Medical Emergency Department Research Articles

Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge

BackgroundEffective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients.MethodsA qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant group’s workplace. Grounded theory techniques were used to guide coding and analytic theme development.ResultsAnalyses resulted in four overarching themes: valuing the program’s utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an “active” referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partner’s program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services.ConclusionResults revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.

Improving myocardial infarction emergency care: a joint intervention study of the Berlin Brandenburg Myocardial Infarction Registry (B2HIR) and emergency medical services (QS-Notfall)

Abstract Background Rapid myocardial reperfusion is needed to improve clinical outcome after a ST-elevation myocardial infarction (STEMI). Missed early explicit STEMI diagnoses were shown to unfavourably delay STEMI care. A networked approach between emergency medical systems (EMS) and cardiology hospital departments is useful to establish early valid pre-hospital STEMI diagnoses. Purpose The publicly funded "QS-Notfall" joint health services research study intended to improve STEMI care in Berlin (BE) and Brandenburg (BB) by implementing pre-hospital tele-ECG transmission and online ECG training for EMS personnel. Methods As part of B2HIR, 21 cardiology hospital departments (19 in BE, 2 in BB) together with EMS (BE firefighters and regional BB EMS), supported by the Berlin Medical Chamber, established 2 joint interventions to accelerate STEMI care. All EMS and hospitals implemented GDPR compliant telemedical transmission and structured handling of pre-hospital ECGs from patients with chest pain. In addition, we developed an ECG e-learning for emergency physicians and EMS personnel ("STEMI einfach erkennen") and communication between EMS and hospitals was enforced. Patients with acute myocardial infarction (AMI) and symptom onset ≤24h were enrolled. Symptom onset, first medical contact, time of hospital admission ("door"), time of guidewire passage into the coronary artery (reperfusion), and respective care delays were assessed. First obtained ECGs were blindly validated by 3 expert cardiologists. We compared a reference period to a 12-month intervention period with regard to care delays. In addition, STEMI care was analyzed according to the actual use of telemedical ECG transmission and according to the validity of ECG diagnoses. Results N=7303 cases were enrolled (reference period 3657, intervention period 3646, age 66.9y, 27.1% female, STEMI 49.4%). The usage of ECG transmission varied notably between hospitals (7.5%–74%). Tele EMS ECG usage in STEMI was associated with shorter door to reperfusion time (BB 11min, p<0.04, BE 12min, p<0.001) compared to STEMI care w/o ECG transmission. The difference was more pronounced during hospital off-hours (BB 30min, p=0.003 and BE 14min, p<0.001). An unmistaken EMS STEMI diagnosis related to a shorter door to reperfusion time (BE: by 106min; BB: by 49min) compared to an unsettled STEMI diagnosis (p<0.001). The rate of ECG transmission for STEMI patients in BE was 21.4%, in BB 55.7%. Accordingly, we found no significant difference in STEMI door to reperfusion delays between the reference period and the intervention period in BE (+1min) and a shorter reperfusion delay (by 11min) in BB (p=0.049). Conclusions The universal implementation of a joint intervention to improve STEMI care in a complex system of various EMS and hospital departments is challenging. Telemedical ECG transmission and an unmistaken early STEMI diagnosis are associated with a significantly shorter time delay to myocardial reperfusion.

Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease–2019 pandemic

PurposeThis study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. MethodsWe examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. ResultsThe overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. ConclusionsWe underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.

Penolakan Pasien Dalam Keadaan Darurat Karena Belum Divaksin

Introduction: Criminal liability arises when the damage caused by the negligence of the hospital's medical staff meets three factors: The three factors are the presence or absence of negligence, wrongdoing, and other relevant sanctions. In addition, under the criminal justice system, if a company commits a crime, its owner can be jailed or fined.Purposes of the Research: This study aims to analyze and explain the refusal of patients in an emergency situation because they have not been vaccinated against the Health Law Number 36 of 2009 and to analyze and explain the legal policy mechanism taken for patients in an emergency situation because they have not been vaccinated who are referred to the hospital.Methods of the Research: The type of research used is normative, which is focused on providing explanations that explain a particular category. Approach the problem of the statute approach (statute approach) and the conceptual approach (conceptual approach). The collection of legal materials through primary legal materials is then free from secondary legal materials. The processing and analysis of legal materials is described in a qualitative way with the aim of describing the findings in the field.Results of the Research: The refusal of patients in an emergency situation because they have not been vaccinated is contrary to the Health Law No. 36 of 2009. In which the Law of the Republic of Indonesia No. 36 of 2009 concerning Health has regulated the refusal of health services by hospitals. The legal policy mechanism that is taken for emergency patients because they have not been vaccinated is that they still pay attention to the existing legal rules for both patients and for the hospital, by prioritizing patient safety first, all patients are entitled to outpatient medical services, inpatient care, or emergency department at a health facility. This is regulated in the Law of the Republic of Indonesia number 29 of 2004 concerning medical practice, Law of the Republic of Indonesia number 36 of 2009 concerning health. The refusal to take care of the patient's health is ignored by medical institutions, because it can worsen the patient's condition.

