Emergency Medical Services Utilization Research Articles

Emergency Medical Services Utilization by Homeless Patients

Background Homelessness is a rapidly growing issue throughout the United States and has important public health implications. Los Angeles, like other large urban cities, has seen a recent increase in homelessness. However, little is known about emergency medical service (EMS) utilization by those experiencing homelessness. Objective: Describe the utilization of emergency medical services by homeless patients. Methods: This is a 12-month retrospective review of electronic health records of all 911-incidents attended by the Los Angeles Fire Department (LAFD) from January to December 2018. The City of Los Angeles is 480 square miles and has a population of 3,949,776 with a homeless population of 31,285 (0.8% of city population). The primary outcome is the frequency of EMS 911-calls for homeless patients. Secondary outcomes include call characteristics. Results: There were 355,411 911-incidents during the study period. Homeless patients were involved in 36,122 (10.2%) incidents. Incidents for the homeless population occurred at a rate of 1155 per 1000 homeless residents or 14 times the rate of housed residents. Of the 217,972 calls resulting in transport to the emergency department, 28,917 (13.3%) were for homeless patients. This translates into a rate of 924 per 1000 homeless patients, which is 19 times higher than housed patients. Homeless patients were younger (mean 46.1 v 52.6 years) and more likely to be male (71% v 49.1%). Acuity was lower in the homeless group, 31.4% v 42.5% received advanced life support. Conclusion: In the City of Los Angeles, people experiencing homelessness demonstrated disproportionately high use of EMS services and ambulance transports, were more frequently younger, male, and had lower acuity conditions when compared with housed patients.

Helicopter and ground emergency medical services transportation to hospital after major trauma in England: a comparative cohort study

BackgroundThe utilization of helicopter emergency medical services (HEMS) in modern trauma systems has been a source of debate for many years. This study set to establish the true impact of...

Can Emergency Medical Services Utilization Rates Be Used to Measure the Success of An Alcohol Amnesty Policy?

Introduction Medical Amnesty/Good Samaritan (MAGS) policies, which eliminate legal charges when students call 9-1-1 for excessive drinking, have been implemented with the goal of reducing barriers to accessing Emergency Medical Services (EMS). This study investigated the impact of MAGS policy implementation on EMS calls on campus and if that EMS call volume could be used to measure policy success. The aim of this study was to compare the prevalence of alcohol-related EMS calls before and after MAGS implementation at a single large public university campus. Methods: A retrospective review of all 9-1-1 calls to on-campus locations was conducted using patient care records (PCRs) from a collegiate EMS agency responding exclusively to on-campus 9-1-1 calls. Calls were excluded if the PCR was marked “incomplete”, were outside the 2015 CBEMS response zone boundaries, or if patient age was <15 or >25 years old to ensure analysis was targeting the on-campus student population. The incidence of alcohol-related 9-1-1 calls was compared between one academic year (AY) prior to (pre-MAGS, AY2015) and two years after MAGS implementation (post-MAGS, AY2016/17). An alcohol-related 9-1-1 call was defined as an EMS provider primary or secondary impression of “Alcohol, Alcohol Intoxication, or Alcohol Ingestion” or a call in which the patient explicitly admitted to alcohol use. Relative risk (RR) with 95% confidence intervals (CI) were used to describe the results. Results: Over the three-year study period, the collegiate EMS agency responded to 2440 calls of which 1283 met inclusion criteria. 58 calls were excluded for being incomplete, 227 were outside the original boundaries and 872 were outside the defined age range. Of those calls, 351 were pre-MAGS and 932 were post-MAGS. Of the total 9-1-1 calls, 127 (36.2%) were related to alcohol pre-MAGS and 327 (35.1%) were related to alcohol post-MAGS policy implementation. The relative risk of a 9-1-1 call being made for alcohol-related issues after MAGS implementation was RR = 0.97 (95% CI 0.83-1.14; P = 0.713). Conclusion: Implementation of a MAGS policy was not associated with a significant change in the number of alcohol-related EMS responses. It is unclear if these results reflect ineffective policy implementation or a general reduction in on-campus alcohol consumption. However, using EMS call volume as a marker for policy success and quality improvement offers an innovative tool through which EMS agencies can provide valuable feedback to other system stakeholders.

