Local Emergency Medical Services Research Articles

Community responses and adaptations following the closure of a rural pharmacy and primary care facility.

This study investigates the experiences of one rural community in Central Pennsylvania following the closure of its singular pharmacy and primary health care facility. It aims to understand community members' responses and adaptations to declining health care accessibility and broader implications for rural health policy and practice. Employing a qualitative case study design, researchers conducted 26 in-depth interviews from May to December 2022. Interviews were grounded in a phenomenological approach and focused on participants' perceptions of their community and experiences accessing health care. Data were analyzed thematically following a coding reliability approach. The closure of the health care facilities resulted in significant social and economic impacts, particularly among vulnerable groups, such as older adults, people with disabilities, and working-class families. Participants reported increased reliance on their social support networks to access care, delays in seeking care due to the strain from longer travel distances, and loss of familiar and trusted care providers. We also found an over-reliance on local emergency medical services for routine care. Although the community demonstrated resilience through the use of social networks, some adaptations carried health risks, including delayed care and unmonitored use of alternative remedies. This study highligths theneed for health care policies that address the immediate loss of services and support the social networks and economic stability that rural communities rely on in the absence of local health care facilities. This research contributes insights for policymakers, health care providers, and community leaders working to support rural communities facing similar health care losses.

Expectations of healthcare professionals of community-based telemedicine in emergency medical service

Background In times of demographic change and an immense shortage of qualified personnel in emergency medical services, telemedicine could offer more efficient solutions for better care. Given the community-based nature of emergency services, local communities play an important role. This study explored the expectations of healthcare professionals and volunteers for telemedicine tools in prehospital emergency medicine. Methods This mixed-methods study was conducted in the rural region of Burgenland in Austria with stakeholders of the local emergency medical service in two focus groups (13 participants) and 99 quantitative questionnaires. Results Combining quantitative and qualitative data, we found that a majority of respondents (almost 80%) already experienced basic telemedicine and consider it valuable. In particular, there is a strong expectation for diagnostic support and inquiries related to potential hospitalization. Findings from two focus groups emphasized the importance of cultivating an improved learning culture, developing a specific mindset, and refining soft skills. The optimal telemedicine solution includes a knowledgeable and experienced tele-emergency physician coupled with user-friendly technology. Conclusion To be clear about the expectations of stakeholders, it is essential to involve all stakeholders right from the beginning. The solution should prioritize the integration of existing structures and be seamlessly incorporated into an evolving learning culture, while also fostering the necessary mindsets alongside educational aspects.

Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions.

Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

Stroke Prevention and Management in Rural Georgia: Evaluating the Effectiveness of a Community Paramedicine Program.

Stroke remains a major public health concern in the state of Georgia with high mortality, disproportionately affecting rural and socioeconomically disadvantaged communities. Georgia's age-standardized stroke death rate is 10.8% higher than the national average, and related comorbidities remain elevated in adult Georgians, contributing to higher stroke prevalence. The Georgia Department of Public Health piloted a Community Paramedicine (CP) program in 2 rural counties to improve stroke management, readmissions, and mortality. Various supportive interventions to address barriers to chronic disease management were provided by a local emergency medical service agency for 90days. This study aims to evaluate the effectiveness of the CP care delivery model in improving stroke outcomes among high-risk individuals. CP leverages emergency medical service infrastructure to provide community health services such as home visits, telemedicine, care coordination, education, and access to social support services. The Georgia Hospital Discharge data and Georgia death records were used to measure stroke rehospitalization and deaths at 30, 60, and 90 days post-discharge for stroke. We compared the health outcomes of high-risk individuals who participated in the CP program to those who did not. Multivariable analysis suggested a reduction in stroke mortality rates among the intervention groups in both counties. The CP program demonstrated effectiveness in assisting patients with managing risk factors through medication adherence for conditions such as hypertension, hypercholesterolemia, and diabetes.

