection and information bias. Methods: 4,150 transported patients in a metropolitan EMS system in Alberta, Canada from 2016/17 were linked to two Emergency Department (ED) databases by a standard strategy using a unique health care number, date/time of ED arrival, and hospital name. An optimized strategy added additional linkage steps incorporating last name, year of birth, and a manual search. The strategies were compared to assess the rate of linkage, and to describe event and patient-level characteristics of unlinked records. Results: The standard strategy resulted in 3,650 out of 4,150 (88.0%) linked records (95% CI 86.9%-88.9%). Of the 500 non-linked records, an additional 381 were linked by the optimized strategy (n = 4,031/4,150 [97.1%; 95% CI: 96.6%-97.6%]). There were no false positive linkages. The highest linkage failure was in 25 to 34 year-old patients (n = 93/478, 19.5%), males (n = 236/1975, 12.0%), Echo level events (n = 15/77, 19.5%), and emergency transport (45/231, 19.5%). The optimized strategy improved linkage in these groups by 68.8% (64/93), 79.2% (187/236), 40.0% (6/15), and 51.1% (23/45) respectively. For dispatch card, the highest linkage failure occurred in Card 24-Pregnancy/Childbirth/Miscarriage (n = 30/44, 68.2%), Card 27-Stab/Gunshot/Penetrating Trauma (n = 6/17, 35.3%), and Card 9-Cardiac/Respiratory Arrest/Death (n = 12/46, 26.1%). The optimized strategy improved linkage by 10.0% (3/30), 83.3% (5/6), and 41.7% (5/12) respectively. For the 119 unlinked records, 71 (59.7%) had sufficient information for linkage, but no appropriately matching records could be found. Conclusion: An optimized sequential deterministic strategy linking EMS data to ED outcomes improved the linkage rate without increasing the number of false positive links, and reduced the potential for bias. Even with adequate information, some records were not linked to their ED visit. This study underscores the importance of understanding how data are linked to hospital outcomes in EMS research and the potential for bias.

Examining the spatial risk environment tied to the opioid crisis through a unique public health, EMS, and academic research collaborative: Lowell, Massachusetts, 2008–2018

Between 2015 and 2018, Lowell Massachusetts experienced outbreaks in opioid overdoses, HIV, and hepatitis C virus infections (HCV) among people who inject drugs. Through an innovative collaboration between emergency medical services (EMS), public health, and academic partners, we assessed the geographic distribution of opioid-related risks to inform intervention efforts. We analyzed data from three unique data sources for publicly discarded syringes, opioid-related incidents (ORIs), and fatal opioid overdoses in Lowell between 2008 and 2018. We assessed the risk environment over time using a geographic information system to identify and characterize hotspots and noted parallel trends within the syringe discard and ORI data. We identified two notable increases in ORIs per day: the first occurring between 2008 and 2010 (from 0.3 to 0.5), and the second between 2011 and 2014 (from 0.9 to 1.3), following the introduction of fentanyl within local drug markets. We also identified seasonal patterns in the syringe discard, ORI, and overdose data. Through our spatial analyses, we identified significant clusters of discarded syringes, ORIs, and fatal overdoses (p < 0.05), and neighborhoods where high densities of these outcomes overlapped. We found that areas with the highest densities shifted over time, expanding beyond the epicenter of the Downtown neighborhood. Data sharing and analyses among EMS, public health, and academic partners can foster better assessments of local risk environments. Our work, along with new public health efforts in Lowell, led to a city-funded position to improve pick-up and proper disposal of publicly discarded syringes, and better targeted harm reduction services.

ICU-free days as a more sensitive primary outcome for clinical trials in critically ill pediatric patients.

