Regional Emergency Medical Services Research Articles

Abstract 16067: The Impact of a Prehospital Mobile Cloud ECG Transmission System on Myocardial Damage and Mid-Term Mortality in Patients With ST-Elevation Myocardial Infarction

Background: Guidelines recommend that the door-to-balloon time (DTBT) should be reduced to ninety minutes or less in patients with STEMI. As such, it is critical that ambulance teams are adequately trained and equipped to identify STEMI utilizing ECG recorders and telemetry when necessary. Aims: This single-center study aims to evaluate the impact of the prehospital mobile cloud 12-lead ECG transmission system (SCUNA ® , MEHERGEN GROUP) on reducing DTBT, myocardial damage, and mortality in STEMI patients. Methods: In June 2018, SCUNA were integrated into the regional emergency medical service (EMS) departments in Uki and Kamimashiki cities in Kumamoto, Japan. We examined and compared door-to-catheterization laboratory time (DTCT), DTBT, peak CK, CK-MB levels, as well as 1-year mortality rates of STEMI cases in the four years before and after the introduction of the SCUNA. From June 2014 to May 2022, a total of 338 STEMI patients were transferred to our institute by ambulances from the two EMS departments. After excluding 29 patients with onset to reperfusion times exceeding 24 hours and 66 patients who were transferred without the use of SCUNA following its introduction, 243 consecutive STEMI patients who underwent emergency percutaneous coronary intervention (PCI) were included in the study. The patients were divided into two groups, 130 patients prior to SCUNA introduction (Pre-SCUNA), 113 patients after SCUNA introduction (Post-SCUNA). Results: There were no significant differences in age, gender, past medical history or Killip classification between the two groups. DTCT, DTBT, and onset to reperfusion time (OTRT) were significantly reduced in the Post-SCUNA group compared to the Pre-SCUNA group (Pre-SCUNA: 40 min vs. Post-SCUNA: 25 min; p < 0.01, 71 min vs. 53 min; p < 0.01, and 201 min vs. 166 min; p = 0.02, respectively). No significant differences were observed between peak CK and CK-MB levels in the two groups. Kaplan-Meier analysis revealed that SCUNA did not improve 30-day and 1-year outcomes compared with the Pre-SCUNA groups. Conclusion: While the prehospital mobile cloud ECG transmission system effectively reduced DTBT, it did not lead to a notable reduction in myocardial damage or mortality rates.

Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models

BackgroundThe regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine...

Comparing Intubation Success Between Flight Nurses and Flight Paramedics in Helicopter Emergency Medical Services

ObjectiveIntubation is a vital skill performed by flight nurses and paramedics. Before flight training, nurses do not routinely intubate and must be trained in proper techniques. Flight paramedics universally train in intubation before flight training and are the primary managers of in-flight airways. The aim of this study was to determine if a difference exists in intubation attempts and success rates between flight nurses and flight paramedics. MethodsA 5-year retrospective chart review was performed from a regional helicopter emergency medical service. Intubation attempts and the success of flight nurses compared with flight paramedics were the primary outcomes. ResultsThree hundred three of 322 cases in which intubation was attempted were successful. Three hundred forty-four total intubation attempts were made. Two hundred seventy-one (88.9%) patients were intubated by paramedics, and 32 (10.5%) were intubated by nurses. Of the 19 unsuccessfully intubated patients, 14 (73.7%) were attempted by a paramedic and 5 (26.3%) by a nurse. Two hundred seventy-seven intubations were successful on the first attempt, 250 (90.3%) of which were performed by a paramedic and 27 (9.7%) by a nurse. ConclusionFlight paramedics performed more intubations with greater success than flight nurses.

Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch—a retrospective, multi-organisational study in the East of England

BackgroundHelicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a ‘general set of criteria with the highest discriminating potential’. However, there have been no published data analyses in the past decade that specifically address this priority, and this priority has been reaffirmed in 2023. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK.MethodsThis retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016–2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥ 50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a > 10% HEMS dispatch rate of all EMS taskings that would result in 10–20 high-utility HEMS dispatches per 24-h period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p < 0.05.ResultsThere were n = 25,491 HEMS dispatches (6400 per year), of which n = 23,030 (90.3%) had an associated AMPDS code. n = 13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n = 8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥ 70% patient contact rate and/or ≥ 70% HLIDD (with a > 10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-h period. This definition derived nine AMPDS codes with high HEMS utility.ConclusionWe have identified nine ‘golden’ AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.

Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation

BackgroundSystems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams, to prioritize interventions and to illustrate the respective implementation context. The present study aimed to explore how systems thinking methods can help decision-makers (1) understand locally specific causes and effects of a key issue and how they are interlinked, (2) identify the most relevant interventions and best fit in the system, and (3) prioritize potential interventions and contextually analyse the system and potential interventions.MethodsA case study approach was adopted in a regional emergency medical services (EMS) system in Germany. We applied systems thinking methods following three steps: (1) a causal loop diagram (CLD) with causes and effects (variables) of the key issue “rising EMS demand” was developed together with local decision-makers; (2) targeted interventions addressing the key issue were determined, and impacts and delays were used to identify best intervention variables to determine the system’s best fit for implementation; (3) based on steps 1 and 2, interventions were prioritized and, based on a pathway analysis related to a sample intervention, contextually analysed.ResultsThirty-seven variables were identified in the CLD. All of them, except for the key issue, relate to one of five interlinked subsystems. Five variables were identified as best fit for implementing three potential interventions. Based on predicted implementation difficulty and effect, as well as delays and best intervention variables, interventions were prioritized. The pathway analysis on the example of implementing a standardized structured triage tool highlighted certain contextual factors (e.g. relevant stakeholders, organizations), delays and related feedback loops (e.g. staff resource finiteness) that help decision-makers to tailor the implementation.ConclusionsSystems thinking methods can be used by local decision-makers to understand their local implementation context and assess its influence and dynamic connections to the implementation of a particular intervention, allowing them to develop tailored implementation and monitoring strategies.

The Role of the Louisiana EMS Designated Regional Coordinator in Emergency Response During 2020/2021 COVID Pandemic and Hurricane Season

Introduction:Post Katrina Louisiana’s Health Department (LDH) used some of the Hospital Preparedness Program (HPP) funding to create a regional Emergency Medical Services liaison position entitled EMS Designated Regional Coordinators (EMS DRC). Regional EMS DRCs work with local pre-hospital agencies, hospital coalitions, and local/state/federal counterparts during the preparedness and response phases of a disaster. This presentation explores the EMS DRCs role during the 2020/2021 COVID pandemic and annual hurricane season.Method:The EMS DRCs were activated at the beginning of the COVID-19 pandemic. EMS agencies across the country were struggling to meet the call volume demand while balancing sick employees. The eleven LA Region 1 EMS agencies reached out to the EMS DRC for assistance. The EMS DRC coordinated with the LA State Health Department to provide surge ambulances to any ambulance agency in need. These units were utilized for COVID response, but once hurricane season hit in both 2020 and 2021 Surge ambulances were quickly transitioned to COVID and Hurricane response.Results:During the initial COVID outbreak, 18 state surge ambulances were divided amongst four agencies. In 2020 Louisiana saw six named storms, one of which caused significant damage. After Hurricane Laura hit in 2020 the EMS DRCs managed 80 Federal surge ambulances stationed across 41 non-congruent hotel shelters. The 2021 COVID response brought another 21 Federal Surge ambulances to the region. Once Hurricane Ida hit that year over 60 surge ambulances got reassigned to six regional EMS agencies for COVID and Hurricane response.Conclusion:The COVID-19 pandemic and subsequent hurricane devastation exposed gaps in EMS response capabilities to response. The EMS DRCs play a significant role in providing continuous care through working relationships with local, state and federal partners

The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course.

Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.

Reasons for Referral of Children aged 0 to 15 years to the Multipurpose Emergency Department of the Mali Hospital

Introduction: A child is defined as “any human being under the age of 18, unless majority is reached earlier due to the legislation applicable to them. In reality, initial care is also found in multipurpose or adult emergency departments. In France (Seine-Saint-Denis), out of 390 children rescued by the Emergency Medical Assistance Service (SAMU) in 2004, 77% of child deaths were medicalized by the Regional Emergency Medical Service (SMUR). all-rounders of the department. As a result, at the hospital in Mali, many children are referred to the emergency department, while there is no pediatrician in the SAU and the technical platform is not well suited to their care,hence the objective of this work.. Methods and Materials: We conducted a prospective, longitudinal study over a period of 12 months from January 1, 2019 to December 31, 2019 at the emergency department of the hospital in Mali. The study involved patients aged zero (0) to fifteen (15) years The parameters studied were socio- demographic and clinical variables Results: During the study period, we collected 458 children aged 0 to 15 out of 6517 visits to the service, i.e. a frequency of 8.12%. The age group of 10 to 15 years was the most representative with 39% of cases. The male sex represented 58% of cases with a sex ratio of 1.36. The patients were uneducated in 10% of the cases, the workers represented 28.8% among the fathers and 54.8% of the mothers were housewives. Children belonging to families with more than three children accounted for 50.9% of cases and 39.5% of patients lived outside Bamako, the capital. Our study shows that 53.9% of patients were admitted between 8 a.m. and 4 p.m., 54.8% of patients came to the service by taxi, vehicle or motorbike and admissions by referral/evacuation represented 60.3% of case. AVP accounted for 48.7% of cases After the initial examination on admission, 36% of patients were classified as category three according to the Clinical Classification of Emergency Patients (CCMU3). Conclusion: The grounds for recourse of children from 0 to 15 years old to the general-purpose SAU of the Hospital of Mali are multiple. Accidents remain the most frequent reason for recourse in the service.