117 Patient and Emergency Department Medical Staff Factors Associated With Abdominal Computed Tomography Scan Utilization in United States Emergency Departments to Evaluate Adults With Diarrhea

117 Patient and Emergency Department Medical Staff Factors Associated With Abdominal Computed Tomography Scan Utilization in United States Emergency Departments to Evaluate Adults With Diarrhea

Pediatric Patients Discharged After Transfer to a Pediatric Emergency Department: Opportunities for Telehealth?

Interemergency department pediatric transfers can be costly, involve risk, and may be disruptive to patients and families. Telehealth could be a way to safely reduce the number of transfers. We made an estimate of the proportion of transfers of pediatric patients to our emergency department (ED) that may have been avoidable using telehealth. This was a retrospective analysis of electronic health record data of all pediatric patients (younger than 19 years) who were transferred to a single urban, academic medical center pediatric emergency department (PED) (annual pediatric volume approximately 15,000) between June 1, 2016, and December 29, 2021. We defined transfers as potentially avoidable with telehealth (the primary outcome) when the encounter at the receiving ED resulted in ED discharge and 1) met our definition of low-resource intensity (had no laboratory tests, diagnostic imaging, procedures, or consultations) or 2) could have used initial ED resources with telehealth guidance. Among 4,446 PED patients received in transfer during the study period, 406 (9%) were low-resource intensity. Of the non-low-resource intensity encounters, as many as another 1,103 (24.8%) potentially could have been avoided depending on available telehealth and initial ED resources, ranging from 210 (4.7%) with only telehealth specialty consultation to 538 (7.4%) with imaging and telehealth specialty consultation, and up to 1,034 (23.3%) with laboratory, imaging, and telehealth specialty consultation. Our results suggest that depending on available telehealth and initial ED resources, between 9% and 33% of pediatric inter-ED transfers may have been avoidable. This information may guide health system design and PED operations when considering implementing pediatric telehealth.

Splenic Trauma as a Result of a Road Accident Involving 5 Cases

The conservative treatment of the spleen represents a major advance in the management of splenic trauma because it helps preserve the immune functions of the spleen and avoid complications of unnecessary laparotomy. In our study, we report the cases of patients whose average age is 30 years, who have consulted the medical and surgical emergency department following a public road accident for the management of a polytrauma resulting in chest-abdominal-pelvic injury. Etiologies were dominated by road accidents, followed by falls, and then assaults. The poly traumatic context was the most common. Two patients were hemodynamically unstable. Computed tomography was performed in all patients and showed splenic parenchymal destruction, classified grade V of the AAST classification. Fluid intraperitoneal effusion of great abundance, associated with a hemooperitone in splenic peri. Nonoperative treatment was adopted. Developments were favorable.

Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care?

Social determinants of health (SDOH) have previously been shown to impact orthopedic surgery outcomes. This study assessed whether greater socioeconomic disadvantage in patients undergoing hemiarthroplasty following femoral neck fracture was associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) payments for care. A US nationwide database was queried for hemiarthroplasties performed between 2010 and 2020. Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage reported on a scale of 0-100, was used to compare two cohorts of greater and lesser deprivation. Patients undergoing hemiarthroplasty from high ADI (95% +) were 1:1 propensity score matched to a comparison group of lower ADI (0-94%) while controlling for age, sex, and Elixhauser Comorbidity Index. This yielded 75,650 patients evenly distributed between the two cohorts. Outcomes studied were 90-day medical complications, ED utilizations, readmissions, and payments for care. Multivariate logistic regression models were utilized to calculate odds ratios (ORs) of the relationship between ADI and outcomes. p Values < 0.05 were significant. Patients of high ADI developed greater medical complications (46.74% vs. 44.97%; OR 1.05, p = 0.002), including surgical site infections (1.19% vs. 1.00%; OR 1.20, p = 0.011), cerebrovascular accidents (1.64% vs. 1.41%; OR 1.16, p = 0.012), and respiratory failures (2.27% vs. 2.02%; OR 1.13, p = 0.017) compared to patients from lower ADIs. Although comparable rates of ED visits (2.92% vs. 2.86%; OR 1.02, p = 0.579), patients from higher ADI were readmitted at diminished rates (10.57% vs. 11.06%; OR 0.95, p = 0.027). Payments were significantly higher on the day of surgery ($7,570 vs. $5,974, p < 0.0001), as well as within 90days after surgery ($12,700 vs. $10,462, p < 0.0001). Socioeconomically disadvantaged patients experience increased 90-day medical complications and payments, similar ED utilizations, and decreased readmissions. These findings can be used to inform healthcare providers to minimize disparities in care. III.