응급실 신규간호사의 응급간호 역량별 교육 요구도 분석

Objectives The purpose of this study was to identify the education needs and priorities for emergency nursing competencies of newly employed emergency room nurses, with the aim of using the findings as foundational data for the development of an educational plan to enhance the emergency nursing competencies of newly employed emergency room nurses. Methods This study is descriptive survey research. Subjects were new nurses in emergency room working at re-gional emergency medical centers, local emergency medical centers and local emergency medical service in-stitutions at 26 institutions, and 110 people who understood the purpose of the study and agreed to participate in the study. The data collection period was from June 15 to July 31, 2023, conducted through an online survey through a QR code, and a total of 97 copies were used in the final analysis(88.2% collection rate). As a research tool, a structured self-report questionnaire was used and consisted of a total of 77 questions, including 9 general characteristics, 34 required competency level for emergency nursing competency, 34 perceived competency level for emergency nursing competency. The collected data were analyzed using frequency and percentage, mean and standard deviation, paired t-test, Borich's needs assesment, and The Locus for Focus Model. The priority items from Borich's formula for demand and the items in quadrant 1 of The Locus for Focus Model were examined to determine any redundancy and to establish the priority order of educational needs, distinguishing between top priority and secondary priority. Results The educational needs for reinforcing emergency nursing competencies of newly employed emergency room nurses revealed four top priority items out of 34 (Clinical indicators of deterioration in cardiovascular patient status, Seizure management, Ventilator management, Clinical indicators of deterioration in neurological patient status). Additionally, ten secondary priority items were identified. Conclusions This study identified four top priority items by analyzing the ranking of educational needs to strength-en the emergency nursing competency of new nurses in the emergency room. Accordingly, it is necessary to de-velop strategies for education on top priority items and long-term education on second priority items in order to strengthen the emergency nursing competency of new nurses in emergency rooms.

Multidisciplinary Collaboration Within Air Medical Transport: It Takes a Team.

The success of each air medical transport mission is dependent on the coordinated efforts of communications specialists, aviation personnel, medical crew members, referring hospitals, local emergency medical services, and fire and law enforcement personnel. Expedited, efficient, and safe patient transport is made possible through the collaboration of all the aforementioned disciplines. In this specialized, unpredictable, and high-pressure environment, each entity plays its own crucial role in rapidly delivering critical care directly to the patient in need.

Description of the Public Safety Medical Response and Patient Encounters Within and During the Indianapolis (USA) Spring 2020 Civil Unrest.

This study describes the local Emergency Medical Services (EMS) response and patient encounters corresponding to the civil unrest occurring over a four-day period in Spring 2020 in Indianapolis, Indiana (USA). This study describes the non-conventional EMS response to civil unrest. The study included patients encountered by EMS in the area of the civil unrest occurring in Indianapolis, Indiana from May 29 through June 1, 2020. The area of civil unrest defined by Indianapolis Metropolitan Police Department covered 15 blocks by 12 blocks (roughly 4.0 square miles) and included central Indianapolis. The study analyzed records and collected demographics, scene times, interventions, dispositions, EMS clinician narratives, transport destinations, and hospital course with outcomes from receiving hospitals for patients extracted from the area of civil unrest by EMS. Twenty-nine patients were included with ages ranging from two to sixty-eight years. In total, EMS transported 72.4% (21 of 29) of the patients, with the remainder declining transport. Ballistic injuries from gun violence accounted for 10.3% (3 of 29) of injuries. Two additional fatalities from penetrating trauma occurred among patients without EMS contact within and during the civil unrest. Conditions not involving trauma occurred in 37.9% (11 of 29). Among transported patients, 33.3% (7 of 21) were admitted to the hospital and there was one fatality. While most EMS transports did not result in hospitalization, it is important to note that the majority of EMS calls did result in a transport. There was a substantial amount of non-traumatic patient encounters. Trauma in many of the encounters was relatively severe, and the findings imply the need for rapid extraction methods from dangerous areas to facilitate timely in-hospital stabilization.

PROTOCOL FOR HUMAN EXPOSURE TO OPIOIDS AND CONCENTRATED MEDETOMIDINE USED IN FIELD APPLICATIONS.