The Effects of Prehospital Care on Outcome in Pediatric Diabetic Ketoacidosis

Objective:Despite the guidelines, significant variations can be encountered in initial therapy for pediatric diabetic ketoacidosis (DKA) in the prehospital setting. These variations occur mostly in fluid administration, insulin dosing, route of administration, and other aspects of the initial resuscitation and stabilization. The aim was to identify the effect of transport care on outcomes in children with DKA admitted to the emergency department (ED).Methods:Patients admitted to a tertiary-care pediatric ED between 2015-2019 with a diagnosis of DKA were retrospectively identified. Details of pre-pediatric ED care, including transport modality, patient demographics, clinical features, laboratory evaluation, fluid therapy, insulin dosing, and short-term outcome were recorded.Results:The study cohort included 147 episodes of DKA in 136 patients aged 9 months-21 years. Emergency Medical Service (EMS) transported only 37.4% of cases. EMS utilization rate was significantly higher (p=0.003) in severe cases, most of whom were >10 years (p=0.04). During transport 85% received intravenous fluid bolus. Use of fluids other than normal saline was significantly higher when transport time was >30 minutes (p=0.001). Acute kidney injury and cerebral edema developed in 21.7% and 7.4% of episodes, respectively. These complications were more common in the EMS transport group. Pediatric intensive care admission rate was also higher in the EMS compared to the non-EMS group (p=0.01).Conclusion:Parents did not call the ambulance for most cases although a higher complication rate occurred in EMS patients. EMS providers and referral facilities should improve their knowledge of pediatric DKA.

Preferences for emergency medical service transport after childhood injury: An emergency department-based multi-methods study

BackgroundPre-hospital emergency medical services (EMS) transport can be associated with benefits following pediatric injury. However, many pediatric trauma patients do not use EMS. The objective of this study was to elucidate guardians’ decision factors for pre-hospital transport for children after injury. MethodsThis is a multi-methods study of pediatric trauma patients (≤14 years) and their guardians presenting to the ED of a Level I Pediatric Trauma Center via both EMS and non-EMS modalities. Demographic information and injury characteristics were collected. Semi-structured interviews were conducted, and qualitative codes were identified and assigned into themes. Results(Quantitative): Of the 29 child-guardian pairs, five participants initially presented by EMS, 18 were admitted, and the majority (66%) sustained mild injuries. Guardians’ assessment of their child's injury severity did not correlate with Injury Severity Score (ISS). Neither EMS status (did or did not use EMS to transport to first hospital) nor rurality status of participants’ place of residence were associated with disparate management in any of the three scenarios. (Qualitative)Five themes emerged, which informed guardians’ transport decisions: Factors Related to the Nature of the Patient's Injury, Guardian Attributes and Prior Experiences, Access and Availability of EMS, Perceived Risks and Benefits of EMS and Hospital, and Collaborative Decision-Making. Injury characteristics and contextual factors, like perceived EMS response times and advice from family or medical providers, were considered in choices about EMS utilization and hospital selection. Despite the view that EMS response times were important in determining what to do following injury, both EMS and non-EMS users were largely unfamiliar with the capabilities of EMS in their area. Finally, guardians described cost to be a theoretical risk of EMS use, and a few cited this as a factor contributing to their decision-making. ConclusionsGuardians used a variety of considerations to make transport decisions, including the five themes identified above. Future studies could explore modalities to disseminate information about pre-hospital decision-making for guardians and determine the relationship between EMS utilization and patient outcomes.

A ready-to-use liquid glucagon for treatment of severe hypoglycemia demonstrates reduced healthcare payer costs in a budget impact model