Relationship of pre-hospital clinical status with behavior of intracranial pressure and outcomes in pediatric patients with severe head trauma.

Introduction: The prehospital phase of the management of pediatric severe traumatic brain injury may have a direct influence on the results. Objective: To evaluate the influence of prehospital variables on intracranial pressure and the results in pediatric patients with severe TBI. Method: A descriptive study of 41 pediatric patients who were admitted to the medical emergency department and later admitted to the pediatric intensive care unit due to severe head trauma was carried out between January 2003 and December 2018. Results: children aged 5-17 years predominate, and the highest number of cases were received between 0-3h at the neurotrauma center. Of the 41 cases, 27 arrived with a non-expedited airway and hypoxia was verified upon arrival by pulse oximetry. A correlation was observed between arterial hypotension on admission and elevated intracranial pressure in 9 of 15 children (60%) and in the deceased (40%). Discussion: Clinical conditions, oxygenation, arterial hypotension, and treatment in the prehospital phase may influence the state of intracranial pressure and other intracranial variables in pediatric patients with severe head injury.

Performance of admission pathways within acute medicine services: Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021

Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services.152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating organisational structure questionnaire and patient-level data over a pre-defined 24-hour period in June 2022. Clinical quality indicators were: Early Warning Score (EWS) measurement within 30 min of hospital arrival; clinician assessment within 4 h; assessment by consultant physician within 6 h (daytime) or 14 h (night-time). Results were compared with 2019, 2020, 2021.7293 sequential patients were included (and compared with 19,817 patients across 2019–2021). In 2022, 69% of patients (95%CI 67.7–69.9%) had an EWS documented within 30 min. 79% of patients (95%CI 77.8–79.7%) were reviewed by a clinical decision maker within 4 h of hospital arrival. Patients assessed in Same Day Emergency Care services were more likely to meet this target than those assessed in Acute Medical Units or Emergency Departments (OR 2.4, 95%CI 2.02–2.87, p<0.001). Overall, 50% of patients received consultant physician review within the target time (3065/6161, 95%CI 48.5–51.0%); performance varied with time of arrival and location of initial assessment. Performance against all three clinical quality indicators was lower than 2019, 2020 and 2021 (p<0.001 for all).Performance against all quality indicators within acute medicine services is deteriorating. However, performance in Same Day Emergency Care Units is greater than in Acute Medical Units or Emergency Departments.

Ambulatory Management of Urinary Tract Infections in Children: Experience of the Pediatric Medical Emergency Department in Rabat

The aim of the study is to describe the clinical epidemiological characteristics and bacteriological profile of UTIs in infants and children, to determine the main risk factors for the occurrence of UTIs, and to identify the causes of UTIs urinary tract infections, to compare the interest of CRP and let procalcitonin assays for the diagnosis of febrile urinary tract infections as well as the interest of imaging (renal scintigraphy and ultrasound of the urinary tree) in the diagnosis of febrile urinary tract infections. This observational study of a cohort of 169 patients (children aged more than 28 days, 119 girls and 40 boys) conducted in the pediatric emergency department of the children's hospital of the university hospital of Rabat over a period of 6 months. The diagnosis of UTIs is based on the detection of germs in the urine, either indirectly by urine dipstick or by urine culture. However, the interpretation of microbiological results can be tricky: an inappropriate urine collection technique, particularly in neonates and young children, is a pitfall that the clinician must take into account to avoid misdiagnosing UTI, usually by over-diagnosis. The location of high UTI involving the renal parenchyma or low UTI limited to the bladder, which determines the morbidity of the infection, the therapeutic management and the imaging work-up, remains a matter of debate. DMSA renal scintigraphy, the reference examination in the case of high UTI, cannot be recommended as a first-line examination because of its cost and the practical difficulties of performing it. Biological markers of inflammation (leucocytosis, CRP, procalcitonin) do not always allow the diagnosis of ANP to be made with certainty.