Wildlife professionals routinely use potent sedatives and anesthetics when chemically immobilizing wildlife and zoo species in remote environments. Accidental exposure to these prescription veterinary drugs is rare but could be rapidly fatal. Commonly used agents include opioids and α2 adrenoreceptor agonists. These drugs can be reversed with specific antagonists; however, they are often not approved for human use. The protocol created here can be used by wildlife health professionals in a field setting with basic human emergency medical response training in coordination with local Emergency Medical Services (EMS). Key components include, building local relationships between EMS and wildlife professionals, focused EMS training, administering opioid and α2 adrenergic antagonists off label, and local evacuation procedures. This framework could allow wildlife management agencies or zoos to mitigate the risk of human exposures to these commonly used drugs, significantly improving occupational safety in an otherwise high-risk environment.

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

Use of Stroke Alert Sticker in the Field Decreases Time to Acute Interventions for Ischemic Stroke Patients.

BACKGROUND: Stroke is a medical emergency requiring timely intervention to optimize patient outcomes. The only treatments currently Food and Drug Administration approved for acute stroke are intravenous (IV) thrombolytics, which require obtaining specific medical history to be administered safely. This medical history may be overlooked in the prehospital setting or lost during patient handoff between emergency medical services (EMS) personnel and hospital staff, delaying treatment. We evaluated whether utilization of a "stroke alert sticker" by EMS to capture key information in the field would decrease door-to-needle (DTN) time. METHODS: Bright-orange "stroke alert stickers" were disseminated to our local EMS agency to be placed on all suspected stroke patients in the field prompting documentation of key elements needed for timely treatment decisions. The "stroke alert sticker" included time last known well, contact information, presenting symptoms, and relevant medications. We evaluated the impact of the "stroke alert sticker" on acute stroke metrics, including DTN time. RESULTS: The project included 220 consecutive stroke alert patients brought to our comprehensive stroke center by a single EMS agency from May 2021 through February 2022. Twenty-one patients were treated with an IV thrombolytic. Overall "stroke alert sticker" use compliance was 40%; for the subgroup of patients who were given an IV thrombolytic, the "stroke alert sticker" was used 60% of the time. In patients who received an IV thrombolytic, prehospital EMS notification was 100% with "stroke alert sticker" use, compared with 75% without (P = .13). In addition, with "stroke alert sticker" utilization, DTN time was reduced by 20 minutes (31 [11] minutes with sticker vs 51 [21] minutes without, P = .04). CONCLUSION: Utilization of the "stroke alert sticker" significantly improved DTN times compared with patients without the sticker. This evidence supports continued use of the "stroke alert sticker" to improve DTN times and patient outcomes.

Hourly Associations between Heat Index and Heat-Related Emergency Medical Service (EMS) Calls in Austin-Travis County, Texas.

This paper aims to investigate the following research questions: (1) what are the hourly patterns of heat index and heat-related emergency medical service (EMS) incidents during summertime?; and (2) how do the lagged effects of heat intensity and hourly excess heat (HEH) vary by heat-related symptoms? Using the hourly weather and heat-related EMS call data in Austin-Travis County, Texas, this paper reveals the relationship between heat index patterns on an hourly basis and heat-related health issues and evaluates the immediate health effects of extreme heat events by utilizing a distributed lag non-linear model (DLNM). Delving into the heat index intensity and HEH, our findings suggest that higher heat intensity has immediate, short-term lagged effects on all causes of heat-related EMS incidents, including in cardiovascular, respiratory, neurological, and non-severe cases, while its relative risk (RR) varies by time. HEH also shows a short-term cumulative lagged effect within 5 h in all-cause, cardiovascular, and non-severe symptoms, while there are no statistically significant RRs found for respiratory and neurological cases in the short term. Our findings could be a reference for policymakers when devoting resources, developing extreme heat warning standards, and optimizing local EMS services, providing data-driven evidence for the effective deployment of ambulances.