Analysis of severe hand trauma injury frequency during “Munich’s Oktoberfest” within the last 9 years in comparison to years with absence due to the COVID-19 pandemic

IntroductionWithin its 2 week period, the Oktoberfest attracts around 6 million visitors yearly to Munich, Germany. Due to alcohol intake, congested halls, and disorderly activities, numerous accidents occur. Although many hand injuries are observed, the impact of Oktoberfest on severe hand trauma injury frequency is under investigated.Materials and methodsData from the regional emergency medical service (EMS) was analyzed over a 9 year period regarding the frequency of severe hand injuries during the world’s largest fair and compared to the corresponding period in the years 2020 and 2021 where the event was cancelled due to the world-wide COVID-19 pandemic. Additionally, we compared the patient numbers during the same period in one Emergency Department of a level-1-trauma and hand trauma center located close to the venue.ResultsAn exploratory description is made from data collected over a 9 year period (2013–2021) with focus on hand injuries before, during and after the “Oktoberfest”. A total of 4017 hand injuries were allocated to hospitals by EMS. There was an increase in severe hand injuries by 66% during the 2-weeks-Oktoberfest-period compared to years where the Oktoberfest did not take place. Pre-pandemic statistics show an increasing severe hand trauma frequency of 57.5% in September, compared to EMS-referrals during the remanding year.ConclusionThe risk of injuring relevant structures of the hand during Oktoberfest is extremely high as compared to other parts of the body due to beer stein and fall-associated injuries. These injuries can lead to lifelong impairments. Our data are the first that quantifies and pinpoints the risk of severe injury to the hand during Oktoberfest and therefore, it is of great interest for visitors, hand surgeons, paramedics and emergency department healthcare workers.

Опыт работы единого центра диспетчеризации, мониторинга и медицинской эвакуации в составе территориального центра медицины катастроф Свердловской области

Summary. The goal of the study is to show, on the basis of analysis of the experience of the unified center of dispatching, monitoring and medical evacuation in the structure of the Territorial Center for Disaster Medicine of Sverdlovsk region, the efficiency of unified dispatching service, operating on the functional basis in the same information field as the regional emergency medical service. Materials and research methods. Sources of information and materials on the research theme: normative and methodological documents regulating order and organization of the Disaster Medicine Service and emergency medical aid; publications in “Disaster medicine”, “Emergency Medical Aid” journals; reports of heads of joint centers and independent territorial disaster medicine centers. Research methods: analytical, statistical, method of direct observation, method of logical and informational modeling. Research results and their analysis. The work of three departments of unified center of dispatching, monitoring and medical evacuation was analyzed: operative-dispatching department, department of consultation and monitoring of intensive care patients, department of monitoring of ambulance calls. It is concluded that this model of a single dispatch service is financially inexpensive, efficient and can be recommended to the regions of Urals, Siberia and the Far East, where there are strong territorial disaster medicine centers and specialized resuscitation and consultative centers.

An allocation model for emergency medical services based on integrated healthcare during an epidemic

Enhanced virus control and patient treatment outcomes during an epidemic requires flexible and efficient medical services. This research explores an epidemic medical service allocation model from an integrated healthcare perspective, aiming to enhance the overall regional emergency medical service capability based on collaborative medical treatment. The study is based on COVID-19 medical services and its main treatment stages, and resource allocation models are constructed for the allocation of multiple medical services. The model addresses the dispersed medical service resources and demands in a certain region, and realizes the division of labor and resource sharing among medical institutions from the perspectives of distance, cost, and fairness with the advantage of integrated healthcare. We design examples in the context of COVID-19 epidemic and verify the validity and applicability of the model under different phases. This paper provides reference to the research and practice of achieving collaborative medical treatment between multiple medical institutions.

