National Association Of EMS Physicians Research Articles

Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement

Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve. To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians recommends that EMS systems and agencies: make health equity a strategic priority and commit to improving equity at all levels. assess and monitor clinical and safety quality measures through the lens of inequities as an integrated part of the quality management process. ensure that data elements are structured to enable equity analysis at every level and routinely evaluate data for limitations hindering equity analysis and improvement. involve patients and community stakeholders in determining data ownership and stewardship to ensure its ongoing evolution and fitness for use for measuring care inequities. address biases as they translate into the quality of care and standards of respect for patients. pursue equity through a framework rooted in the principles of improvement science.

Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement

Exsanguination remains the leading cause of preventable death among victims of trauma. For adult and pediatric trauma patients in the prehospital phase of care, methods to control hemorrhage and hemostatic resuscitation are described in this joint consensus opinion by the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.

Guest Editorial: AAENP Releases Position Statement: The Role of Nurse Practitioners in Emergency Medical Services.

Recently, there has been a national discussion about nurse practitioners (NPs) working within emergency medical services (EMS). The National Association of EMS Physicians, the Society for Emergency Medicine Physician Assistants (SEMPA), and most recently, the American Academy of Emergency Nurse Practitioners (AAENP) have all issued position statements on this issue (AAENP, 2022; SEMPA, 2021; Wright et al., 2021). The joint mission should be centered around high-quality patient care, a multidisciplinary team, and elevating the level of NP practice available in the prehospital and interfacility settings. NPs working in prehospital roles can add value to rural, suburban, and urban environments. In rural America, providing adequate EMS response creates challenges for ambulance providers (National Rural Health Association, 2018). Urban EMS programs are already utilizing NPs as a potential solution to augment care delivery within the EMS system in various roles (Sanko et al., 2020). However, NPs face regulatory challenges, limiting or prohibiting more active involvement in the EMS system. According to the American Association of Nurse Practitioners (AANP), NPs in full practice authority states are more likely to practice in rural and underserved areas (AANP, 2022). To enable NPs to contribute more to prehospital care, national health care practice models and state regulators must consider rule changes that strengthen the utilization of NPs in EMS systems. NPs with appropriate training are in an ideal space to support rural EMS systems. In addition, there are barriers to NPs working in EMS leadership roles. One of the most significant barriers is the National Registry of Emergency Medical Technicians (NREMT, 2019) requirement that all paramedics and advanced emergency medical technicians have a physician medical director. This rule becomes problematic in some of the most rural areas of the country that struggle to find medical direction. Although medical directors trained in EMS fellowships may be ideal, the physician-only language written in NREMT's guidelines marginalizes rural health care and prevents qualified NPs from participating in certain levels of medical direction. AAENP (2022) believes that “NPs are uniquely positioned to provide and direct care of the patient within a multidisciplinary EMS system. The AAENP supports utilization of NPs in EMS to the full extent of their licensure, education, and scope of practice based on state and agency regulations.” —Wesley D. Davis, DNP, ENP-C, FNP-C, AGACNP-BC, CEN, FAANP, FAEN Family and Emergency Nurse Practitioner Program Coordinator and Assistant Professor, College of Nursing University of South Alabama Mobile, Alabama —Chivas Guillote, DNP, ENP, FNP, AGACNP, LP Vice President of Clinical Services Harris County Emergency Corps Houston, Texas Guest Editors

Prehospital Surgical Airway Management: An NAEMSP Position Statement and Resource Document

Bag-valve-mask ventilation and endotracheal intubation have been the mainstay of prehospital airway management for over four decades. Recently, supraglottic device use has risen due to various factors. The combination of bag-valve-mask ventilation, endotracheal intubation, and supraglottic devices allows for successful airway management in a majority of patients. However, there exists a small portion of patients who are unable to be intubated and cannot be adequately ventilated with either a facemask or a supraglottic airway. These patients require an emergent surgical airway. A surgical airway is an important component of all airway algorithms, and in some cases may be the only viable approach; therefore, it is imperative that EMS agencies that are credentialed to manage airways have the capability to perform surgical airways when appropriate. The National Association of Emergency Medical Services Physicians (NAEMSP) recommends the following for emergency medical services (EMS) agencies that provide advanced airway management. A surgical airway is reasonable in the prehospital setting when the airway cannot be secured by less invasive means. When indicated, a surgical airway should be performed without delay. A surgical airway is not a substitute for other airway management tools and techniques. It should not be the only rescue option available. Success of an open surgical approach using a scalpel is higher than that of percutaneous Seldinger techniques or needle-jet ventilation in the emergency setting.

Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study

BackgroundPatients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA.MethodsA retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival.ResultsOf 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%.ConclusionThe chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

Correction to: Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular

Correction to: Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners

The National Association of EMS Physicians (NAEMSP) has had a position statement on patient restraint since 2002 (1), which was updated in 2017 (2). This document updates and replaces these previou...

Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement.

* Abbreviations: ALS — : advanced life support BLS — : basic life support EMS — : emergency medical services The National Association of EMS Physicians, along with these coauthoring associations: American Academy of Pediatrics, American College of Surgeons Committee on Trauma, EMS for Children Innovation and Improvement Center, Emergency Nurses Association, and National Association of State EMS Officials and as also endorsed by the National Association of Emergency Medical Technicians, believes that the delivery of high-quality and effective EMS care is dependent on several factors, including but not limited to the presence of the following: Several documents, including previous versions of this joint position statement, the National Model EMS Clinical Guidelines Version 2.2 , the 2018 National EMS Scope of Practice Model , the Clinical Credentialing of EMS Providers , Physician Oversight of Pediatric Care in Emergency Medical Services , Pediatric Readiness in Emergency Medical Services Systems , and core performance measures from the US Department of Health and Human Services Health Resources and Services Administration EMS for Children (EMSC) Program have been developed to lay the foundation of several of the concepts noted above.1–9 Ensuring that EMS providers are properly equipped to perform their clinical duties is an important function of oversight in EMS systems. In the past, this regulatory oversight has been based on the publication of minimum recommended equipment standards, including previous versions of this document.2–4 These efforts have attempted to provide a listing of the minimum items recommended for basic life support (BLS) and advanced life support (ALS) ground ambulances. The field of EMS … Address correspondence to John Lyng, MD, NRP, National Association of EMS Physicians, 4400 College Blvd, Suite 220, Overland Park, KS 66211. E-mail: jlyngmd{at}gmail.com

Role of Emergency Medical Services in Disaster Response - National Association of EMS Physicians Position Statement

This is the official position statement of the National Association of EMS Physicians on the role of emergency medical services (EMS) in disaster response.

Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional

Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional

Physician Oversight of Air-Based Emergency Medical Services: A Joint Position Statement of NAEMSP, ACEP, and AMPA

The National Association of EMS Physicians (NAEMSP®) affirmed the core principles of EMS physician oversight in the position statement Physician Oversight of Emergency Medical Services. [1] That document described the core principles of physician oversight and further defined activities that constitute delivery of EMS. In a subsequent position statement, Physician Oversight of Specialized EMS, NAEMSP® provided further discussion, stating that delivery of EMS in [certain] environments often requires clinical and operational aptitudes that demand both specialized training and specialized oversight. [2] One such environment is delivery of EMS in the air-based EMS (AEMS) setting, including helicopter and fixed wing transport vehicles. Recognizing the importance of providing focused guidance on the topic of physician oversight of air-based EMS, NAEMSP®, the American College of Emergency Physicians (ACEP), and the Air Medical Physicians Association (AMPA) collaborated to write this document.

Out with the Old and in With the New: Deimplementation in Emergency Medicine.

Much of emergency medicine care and quality standards are rooted in evidence-based guidelines. The Society for Academic Emergency Medicine (SAEM) and the journal Academic Emergency Medicine through publications, conferences, and various initiatives have encouraged the emergency medicine community to create and disseminate evidence-based guidelines. New and updated guidelines must also be implemented into practice. Increasing numbers of publications in this journal and elsewhere are shining light on how the theories and frameworks of implementation science can increase the uptake, reach, and sustainability of evidence-based guidelines in emergency medicine.

Code of Ethics for EMS Physician Medical Directors

Jointly submitted and approved by the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP), and the Air Medical Physician Association (AMPA).EM...

Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement

The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of the trauma patient in both the prehospital and hospital setting.

Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP

Background Millions of patients receive medications in the Emergency Medical Services (EMS) setting annually, and dosing safety is critically important. The need for weight-based dosing in pediatric patients and variability in medication concentrations available in the EMS setting may require EMS providers to perform complex calculations to derive the appropriate dose to deliver. These factors can significantly increase the risk for harm when dose calculations are inaccurate or incorrect. Methods We conducted a scoping review of the EMS, interfacility transport and emergency medicine literature regarding pediatric medication dosing safety. A priori, the authors identified four research topics: (1) what are the greatest safety threats that result in significant dosing errors that potentially result in harm to patients, (2) what practices or technologies are known to enhance dosing safety, (3) can data from other settings be extrapolated to the EMS environment to inform dosing safety, and (4) what impact could standardization of medication formularies have on enhancing dosing safety. To address these topics, 17 PICO (Patient, Intervention, Comparison, Outcome) questions were developed and a literature search was performed. Results After applying exclusion criteria, 70 articles were reviewed. The methods for the investigation, findings from these articles and how they inform EMS medication dosing safety are summarized here. This review yielded 11 recommendations to improve safety of medication delivery in the EMS setting. Conclusion These recommendations are summarized in the National Association of EMS Physicians® position statement: Medication Dosing Safety for Pediatric Patients in Emergency Medical Services.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Abstract 412: Chance of Survival Decreases Within 10 Minutes of Transport in Trauma Patients Receiving Preospital Cardiopulmonary Resuscitation