Leading Improvements in Rural Healthcare Through Mobile Simulation

Simulation in Motion – Iowa (SIM-IA) is a high-fidelity simulation education for health care providers throughout Iowa. SIM-IA is administered by the University of Iowa College of Nursing with mobile simulation trucks in Iowa City (east), Des Moines (central), and Sioux City (west). SIM-IA’s goal is to provide simulation continuing education to improve patient outcomes. In year 1, SIM-IA provided 110 sessions for over 2200 providers. Second-year goals include expanding from emergency medical service (EMS) providers to hospital and long-term care facility providers. Major implementation challenges include planning, budgeting, and supplies during COVID-19 pandemic, decentralized simulation staff, fiscal sustainability, and diverse local EMS protocols.

An assessment of information needs and workflows for emergency service providers and caregivers of children with medical complexity

BackgroundThe goal of Project Austin, an initiative to improve emergency care for rural children who are medically complex (CMC), is to provide an Emergency Information Form (EIF) to their parents/caregivers, to local Emergency Medical Services, and Emergency Departments. EIFs are standard forms recommended by the American Academy of Pediatrics that provide pre-planned rapid response instructions, including medical conditions, medications, and care recommendations, for emergency providers. Our objective is to describe the workflows and perceived utility of the provided emergency information forms (EIFs) in the acute medical management of CMC.MethodsWe sampled from two key stakeholder groups in the acute management of CMC: four focus groups with emergency medical providers from rural and urban settings and eight key informant interviews with parents/caregivers enrolled in an emergency medical management program for CMC. Transcripts were thematically analyzed in NVivo© by two coders using a content analysis approach. The thematic codes were combined into a codebook and revised the themes present through combining relevant themes and developing of sub-themes until they reached consensus.ResultsAll parents/caregivers interviewed were enrolled in Project Austin and had an EIF. Emergency medical providers and parents/caregivers supported the usage of EIFs for CMC. Parents/caregivers also felt EIFs made emergency medical providers more prepared for their child. Providers identified that EIFs helped provide individualized care, however they were not confident the data was current and so felt unsure they could rely on the recommendations on the EIF.ConclusionEIFs are an easy way to engage parents, caregivers, and emergency medical providers about the specifics of a care for CMC during an emergency. Timely updates and electronic access to EIFs could improve their value for medical providers.

Effect of shift length on paramedic anxiety

Introduction: Paramedics frequently experience extremely stressful situations. A combination of the unknown, long shifts and witnessing human distress and tragedy can have lasting effects on the psyche of these individuals. The purpose of this study was to determine if there was a difference between anxiety levels experienced by paramedics who work 12-hour shifts and those working 24-hour shifts. It was hypothesised that those required to work longer shifts would experience higher levels of anxiety. Methods: This survey research study measured anxiety experienced by paramedic practitioners (n=78) at three local emergency medical services using the Beck Anxiety Inventory. A binary logistical regression analysis was used to determine whether any results met criteria for significance and to determine the odds ratio for categories that did reach significance. Results: Paramedics who worked 24-hour shifts were significantly more likely to experience moderate-to-severe anxiety than those working 12-hour shifts (P=0.042; OR 0.002). Age affects the likelihood that participants experienced moderate-to-severe anxiety (P=0.028; OR=0.594); as age increases, the likelihood of experiencing moderate-to-severe anxiety decreases significantly. Conclusion: Paramedics who worked 24-hour shifts were significantly more likely to experience moderate-to-severe anxiety than those working 12-hour shifts. Age also affects whether paramedics experience moderate-to-severe anxiety; the older the individual, the better able they are at moderating their anxiety. Emergency medical service administrators are encouraged to reconsider the use of 24-hour shifts. If not already in place, strategies should be developed to assist paramedics and other prehospital care practitioners to recognise and address anxiety and other mental health disorders.

Virtual Rural Trauma Team Development Course: Trying to Zoom in on a Solution.