Research aim: To model the annual value of a novel ready-to-use, room-temperature stable liquid glucagon rescue pen and prefilled syringe (GRP, G-PFS; Xeris Pharmaceuticals, Inc.) for treatment of severe hypoglycemia events (SHE) versus current lyophilized powder glucagon emergency kits (GEK). GRP is a prefilled auto-injector designed to promptly administer concentrated liquid glucagon in a simple two-step process. G-PFS is a stable liquid formulation of glucagon in a prefilled syringe. In simulated emergencies, GRP and G-PFS demonstrated high functional efficacy, where 99% of users successfully administered a full-dose of drug. Studies with currently available injectable GEK suggest very low success rates (6–31%). The high functional efficacy of GRP and G-PFS significantly reduces user errors and may reduce utilization across emergency medical services (EMS), emergency departments (ED), and inpatient and outpatient costs for SHE.Methods: To estimate the economic impact of GRP and G-PFS, we developed a one-year budget impact model from a US commercial health plan perspective. Cost offsets from successful glucagon administration incorporated EMS, ED, inpatient, and outpatient utilization. Diabetes prevalence and event probabilities were estimated from publicly-available sources and clinical expert opinion. Costs (US$) were obtained from the 2018 Medicare Fee Schedules and adjusted to represent commercial payer costs.Results: GRP and G-PFS led to fewer EMS, ED, inpatient, and outpatient costs compared to GEK and no kit, resulting in total per-patient SHE costs of $2,564, $3,606, and $3,849, respectively. Costs for 1 million covered lives were 8.2 million following the introduction of GRP and G-PFS compared to almost 9 million before GRP and G-PFS.Limitations: The model is limited by reliance on assumptions based on expert opinion for key variables, primarily the probability of: (1) ambulance calls, (2) ambulance transport to the ED, and (3) non-ambulance transport to the ED.Conclusions: A budget impact model suggests GRP and G-PFS can lead to significant annual cost savings for US commercial payers.

Opportunities for Emergency Medical Services Intervention to Prevent Opioid Overdose Mortality

Objectives The opioid crisis is a growing cause of mortality in the United States and may be mitigated by innovative approaches to identifying individuals at-risk of fatal opioid overdose. We examined Emergency Medical Services (EMS) utilization among a cohort of individuals who died from opioid overdose in order to identify potential opportunities for intervention. Methods: Individuals who died of unintentional opioid overdose in a large North Carolina county between 01/01/2014 and 12/31/2016 were studied in a retrospective cohort. Death records obtained from North Carolina Vital Records were linked to EMS patient care records obtained from the county EMS System in order to describe the EMS encounters of each decedent in the year preceding their death. Patient demographics and EMS encounters were assessed to identify encounter characteristics that may be targeted for intervention. Chi-square tests and odds ratios were used to evaluate and characterize the statistical significance of differences in EMS utilization. Results: Of the 218 individuals who died from unintentional opioid overdose in the study interval, 30% (n = 66) utilized EMS in the year before their death and 17% (n = 38) had at least one EMS encounter with documented drug or alcohol use (i.e. “drug-related encounter”). The mean age at death was 38 (range 19-74) years, 30% were female, 89% were White, and 8% were Black/African American. Factors associated with higher incidence of EMS utilization included age (P<.001), gender (P=.006), and race (P<.001). Decedents aged 56-65 had the highest EMS utilization (47%) and patients aged <25 and 25-35 had more drug-related EMS encounters (29% and 20%, respectively). The most common reasons for EMS utilization were “other medical” (27%), “non-traumatic pain” (20%), “traumatic injury” (16%), and “poisoning/drug ingestion” (14%). Drug or alcohol use was documented by EMS in 33% of all encounters and an opioid prescription was reported in 22% of encounters. Conclusions: Nearly one-third of individuals who died from accidental opioid overdose utilized EMS in the year before their death and nearly one-fifth had a drug-related encounter. EMS encounters may present an opportunity to identify individuals at-risk of opioid overdose and, ultimately, reduce overdose mortality.

Exploring willingness to engage with law enforcement among syringe service program participants in New York City

BackgroundIn New York City (NYC), 1,487 unintentional overdose deaths occurred in 2017, largely driven by the presence of fentanyls in the illicit drug market. In response to fentanyl-involved overdoses, law enforcement entities both nationally and in NYC have taken a new interest in overdose events. This study explored attitudes toward and willingness to engage with police among NYC syringe service program (SSP) participants, a population likely to have had experiences with overdose and/or police. MethodsBetween March and July 2017, 332 surveys were conducted with a convenience sample of NYC SSP participants. ResultsMost respondents (76%) reported ever being arrested for a drug-related crime. Few respondents (5%) reported a previous arrest in the context of an overdose event. Of the 62 respondents who had witnessed an overdose in the previous 12 months, 25% had not called 911 because of concerns about law enforcement. Over half (51%) of all respondents reported they would not be willing to aid police in their investigation of the person who supplied the drugs. ConclusionPolice investigations of both fatal and non-fatal drug overdose events have the potential to exacerbate mistrust of law enforcement and discourage emergency medical service utilization among PWUD.