Explanatory factors relating to medication error reporting among emergency medicine clinicians: A qualitative study

Objectives We used an in-depth qualitative approach to investigate the factors that contribute to medication error (ME) reporting among emergency department (ED) clinicians. More specifically, we explored the explanatory factors relating to underreporting by the different staff involved in ED medication management, the underlying processes involved in clinician and manager responses to MEs, and programmatic factors that impede and facilitate ME reporting. Methods We applied a purposive maximum variation sampling to recruit interview participants in nursing, medical, and pharmacy roles. We conducted semistructured interviews based on an interview guide. We performed a thematic analysis of all data and developed a general content model. Results The developed model shows how the series of extracted themes—norms of reporting, reporting culture, and evaluation and feedback—affect one another. The theme norms of reporting were mainly influenced by clinicians’ knowledge and attitudes. The theme of reporting culture directly affected ME reporting. Evaluation and feedback affected all factors that contributed to ME reporting. Participants’ intention to report was mainly affected by the extent to which the reporting led to an obvious outcome. Conclusions The comprehensive model of ME reporting provides guidance for healthcare leaders who strive to increase such reporting. The model encompasses broad concepts that are not limited to ME reporting and may be applicable to improving reporting for all kinds of medical errors.

Medical emergency department triage data processing using a machine-learning solution

Over the years, artificial intelligence has demonstrated its ability to overcome many challenges in our day-to-day life. The evolution of it inquired more studies about Machine Learning possible solutions for different domains, including health care. The increasing demand for artificial intelligence solutions has brought accessibility to loads of data, including clinical data. The availability of medical records facilitates new opportunities to explore Machine Learning models and their abilities to process a significant amount of data and to identify patterns with the purpose of solving a medical problem. Understanding the applicability of artificial intelligence on this type of data has to be a compelling aim for emergency medicine clinicians. This paper focuses on the general clinical problem of the complex correlation between medical records and later diagnosis and, especially, on the process of emergency department triage which uses the Emergency Severity Index (ESI) as triage protocol. This study presents a comparison between three different Machine Learning models, such as Logistic Regression, Random Forest Tree and NN-Sequentail, with the purpose of classifying patients with an emergency code. We conducted four experiments because of imbalanced data. A web-based application was developed to improve the triage process after our theoretical and exploratory results. Overall, in all experiments, the NN-Sequential model had better results, having, in the first experiment, a ROC-AUC score for each ESI emergency code of: 0.59%, 0.76%, 0.71%, 0.78% 0.64%. After applying methods to balance the data, the model yielded a ROC-AUC score for each emergency code of 0.72%, 0.75%, 0.69%, 0.74%, 0.78%. In the last experiment consisting of a three-class classification problem, the NN-Sequential and Random Forest Tree models had similar metric outcomes, and the NN-Sequential algorithm had a ROC-AUC score for each emergency code of: 0.76%, 0.72%, 0.84%. Without any doubt, our research results presented in this paper endorse this tremendous curiosity in Machine Learning applications to enrich aspects of emergency medical care by applying specific methods for processing both medical data and medical records.

Integrating Psychiatric Services in the Emergency Room to Improve Patient Care by Using Quality Improvement Methods.

Prolonged length of stay in emergency departments (EDs) for patients with a psychiatric chief complaint is a widespread problem. Prolonged stays can lead to adverse outcomes and poor quality of care. We sought to improve quality of care for patients in the medical ED who needed psychiatric care. To identify the areas of weakness, we queried the ED staff via an online survey about the perception of the challenges working with our Comprehensive Psychiatric Emergency Program (CPEP), which is located adjacent to and works closely with the medical ED providing psychiatric consultation. We identified several action steps and used the Plan-Do-Study-Act methodology for implementation. We reported a reduction in time to complete consultations and improved communication between CPEP and the medical ED staff.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters

To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic. Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters. Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19. We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment.

Management of Accidental Ingestions of Caustic Products in Emergency Departments in Dakar : About 31 Cases