The COVID-19 pandemic prevented centers from providing in-person interactive training programs such as the Rural Trauma Team Development Course. Adapting the course to a virtual platform is an option, yet little is known regarding the feasibility of using this format. This study aimed to evaluate the feasibility of providing a virtual rural trauma development course during COVID-19. This is a descriptive study of emergency medical technicians, nurses, emergency department technicians, and physicians from four rural community health care facilities and local emergency medical services who participated in a virtual Rural Trauma Team Development Course held in November 2021 which was transformed into a virtual platform using live remote interactive lectures, recorded case-based scenarios, and interactive virtual-based questions. The course was evaluated by the changes instituted at the centers based on program recommendations and a participant survey. A total of 41 participants were studied, of whom 31 (75%) returned the emailed postprogram survey. The majority (>75%) of respondents rated the activity as very good, with course objectives met. All four facilities instituted changes following the program, including enhancing policy and procedures, guidelines, advancing performance improvement triggers, and equipment acquisition. Individual-reported participant satisfaction was very high. The Rural Trauma Team Development Course can be provided virtually and is a feasible option for trauma centers to provide initial trauma management in the rural community in a safe pandemic-restrictive atmosphere.

A Comprehensive Coalition-Based Regional Approach to Pediatric Disaster Planning

Introduction:Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events. To prepare NYC for a large-scale Pediatric Disaster, NYCPDC has worked with an increasing number of providers that initially included only a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include local public health, emergency management and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.Method:The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through repeated discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.Results:The plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing guidelines and templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments including Pediatric and Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists has been provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This initially included pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.Conclusion:The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.The NYCPDC has responded to real time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (including the National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.

Standards of Medical Planning and Response for Emergency Medical Teams During Mass Gatherings: A Systematic Review

Introduction:Mass gathering events (MGE), organized or unplanned, can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. MGEs also have the potential to cause a mass casualty incident. But MGE can also lead to improvements in the organization of local emergency medical services or public health that form the legacy of that MGE. Emergency medical teams (EMTs) could be deployed to ensure health security as a surge in MGE. But these EMTs should be built on guiding principles and core standards. However, to the best of our knowledge, there are no standards on medical planning and response during any type of MGE (e.g., sports, religious, or festivals).Method:A systematic review was performed in accordance with current guidelines, using six databases, namely Medline (via the PubMed interface), Scopus, Embase, Cochrane Library, ScienceDirect, and CINAHL, as well as literature sourced by Google Scholar and The Journal of Prehospital and Disaster Medicine. Studies published on minimum standards or medical planning and response during MGE from 2002-2022, written in English, were selected and assessed for eligibility by two reviewers.Results:From a total of 20,159 articles, 138 were screened, and 32 were assessed for eligibility. Two were only abstracts, and the others did not contain any description of minimal standards available for medical planning or response in different types of MGE.Conclusion:No studies were found that describe any form of standards for medical planning and the response of emergency medical teams in different types of mass gathering events (e.g., sports, religious, festivals). There is a need for minimum standards for emergency medical teams deploying as a surge in mass gathering events.

Commentary on Jones et al.: We must consider emergency medical services data an opportunity for a view into a community.

Jones et al. demonstrate that through hard work and thoughtful review, even disparate data can assist the advancement of public health and public policy across jurisdictions. An emergency medical services industry-led focus on documentation standards and data integration can make this easier and more effective for our patients. Jones et al. have taken on the challenging task of identifying the characteristics of opioid-related incidents (ORI) from emergency medical services (EMS) calls to assess the impact of opioids in Massachusetts. They responded to a legislative mandate to review EMS records by creating a free text search and a five-tier severity cascade where opioid use can be identified, even without overdoses [1]. These researchers demonstrate the need to review all available data despite the fact that Massachusetts [2], like much of the United States, utilizes multiple EMS documentation platforms, written in disparate documentation styles, then aggregated through the National EMS Information System (NEMSIS) [3]. Authors have focused previously upon the use of naloxone to identify a non-fatal overdose [4-6], but many ORI do not receive naloxone [7]. Jones et al. used a free text search for terms in the narrative to point to specific types of ORI. This search function was elegantly designed to go beyond the discrete variables of NEMSIS and search for ORI by intoxicant name and concerning symptoms. Jones et al. have previously demonstrated gender disparity with EMS naloxone administration, indicating why it is vital to use narrative data to identify ORI [8]. The strength of this search and the ORI severity cascade is further demonstrated, as 29% of the opioid intoxications and 36% of all ORI did not receive naloxone. The OTHER ORI allows a broad range of conditions that can factor into the impact of opioid use disorder and serve as a further marker for opportunity for intervention and change. EMS records are the first chapter of the story of nearly every critical patient encounter and assist in the care of vulnerable patients. However, when hospital systems implement an electronic health record they frequently save money by not integrating local EMS data. When embedded in the health-care continuum, EMS data can help to advance public health and public policy. Jones et al.’s multi-tiered approach to ORI is an important step towards realizing this goal. Michael Winter Dailey: Writing—original draft (lead); writing—review and editing (equal). Emma Furlano: Writing—original draft (supporting); writing—review and editing (equal).

Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians.

To quantify geographic disparities in sub-optimal re-triage of seriously injured patients in California. Re-triage is the emergent transfer of seriously injured patients from the emergency departments of non-trauma and low-level trauma centers to, ideally, high-level trauma centers. Some patients are re-triaged to a second non-trauma or low-level trauma center (sub-optimal) instead of a high-level trauma center (optimal). This was a retrospective observational cohort study of seriously injured patients, defined by an Injury Severity Score > 15, re-triaged in California (2009-2018). Re-triages within one day of presentation to the sending center were considered. The sub-optimal re-triage rate was quantified at the state, regional trauma coordinating committees (RTCC), local emergency medical service agencies, and sending center level. A generalized linear mixed-effects regression quantified the association of sub-optimality with the RTCC of the sending center. Geospatial analyses demonstrated geographic variations in sub-optimal re-triage rates and calculated alternative re-triage destinations. There were 8,882 re-triages of seriously injured patients and 2,680 (30.2 %) were sub-optimal. Sub-optimally re-triaged patients had 1.5 higher odds of transfer to a third short-term acute care hospital and 1.25 increased odds of re-admission within 60 days from discharge. The sub-optimal re-triage rates increased from 29.3 % in 2009 to 38.6 % in 2018. 56.0 % of non-trauma and low-level trauma centers had at least one sub-optimal re-triage. The Southwest RTCC accounted for the largest proportion (39.8 %) of all sub-optimal re-triages in California. High population density geographic areas experienced higher sub-optimal re-triage rates.

Preparation of Medical Supply for Prehospital Emergencies and Disasters: An Internet-Based Simulation Drill.

Mass casualties caused by natural disasters and man-made events may overwhelm local emergency medical services and healthcare systems. Logistics is essential to a successful emergency medical response. Drills have been used in disaster preparedness to validate plans, policies, procedures, and agreements, and identify resource gaps. The application of the internet to facilitate the conduct of exercise was still limited. This study aimed to investigate the optimal preparation of medical supplies by medical emergency response teams (MERTs) during emergencies and disasters using an internet-based drill. An internet-based drill based on real-life mass casualty incidents (MCIs) was developed and conducted in Taiwan from June 2017 to July 2018. The drill involved an MCI with 50 events delivered under two scenarios: (1) reduced transfer capacity and well-functioning local healthcare facilities (emergency module); (2) severely reduced transfer capacity and dysfunctional local healthcare facilities (disaster module). For each event, medical supplies commonly prepared by local MERTs in Taiwan were listed in structured questionnaires and participants selected the supplies they would use. Forty-three senior medical emergency responders participated in the survey (responding rate of 47.3%). Resuscitation-related supplies increased from emergency to disaster module (e.g., intubation from 9.1% to 13.9%; dopamine from 3.2% to 5.0%; all p < 0.001). In the subgroup analysis of events with life-threatening injuries, the utilization of resuscitation-related supplies (e.g., intubation from 46.6% to 65.3%; p < 0.001) remained higher in the disaster than in the emergency module. Compared to emergency medical technicians, physicians and nurses are more likely to use intravenous/intramuscular analgesics. The severity of scenarios and the professional background of emergency responders have a different utilization of medical supplies in the simulation drill. The internet-based drill may contribute to optimizing the preparedness of medical response to prehospital emergencies and disasters.