Abstract WP274: No Improvement in Emergency Medical Services Use by Stroke Patients From 1999-2015: A Population-Based Study

Objective: We sought to assess whether the proportion of stroke patients who utilized Emergency Medical Services (EMS) has changed over time in a population-based epidemiological study. Methods: Stroke and transient ischemic attack (TIA) patients were identified in a population of 1.3 million in the Cincinnati area from data in 1999, 2005, 2010, and 2015. Patient charts and EMS records were analyzed by research nurses and reviewed by study physicians. This analysis excluded strokes/TIAs that occurred while in a hospital, out of town, during EMS transport, or at unknown location. Patients with unknown EMS utilization, stroke severity, baseline pre-stroke disability, race, stroke type, or under age 18 were excluded. Proportion of EMS utilization by stroke patients was calculated and Cochran-Armitage Trend Test was used to analyze trends in EMS utilization over time. Multivariable logistic regression was used to determine the association between age, race, sex, prior stroke, stroke type, where the stroke occurred, stroke severity, and pre-stroke disability with EMS use. Results: In 1999, 2005, 2010 and 2015, 2968 of 3860, 2900 of 3643, 3010 of 3503, and 3327 of 3767 stroke cases were included, respectively. EMS use by stroke patients did not change significantly over time (52%, 51%, 52%, 53%, p=0.12 for trend). In 1999 and 2015, age, pre-stroke disability, stroke severity, hemorrhagic stroke and stroke occurring at work were significantly associated with EMS use. Race, sex, and prior stroke were not. Slight variation in associations occurred in 2005 and 2010, with stroke at work not reaching significance in 2005 and 2010, and pre-stroke disability not reaching significance in 2005. Conclusion: EMS use by stroke patients in our population did not change from 1999 to 2015. With the recent advances in treatment options for stroke, novel and effective approaches to increase EMS use are warranted.

Abstract WP292: Temporal Trends in the Use of Ems Service as a Mode of Arrival by Acute Ischemic Stroke Patients

Intro: Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with IV tPA or endovascular intervention. We investigate the use of EMS services in three large states across the US during the past decade. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 9,251 stroke admissions from 01/2010 - 12/2018. Overall rates of EMS use and temporal trends were computed. Factors associated with EMS use were evaluated with univariate analysis. Results: Of the 9,251 patients, 29.2 % (2,697/9,251) presented via EMS service. Overtime use of EMS service increased from 29% in 2010-11 to 34% in 2018. Use of EMS increased among severe stroke patients but decreased among mild stroke patients. Patients presenting via EMS were older, more often females while less often African Americans. They had more stroke risk factors, including hypertension, diabetes, atrial fibrillation and previous stroke/TIA. Smokers less often use EMS services. Median NIHSS was higher among patients presenting via EMS, and those with altered level of consciousness used EMS more often. In-hospital intervention rates (IV tPA/endovascular) were higher among patients presenting via EMS. Conclusion: Our results showed that after extensive EMS education in most parts of the study states, stroke presentation has increased via EMS overtime. Disparity in the use of EMS still exists with African Americans using the service less often. Patients should be encouraged to use EMS services and decrease delay in presentation which can results in higher rates of intervention.

Temporal Trends and Future Predictions of Regional EMS System Utilization Using Statistical Modeling.