BackgroundOur objective was to assess the association between intensive care unit (ICU)‐free days and patient outcomes in pediatric prehospital care and to evaluate whether ICU‐free days is a more sensitive outcome measure for emergency medical services research in this population.MethodsThis study used data from a previous pediatric prehospital trial. The original study enrolled patients ≤12 years of age and compared bag‐valve‐mask‐ventilation (BVM) versus endotracheal intubation (ETI) during prehospital resuscitation. For the current study, we defined ICU‐free days as 30 minus the number of days in the ICU (range, 0–30 days) and assigned 0 ICU‐free days for death within 30 days. We compared ICU‐free days between the original study treatment groups (BVM vs ETI) and with the original trial outcomes of survival to hospital discharge and Pediatric Cerebral Performance Category (PCPC).ResultsMedian ICU‐free days for the BVM group (n = 404) versus ETI group (n = 416) was not statistically different: 0 ICU‐free days (interquartile range, 0–10) versus 0 (0–0), P = 0.219. Median ICU‐free days were greater for BVM group in 3 subgroups: foreign body aspiration 30 (0–30) versus 0 (0–21), P = 0.028; child maltreatment 0 (0–14.2) versus 0 (0‐0), P = 0.004; and respiratory arrest 25 (1–29) versus 7.5 (0–27.7), P = 0.015. In the original trial, neither survival nor PCPC demonstrated differences in all 3 subgroups—survival was greater with BVM for child maltreatment and respiratory arrest and favorable PCPC was greater with BVM for foreign body aspiration. Overall, in the current study, patients with more ICU‐free days also had greater survival to hospital discharge and more favorable PCPC scores.ConclusionsThis initial study of the association between ICU‐free days and patient outcomes during prehospital pediatric resuscitation appears to support the use of ICU‐free days as a clinical endpoint in this population. ICU‐free days may be more sensitive than either mortality or PCPC alone while capturing aspects of both measures.

Emergency Medical Services for Children: Pediatric Emergency Medicine Research.

Caring for children who are acutely ill and injured involves coordinated efforts in multiple settings, including primary care, prehospital, the emergency department, and in the hospital. Research is essential to identify new science to improve health outcomes and to deliver resource-efficient emergency care to pediatric populations. This article reviews the current state of research in emergency medical services for children (EMSC). Efforts over the past 20 years have strengthened the emergency medical services infrastructure, as pediatric readiness in emergency medical services continues to be a critical area of focus, because more than 80% of children are cared for outside of pediatric-specific health centers. Research on sepsis, trauma, and respiratory illnesses is part of the core agenda for the Pediatric Emergency Care Research Network and EMSC research. These domains represent a mix of high-frequency illnesses and low-frequency illnesses with potential for high morbidity or mortality, which, if studied, can help optimize care of pediatric patients. [Pediatr Ann. 2021;50(4):e155-e159.].

Drones in Emergency Medical Services: A Systematic Literature Review with Bibliometric Analysis

This paper conducts a systematic literature review with bibliometric analysis for drone-related research in Emergency Medical Services (EMS). Forty publications were extracted from the SCOPUS database during 2015–2019 for further analysis. The results show the current research landscape and guide future research directions. Interestingly, the occurrence of the COVID-19 pandemic made the use of drones necessary to assist EMSs lifesaving tasks to reduce fatality, which has also attracted more attention from the academic community. It was found that the co-evolution of drone technologies and entrepreneurial activities in the EMS ecosystem offers drone uses beyond medical applications.

Applying a Model of Teamwork Processes to Emergency Medical Services.

IntroductionEffective teamwork has been shown to optimize patient safety. However, research centered on the critical inputs, processes, and outcomes of team effectiveness in emergency medical services (EMS) has only recently begun to emerge. We conducted a theory-driven qualitative study of teamwork processes—the interdependent actions that convert inputs to outputs—by frontline EMS personnel in order to provide a model for use in EMS education and research.MethodsWe purposively sampled participants from an EMS agency in Houston, TX. Full-time employees with a valid emergency medical technician license were eligible. Using semi-structured format, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS. Phone interviews were recorded and transcribed. Using a thematic analytic approach, we combined codes into candidate themes through an iterative process. Analytic memos during coding and analysis identified potential themes, which were reviewed/refined and then compared against a model of teamwork processes in emergency medicine.ResultsWe reached saturation once 32 respondents completed interviews. Among participants, 30 (94%) were male; the median experience was 15 years. The data demonstrated general support for the framework. Teamwork processes were clustered into four domains: planning; action; reflection; and interpersonal processes. Additionally, we identified six emergent concepts during open coding: leadership; crew familiarity; team cohesion; interpersonal trust; shared mental models; and procedural knowledge.ConclusionIn this thematic analysis, we outlined a new framework of EMS teamwork processes to describe the procedures that EMS operators employ to convert individual inputs into team performance outputs. The revised framework may be useful in both EMS education and research to empirically evaluate the key planning, action, reflection, and interpersonal processes that are critical to teamwork effectiveness in EMS.