Background: Caustics are corrosive substances whose ingestion causes tissue damage that can range from mucosal irritation to total necrosis or even perforation of the affected digestive or bronchial segment. Ingestion is often accidental in children and a real public health problem in low and middle income countries, particularly in Africa.&#x0D; Aims: The main objective of this study was to describe the epidemiological, diagnostic, therapeutic and scalable aspects of accidental ingestions of caustics in the medical emergency department of the National Children's Hospital Center Albert Royer (NCHCAR) in Dakar.&#x0D; Methods: This is a descriptive and analytical study over a 12-month period, from March 2020 to February 2021. The study population was children aged 0 to 15 years who were seen in consultation or hospitalized following a caustic product ingestion.&#x0D; Results: During the study period, we included 31 children for accidental ingestion of caustics out of a total of 900 hospitalized children, i.e., a hospital frequency of 3.44% (31/900). The mean age of the children was 21.29±13.10 months and the extremes were 8 and 60 months. The age group [12-18 months] was the most represented (25.81%). Boys were predominant (51.61%) with a sex ratio of 1.07. Sodium hypochlorite (bleaching water) was the main product ingested (64.52%); caustic soda concerned 22.58% of children. More than half (77.45%) of the children were symptomatic with mainly digestive signs including oral ulcerations (41.93%) and vomiting (38.71%). The oesogastroduodenal fibroscopy performed in 19 of the 31 children (61.29%) was normal in 14 children (73.68%). Five children had endoscopic lesions of which 2 cases were stage I and 3 cases stage IIa of the Zargar classification. Initial management was exclusively medical with antisecretory drugs (70.97%), analgesics (38.71%) and corticosteroids (35.48%). The evolution was favorable for the majority of patients. One child presented a dysphagia to solids after 4 weeks of evolution treated by endoscopic dilatation. &#x0D; Conclusion: Accidental ingestions of caustics are frequent in emergency departments. They generally affect children under 24 months of age. The management is medical in the uncomplicated forms which are more and more predominant. Prevention is based on education and awareness of the dangers of caustic products.

Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda

Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED. 49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%. 31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X2= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X2= 0.85, p 0.38 vs X2= 8.5, p 0.004 respectively). Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.

CO143 Impact of Investigational, at-Home, Self-Administered, Intranasal Etripamil on the Need for Additional Medical Intervention in Patients with Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia (PSVT) causes economic burden due to a frequent need for medical interventions and emergency department (ED) visits with substantial costs. The NODE-301 study evaluated the efficacy and safety of the novel, fast-acting, investigational intranasal calcium channel blocker etripamil for conversion of PSVT in an at-home setting. This analysis assessed the impact of etripamil on the need for additional medical intervention.

Community paramedicine in Central Oregon: A promising model to reduce non-urgent emergency department utilization among medically complex Medicaid beneficiaries.

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non-urgent care was measured by emergency medicine ED visits and avoidable ED visits. The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76-0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44-0.84) or 2.3 visits saved for every 100 people. Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home-based setting.

Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019: Injury Diagnosis Matrix, Incident Context, and Public Health Considerations.

The epidemic of gun violence in the United States (US) is exacerbated by frequent mass shootings. In 2021, there were 698 mass shootings in the US, resulting in 705 deaths and 2,830 injuries. This is a companion paper to a publication in JAMA Network Open, in which the nonfatal outcomes of victims of mass shootings have been only partially described. We gathered clinical and logistic information from 31 hospitals in the US about 403 survivors of 13 mass shootings, each event involving greater than 10 injuries, from 2012-19. Local champions in emergency medicine and trauma surgery provided clinical data from electronic health records within 24 hours of a mass shooting. We organized descriptive statistics of individual-level diagnoses recorded in medical records using International Classification of Diseases codes, according to the Barell Injury Diagnosis Matrix (BIDM), a standardized tool that classifies 12 types of injuries within 36 body regions. Of the 403 patients who were evaluated at a hospital, 364 sustained physical injuries-252 by gunshot wound (GSW) and 112 by non-ballistic trauma-and 39 were uninjured. Fifty patients had 75 psychiatric diagnoses. Nearly 10% of victims came to the hospital for symptoms triggered by, but not directly related to, the shooting, or for exacerbations of underlying conditions. There were 362 gunshot wounds recorded in the Barell Matrix (1.44 per patient). The Emergency Severity Index (ESI) distribution was skewed toward higher acuity than typical for an emergency department (ED), with 15.1% ESI 1 and 17.6% ESI 2 patients. Semi-automatic firearms were used in 100% of these civilian public mass shootings, with 50 total weapons for 13 shootings (Route 91 Harvest Festival, Las Vegas. 24). Assailant motivations were reported to be associated with hate crimes in 23.1%. Survivors of mass shootings have substantial morbidity and characteristic injury distribution, but 37% of victims had no GSW. Law enforcement, emergency medical systems, and hospital and ED disaster planners can use this information for injury mitigation and public policy planning. The BIDM is useful to organize data regarding gun violence injuries. We call for additional research funding to prevent and mitigate interpersonal firearm injuries, and for the National Violent Death Reporting System to expand tracking of injuries, their sequelae, complications, and societal costs.