Trends in utilization of Emergency Medical Services (EMS) systems can be used to extrapolate future use of an EMS system, which will be valuable for the budgeting and planning of finances and resources. The best model for incorporation of seasonal and regional fluctuations in utilization to predict future utilization is unknown. Authors aimed to trend patterns of utilization in a regional EMS system to identify the needs of a growing population and to allow for a better understanding of how the EMS system is used on a basis of call volume and frequency of EMS transportation. The authors then used a best-fitting prediction model approach to show how the studied EMS system will be used in future years. Systems data were retrospectively extracted by using the electronic medical records of the studied EMS system and its computer-assisted dispatch (CAD) database from 2010 through 2017. All EMS dispatches entering the system's 9-1-1 public service access point were captured. Annual utilization data were available from 2010 through 2017, while quarterly data were available only from 2013 through 2017. The 9-1-1 utilization per capita, Advanced Life Support (ALS) utilization per capita, and ALS cancel rates were calculated and trended over the study period. The methods of prediction were assessed through a best-fitting model approach, which statistically suggested that Additive Winter's approach (SAS) was the best fit to determine future utilization and ALS cancel rates. Total 9-1-1 call volume per capita increased by 32.46% between 2010 and 2017, with an average quarterly increase of 0.78% between 2013 and 2017. Total ALS call volume per capita increased by 1.93% between 2010 and 2017. Percent ALS cancellations (cancelled en route to scene) increased by eight percent between 2010 and 2017, with an average quarterly increase of 0.42% (2013-2017). Predictions to end of 2019 using Additive Winter's approach demonstrated increasing trends in 9-1-1 call volume per capita (R2=0.47), increasing trends of ALS utilization per capita (R2=0.71), and increasing percent ALS cancellation (R2=0.93). Each prediction showed increasing future trends with a 95% confidence interval. The authors demonstrate paramount per capita increases of 9-1-1 call volume in the studied ALS system. There are concomitant increases of ALS cancellations prior to arrival, which suggests a potential burden on this regional ALS response system.

Re-contact demographics and clinical characteristics of diabetic patients treated for a hypoglycaemic episode in the pre-hospital environment: a rapid literature review.

Introduction:Diabetes mellitus has been referred to as an ‘epidemic’ and the World Health Organization reported 422 million people with the disease in 2014. Hypoglycaemia is common among emergency presentations, yet understanding around the utilisation of emergency medical services (EMS) for this is incomplete.Ambulance service referral pathways for those suitable to be treated in the community have been developed as a means of managing this growing demand. However, there is limited evidence to suggest how they should be constructed or implemented.The aim of this review was to examine patients who re-contacted the health services following EMS non-transport for a hypoglycaemic episode and to determine if risk factors could be identified.Methods:Medline/PubMed and CINAHL online databases were searched for papers published between 1998 and 2018 relating to re-contacts following an interaction with EMS. The Cochrane Library online database was also searched, as well as manual searches from key journals. Relevant clinical manuals, guidelines and specific grey literature were also hand searched.Results:After duplicates were removed, 260 articles were identified, with 41 selected for full review. These were then reduced by excluding those that did not provide any data on re-contact rates/demographics. The remaining papers were then assessed using the Critical Appraisal Skills Programme (CASP) appraisal tool and those identified as of low quality were removed. This produced 17 papers for final inclusion.Conclusion:The literature demonstrates that ambulance clinicians can appropriately treat hypoglycaemia in the community and identify those requiring further assessment at emergency departments. However, due to the very nature of diabetes, repeat episodes will and do occur, regardless of community or emergency department management, but these are rarely in the acute phase. Some groups are higher risk, but thorough holistic assessment is vital for identifying those suitable for community management.

Factors Affecting the Utilization of Emergency Medical Services by Age Group among Elderly Individuals

Factors Affecting the Utilization of Emergency Medical Services by Age Group among Elderly Individuals

Abstract 5: Prevalence, Characteristics, and Accuracy of Stroke Diagnosis for Scene Transports to a Comprehensive Stroke Center by Helicopter Emergency Medical Services: A One Year Retrospective Evaluation