Introduction: Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. The joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposes stopping cardiopulmonary resuscitation (CPR) more than 15 minutes after TCA. However, with advances in resuscitation strategies, recent published data show improved outcomes. Data supporting TCA’s critical time limit is lacking. Hypothesis: We studied whether longer transport time is associated with poor outcomes in TCA. Methods: Retrospective review from the Japan Trauma Data Bank (2004-2017). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale score (AIS) ≥ 3 trauma and CPR performed during the transport. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing survival data. Primary outcome was the association between transport time and survival in patients with no vital signs at arrival. For secondary outcomes, survival between penetrating injury/blunt injury and no vital signs (Revised Trauma Score [RTS] = 0)/any vital sign (RTS > 0) were compared. For the primary outcome, probability of survival was drawn with risk ratio (reference 15 min) according to transport time. Fisher’s exact test was used to compare secondary outcomes. Results: 5,334 patients were included. Patient characteristics were age (53 ± 21 years), sex (67% male), Injury Severity Score (31 ± 13), blunt trauma (95%), and transportation time (16 ± 15 min). Overall survival rate was 4.5%, survival rate in patients without vital sign at arrival was 1.2%. Survival rate decreased within 10 min ( Figure ). Penetrating trauma increased the chance of survival compared with blunt trauma (7.7% vs. 4.1%, OR 1.9, p = 0.006). Chance of survival increased when the patient had any vital sign at arrival (28% vs. 1.2%, OR 33, p < 0.001). Conclusions: Longer transport time was associated with worse outcome, supporting the current guideline.

Medical Protocols

Several years ago, the Commission on Accreditation of Medical Transport Systems (CAMTS) Board of Directors established a medical protocol committee composed of the physicians on the board representing the American Academy of Pediatrics, the Association of Critical Care Transport, the American College of Emergency Physicians, the Air Medical Physician Association, and the National Association of EMS Physicians to review select medical protocols (clinical guidelines) submitted by medical transport systems applying for accreditation. Over the past 20 years, the board of directors has reviewed about 4,000 applications for accreditation that includes a review of the medical protocols. The board's intent with every review is to help programs improve the quality of patient care and safety of their service. The medical protocol committee was formed because during these reviews there were weaknesses identified regarding medical protocols; there were no protocols for certain patient diagnoses that would be transported based on the program's scope of care, and some protocols were not congruent with current medical practice. The committee recognizes physician preferences but provides feedback specific to the protocols reviewed that may indicate deviation from current generally accepted clinical practice and evidence-based medicine (when available). See the study by Evans et al 1 Evans IV Phillips GS Alpern ER et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018; 320: 358-367 Crossref PubMed Scopus (77) Google Scholar for pediatric sepsis. 1 Evans IV Phillips GS Alpern ER et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018; 320: 358-367 Crossref PubMed Scopus (77) Google Scholar Eileen Frazer, RN, CMTE, is the CAMTS executive director. She can be reached at [email protected] and (864) 287-4177.

Non-Auto-Injector Epinephrine Administration by Basic Life Support Providers: A Literature Review and Consensus Process

Anaphylaxis is a life-threatening condition with a known effective prehospital intervention: parenteral epinephrine. The National Association of EMS Physicians (NAEMSP) advocates for emergency medical services (EMS) providers to be allowed to carry and administer epinephrine. Some states constrain epinephrine administration by basic life support (BLS) providers to administration using epinephrine auto-injectors (EAIs), but the cost and supply of EAIs limits the ability of some EMS agencies to provide epinephrine for anaphylaxis. This literature review and consensus report describes the extant literature and the practical and policy issues related to non-EAI administration of epinephrine for anaphylaxis, and serves as a supplementary resource document for the revised NAEMSP position statement on the use of epinephrine in the out-of-hospital treatment of anaphylaxis, complementing (but not replacing) prior resource documents. The report concludes that there is some evidence that intramuscular injection of epinephrine drawn up from a vial or ampule by appropriately trained EMS providers—without limitation to specific certification levels—is safe, facilitates timely treatment of patients, and reduces costs.