LO18: The state of the evidence for emergency medical services (EMS) care of prehospital hypoglycemia: an analysis of appraised research from the Prehospital Evidence-based Practice Program

Introduction: The Prehospital Evidence-based Practice (PEP) program is an online, freely accessible, continuously updated repository of appraised EMS research evidence. This report is an analysis of published evidence for EMS interventions used to assess and treat patients suffering from hypoglycemia. Methods: PubMed was systematically searched in June 2019. One author screened titles, abstracts and full-texts for relevance. Trained appraisers reviewed full text articles, scored each on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings for each intervention's primary outcome), abstracted the primary outcome, setting and assigned an outcome category (patient or process). Second party appraisal was conducted for all included studies. The level and direction of each intervention was plotted in an evidence matrix, based on appraisals. Results: Twenty-nine studies were included and appraised for seven interventions: 5 drugs (Dextrose 50% (D50), Dextrose 10% (D10), glucagon, oral glucose and thiamine), one assessment tool (point-of-care (POC) glucose testing) and one call disposition (treat-and-release). The most frequently reported study primary outcomes were related to: clinical improvement (n = 15, 51.7%), feasibility/safety (n = 8, 27.6%), and diagnostics (n = 6, 20.7%). The majority of outcomes were patient focused (n = 18, 62.0%). Conclusion: EMS interventions for treating hypoglycemia are informed by high-quality supportive evidence. Both D50 and D10 are supported by high-quality evidence; suggesting D10 may be an effective alternative to the standard D50. “Treat-and-release” practices for hypoglycemia are supported by moderate-quality evidence for the patient related outcomes of relapse, patient preference and complications. This body of evidence is high-quality, patient-focused and conducted in the prehospital setting thus generalizable paramedic practice.

The Process of Team Building Among Content Experts and Methodologists: An Example From an Emergency Medical Services Research Investigation Kick-Off Meeting

Background: Community-engaged research engages the community in a collaborative manner to improve the local setting and has been increasingly applied to health services research. These complex studies require collaboration and team building among clinical experts, methodologists, and community stakeholders, yet few examples of this process have been published. Aim: Through a study of community emergency medical services, our aim was to understand team building among content experts and methodologists to advance the framework for adaptive community-engaged research. Methods: We collected process field notes and transcripts from the project kick-off meetings and analyzed the data using an immersion/crystallization process, which is an exploratory qualitative analysis characterized by continual review of the data collected. All 25 members of the study’s research team, who are both local to Michigan and reside out-of-state, were invited to attend. Results: We describe the process of the kick-off event for this community-engaged study and report major themes: collaborating throughout each stage of the kick-off meeting, building trusting relationships by challenging each other’s perspectives and sharing expertise, and gaining shared experiences of learning and understanding of study content and goals. Conclusion: Team-building in community engaged health research requires thoughtful effort, and planned kick-off meeting can be a useful strategy to build a shared vision among content experts and methodologists.

What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review.

BackgroundThe Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine.MethodsWe searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical.ResultsTwenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future.ConclusionThis review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain.Trial registrationPROSPERO registration number: CRD42019123896.

Symptom, diagnosis and mortality among respiratory emergency medical service patients.

ObjectiveBreathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital.MethodsPopulation-based historic cohort study in the North Denmark Region 2012–2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates.ResultsThere were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups.ConclusionsThe over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.

Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This conference convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps. Planning committee and conference participants included emergency physicians, pediatric emergency physicians, pediatricians, and researchers with expertise in research dissemination and translation, as well as comparative effectiveness, in collaboration with patients, patient and family advocates from national advocacy organizations, and trainees. Topics that were explored and deliberated through subcommittee breakout sessions led by content experts included 1) pediatric emergency medical services research, 2) pediatric emergency medicine (PEM) research network collaboration, 3) PEM education for emergency medicine providers, 4) workforce development for PEM, and 5) enhancing collaboration across emergency departments (PEM practice in non-children's hospitals). The work product of this conference is a research agenda that aims to identify areas of future research, innovation, and scholarship in PEM.

Establishing the Key Outcomes for Pediatric Emergency Medical Services Research

The evidence supporting best practices when treating children in the prehospital setting or even the effect emergency medical services (EMS) has on patient outcomes is limited. Standardizing the critical outcomes for EMS research will allow for focused and comparable effort among the small but growing group of pediatric EMS investigators on specific topics. Standardized outcomes will also provide the opportunity to collectively advance the science of EMS for children and demonstrate the effect of EMS on patient outcomes. This article describes a consensus process among stakeholders in the pediatric emergency medicine and EMS community that identified the critical outcomes for EMS care in five clinical areas (traumatic brain injury, general injury, respiratory disease/failure, sepsis, and seizures). These areas were selected based on both their known public health importance and their commonality in EMS encounters. Key research outcomes identified by participating stakeholders using a modified nominal group technique for consensus building, which included small group brainstorming and independent voting for ranking outcomes that were feasible and/or important for the field.

Can Altering Grip Technique and Bag Size Optimize Volume Delivered with Bag-Valve-Mask by Emergency Medical Service Providers?

Introduction: Emergency Medical Services (EMS) professionals rely on the bag-valve-mask (BVM) to provide life-saving positive-pressure ventilation in the prehospital setting. Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. A recent study has shown that the volumes typically delivered by EMS professionals with the adult BVM are often higher than recommended by lung-protective ventilation protocols. Our primary objective was to determine if a group of EMS professionals could reduce the volume delivered by adjusting the way the BVM was held. Secondary objectives included 1) if the adjusted grip allowed for volumes more consistent with lung-protection ventilation strategies and 2) comparing volumes to similar grip strategies used with a smaller BVM. Methods: A patient simulator of a head and thorax was used to record respiratory rate, tidal volume, peak pressure, and minute volume delivered by participants for 1 minute each across 6 different scenarios: 3 different grips (using the thumb and either 3 fingers, 2 fingers, or one finger) with 2 different sized BVMs (adult and pediatric). Trials were randomized by blindly selecting a paper with the scenario listed. A convenience sample of EMS providers was used based on EMS provider and research staff availability. Results: We enrolled 50 providers from a large, busy, urban hospital-based EMS agency a mean 8.60 (SD = 9.76) years of experience. Median volumes for each scenario were 836.0 mL, 834.5 mL, and 794 mL for the adult BMV (p = 0.003); and 576.0 mL, 571.5 mL, and 547.0 mL for the pediatric BVM (p < 0.001). Across all 3 grips, the pediatric BVM provided more breaths within the recommended volume range for a 70 kg patient (46.4% vs. 0.4%; p < 0.001) with only a 1.1% of breaths below the recommended tidal volume. Conclusion: The study suggests that it is possible to alter the volume provided by the BVM by altering the grip on the BVM. The tidal volumes recorded with the pediatric BVM were above recommended range in 2 of the 3 grips. The volumes of the pediatric BVM were overall more consistent with lung-protective ventilation volumes when compared to all 3 finger-grips of the adult BVM.

Determining Potentially Avoidable Emergency Medical Services (EMS) Transports: A Population Level Study Using Linked Administrative Data in Alberta Health Services (AHS)

IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model.&#x0D; Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta.&#x0D; We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission.&#x0D; ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals&lt;18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%).&#x0D; Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.

Promoting Continuing Professional Education and Research in Emergency Medical Services (EMS)

Promoting Continuing Professional Education and Research in Emergency Medical Services (EMS)