Ischemic strokes affect 795,000 people per year in the US and are a major cause of long-term disability and mortality. These patients are often assessed by EMS at the scene and transported to appropriate centers of care for further evaluation and treatment. Utilization of helicopter emergency medical services (HEMS) greatly improves access to comprehensive stroke centers (CSC). However, the number of patients who have been air lifted from scene calls to a single CSC for suspected stroke with a non-stroke final diagnosis remains unclear. In this retrospective observational study, we aim to determine the volume and demographics of patients with suspected stroke and subsequently transported via HEMS from scene to a CSC. Between January 1, 2017 and December 31, 2017, 717 prehospital records of patients airlifted by a two-helicopter program from scene calls to a single CSC were analyzed for stroke alerts. Final diagnosis was determined from EMR. No patients were excluded. Parameters such as patient home county, age, race, sex, and transport times were collected from prehospital charts. Home counties were categorized according to the CDC Urban-Rural Classification Scheme for Counties. Counties were classified as one of four urban-rural designations: Large Central Metro, Large Fringe Metro, Medium/Small Metro and Nonmetro. In 2017, of the 717 airlifted patients, 37 patients were airlifted from on-scene calls and suspected of stroke. Demographics of these suspected stroke patients include 49% African American (18), 49% White, Non-Hispanic (18) and 2% White, Hispanic (1). Most airlifted patients were home to rural counties (84%, 31) indicated as “Nonmetro”. Of the 37 patients suspected of stroke by EMS, 32% were diagnosed with ischemic stroke (12), 19% were diagnosed with intracerebral hemorrhage (7) and 8% were diagnosed with transient ischemic attack (3). 41% of the suspected ischemic stroke patients had a final diagnosis which was not stroke related and were admitted for other medical conditions (15). Demographics of the 15 stroke mimics included 47% African American (7) and 53% White, Non-Hispanic (8). Our analysis revealed that 84% (31/37) transported to a CSC via HEMS from scene calls suspected of stroke were home to rural counties, classified as “Nonmetro”. Patients in rural counties are inherently at risk for increased stroke mortality due to geographic isolation from centers of higher stroke care. In our sample, HEMS appears to be most utilized by the rural population for stroke care and may help address the lack of access to advanced stroke services. Demographics did not vary between patients with true strokes and stroke mimics. Of all suspected stroke patients airlifted from scene to a CSC, 22 were true strokes and 15 were stroke mimics. Although this study has numerous limitations including small sample size, retrospective methodology, and from a single CSC, it suggests that HEMS may serve to equalize the barriers to access for timely and definitive stroke interventions in rural populations. Future analyses should consider including multiple CSCs and HEMS programs to determine the generalizability of these findings.

Utilization History of Emergency Medical Services Among West Virginia Drug Overdose Decedents

Utilization History of Emergency Medical Services Among West Virginia Drug Overdose Decedents

The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)

BackgroundPrior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia.MethodsWe conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years.ResultsBetween May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men.ConclusionsThere is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.

Disaster Planning for the Urban Homeless Population in the United States

Introduction:Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1Methods:A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.Results:Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.Discussion:Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.

Trends and barriers of emergency medical service use in Addis Ababa; Ethiopia

BackgroundThe increasing burdens of trauma and time sensitive non-communicable disease in Addis Ababa necessitate a robust emergency medical care system. The objectives of this study were to assess the proportion of patients who used emergency medical services (EMS) and to quantitatively and qualitatively assess barriers to EMS utilization in Addis Ababa.MethodsA cross-sectional quantitative and qualitative study was conducted on patients who visited five selected public hospitals in Addis Ababa with specific emergency conditions. Data were collected by trained nurses using a standardized questionnaire. Descriptive statistics and logistic regression was done on cleaned and coded quantitative data using SPSS version 20. Thematic analysis was performed on the qualitative data. Ethical approval was obtained prior to the study.ResultsA total of 429 participants completed the survey with a non-response rate of 5.1%. The most common emergency scene was the home (n = 222, 51.8%) followed by road side (n = 159, 37.1%). Only 87(20.3%) patients arrived by ambulance, though a majority (53.4%) of participants recalled at least one access number for an ambulance service and 96.3% stated that ambulances were an important part of the continuum of care for their emergency condition. A higher proportion of participants believed that ambulance transportation is generally safer (n = 341, 78.5%) and faster (n = 298, 69.5%) than emergency transport by taxi or private car. Patients who were non-Amharic speaking had a negative association with arriving by ambulance (P = 0.001, OR 0.47; C.I, 0.31, 0.71). The median acceptable time to get the ambulance (according to respondent’s perception) was 16 min but actually perceived ambulance waiting time was 40 min.ConclusionEMS utilization in Addis Ababa is relatively low and emergency patients are instead being transported by taxi or private car. Perceived longer ambulance waiting time and language barriers may have contributed for low utilization. Findings of this study suggest an action to improve access by improving ambulance availability while simultaneously enhancing the public’s knowledge and perception of EMS in Addis Ababa.

MON-169 Characteristics of Patients with Recurrent EMS Utilization for Hypoglycemia in a Large Urban System

Background: Hypoglycemia is a life-threatening condition that frequently results in utilization of Emergency Medical Services (EMS). After prehospital treatment, many patients refuse to be transported to the hospital. Understanding the characteristics of hypoglycemic patients with high EMS utilization may help providers optimize resource allocation. Objective: To describe the demographics and clinical characteristics of patients who utilize EMS for hypoglycemia and to determine which factors are associated with recurrent EMS utilization. Methods: We performed a retrospective chart review of prehospital care records from the municipal EMS provider in a large city. All patients who received prehospital treatment for hypoglycemia (oral glucose, parenteral dextrose, or intramuscular glucagon) over a one-year period were identified. Patients with no recorded finger-stick glucose or an initial glucose level greater than 70 mg/dl were excluded, as were those in cardiac arrest and under 5 years of age. Extracted information included demographics, prehospital treatment, disposition, and the number of subsequent EMS utilizations within 365 days. We obtained median income data from the U.S. Census Bureau and the overall prevalence of diabetes in the city from the public health commission. Results: We identified 549 subjects, mean age 55 years (range 9 to 104, 65% male). The mean minimum glucose level was 44 mg/dl with standard deviation (SD) of 15. For treatment, 69% of patients received oral glucose, 26% received parenteral dextrose, 3% received glucagon, and 2% received more than one medication. At the index visit, 81% of patients accepted hospital transport and 19% refused. The rate of recurrent EMS utilization for hypoglycemia was 10%, and 3% of patients had three or more utilizations within the year. The mean blood glucose at the index visit was 38 mg/dl (SD 15) for patients with multiple EMS utilizations and 44 mg/dl (SD 14) in those with only one EMS visit (P=0.006). Repeat utilizers were more likely to have received medications other than oral glucose at the index visit, 51% versus 28% (P<0.001). Age, gender, median zip code income, and disposition were not associated with recurrent EMS utilization. The overall incidence of hypoglycemia requiring EMS treatment relative to the estimated diabetic population was 0.84% per year. Conclusion: A low proportion of patients utilizing EMS for hypoglycemia had subsequent EMS visits within 365 days. Those who did had lower blood glucose levels at the index visit and were more likely to receive prehospital treatment with medications other than oral glucose. Demographic characteristics were less useful at predicting repeat utilization. Refusing transport to the hospital after EMS treatment for hypoglycemia did not raise a patient's risk of recurrent utilization, suggesting that EMS treat-and-release protocols may be appropriate for some patients.

Helicopter Emergency Medical Services Utilization

BackgroundThe decision to utilize HEMS is a complex process that involves many considerations. Professional associations and agencies have published guidelines to assist providers with decision making for the utilization of helicopter transport. Study ObjectiveDetermine if requests for HEMS align with recently published utilization guidelines. Study DesignA retrospective chart review was performed during a six-month period. Reviewers versed in Wisconsin HEMS Utilization, NAEMSP, and CAMTS guidelines determined if transport criteria were met. Charts were categorized according to whether or not criteria for each set of recommendations were followed. Results514 charts were reviewed; 439 consisted of completed patient transports. CAMTS, NAEMSP, and WI HEMS guidelines satisfied 85.4%, 83.4%, and 53.1% of requests, respectively. Statistically significant differences existed when comparing rates meeting criteria between WI HEMS and CAMTS and between WI HEMS and NAEMSP guidelines (p-value <0.0001). This was true in all subgroups except STEMI, which did not show significant difference. No difference existed between rates for CAMTS and NAEMSP guidelines in any group. ConclusionSignificant difference between Wisconsin HEMS utilization versus NAEMSP guidelines, and between Wisconsin HEMS utilization and CAMTS guidelines in all subgroups except STEMI patients exist. No statistically significant difference existed between NAEMSP and CAMTS guidelines.