Sesame-induced anaphylaxis in pediatric patients from the cross-Canada anaphylaxis registry

BackgroundSesame can cause severe allergic reactions and is a priority allergen in Canada. ObjectiveTo assess clinical characteristics and management of pediatric sesame-induced anaphylaxis and identify factors associated with epinephrine treatment. MethodsBetween 2011 and 2021, children with sesame-induced anaphylaxis presenting to 7 emergency departments (ED) in 4 Canadian provinces and 1 regional emergency medical service were enrolled in the Cross-Canada Anaphylaxis Registry. Standardized recruitment forms provided data on symptoms, severity, triggers, and management. Multivariate logistic regression evaluated associations with epinephrine treatment pre-ED and multiple epinephrine dosages. ResultsOf all food-induced anaphylactic reactions (n = 3279 children), sesame accounted for 4.0% (n = 130 children), of which 61.5% were boys, and the average (SD) age was 5.0 (4.9) years. Hummus containing sesame paste triggered 58.8% of reactions. In the pre-ED setting, 32.3% received epinephrine, and it was more likely to be used in boys (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.08-1.50) and those with a known food allergy (aOR, 1.36; 95% CI, 1.11-1.68]). In the ED, 47.7% of cases received epinephrine, with older children more likely to receive multiple epinephrine doses (aOR, 1.00; 95% CI, 1.00-1.02). ConclusionIn Canada, hummus is the major trigger of sesame-induced anaphylaxis. Knowledge translation focused on prompt epinephrine use and product-labeling policies are required to limit sesame reactions in communities.

Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system.

Universal spinal immobilization has been the standard of prehospital trauma care since the 1960s. Selective immobilization has been shown to be safe and effective for emergency medical services use, but it is unclear whether such protocols reduce unnecessary and potentially harmful immobilization practices. This study evaluated the impact of a selective spinal immobilization protocol on practice patterns in a regional trauma system. All encounters for traumatic injury in the Tidewater Emergency Medical Services region from 2010 to 2016 were extracted from the Virginia Pre-Hospital Information Bridge. An interrupted time series analysis was used to assess practice change after system-wide protocol implementation in 2013. Intravenous access was used as a nonequivalent outcome measure in the absence of an appropriate control group. A total of 63,981 encounters were analyzed. At baseline, 16.7% of patients underwent full immobilization. The preprotocol slope was slightly positive (0.2% per month; 95% confidence interval, 0.1-0.2%). Slope and level changes after protocol implementation did not differ from those observed for intravenous access (-0.4% vs. -0.4% per month [ p = 0.4917] and -1.6% vs. -1.1% [ p = 0.1202], respectively). Cervical spinal immobilization became more common over the postimplementation period (0.1% per month; 95% confidence interval, 0.1-0.1%). Rates of immobilization for isolated penetrating trauma remained unchanged. Implementation of a selective spinal immobilization protocol did not reduce prehospital immobilization rates in a regional trauma system. Given the entrenched nature of immobilization practices, more intensive education and training strategies are needed. Efforts should prioritize eliminating immobilization for isolated penetrating trauma given its association with increased mortality. Therapeutic/Care Management; Level IV.

The Feedback Form and Its Role in Improving the Quality of Trauma Care.

Background: One of the tasks of a level I trauma center is quality improvement of level II and level III regional hospitals and emergency medical services by means of continuous education and learning processes. One of the tools for this, which provides constant monitoring of the quality of treatment, is feedback. The purpose of the study was to evaluate the effect of feedback on the quality of trauma care. Methods: Retrospective cohort study comprising two periods of time, 2012–2013 and 2017–2018. The study group included physicians and pre-hospital staff who treated patients prior to referral to the level I center. Upon arrival when the trauma teams identified issues requiring improvement, they were asked to fill in feedback forms. Data on patients treated in the trauma shock room for whom feedback forms were filled out were also extracted. Results: A total of 662 feedback forms were completed, showing a significant improvement (p ˂ 0.0001). The majority of the medical personnel who received the most negative feedback were the pre-hospital staff. A significant increase was revealed in the number of feedbacks with reference to mismanagement of backboard spinal fixation, of the pre-hospital staff, in 2012–2013 compared to 2017–2018 (p < 0.001). Improvement in reducing the time of treatment in the field was also revealed, from 15.2 ± 8.3 min in 2012–2013 to 13.4 ± 7.9 min in 2017–2018. Conclusion: The findings show that feedback improves the treatment of injured patients. Furthermore, constantly monitoring the quality of treatment provided by the trauma team is vital for improvement.

Abstract WP90: Upgrading To Endovascular Thrombectomy Performing Hospitals Increases Overall Acute Ischemic Stroke Admissions

Introduction: Given the impact of endovascular therapy (EVT) on clinical outcomes and usage of pre-hospital bypass protocols to route acute ischemic stroke (AIS) patients with suspected large vessel occlusion (LVO) to EVT-performing hospitals (EPH), there is substantial interest in upgrading stroke center certification to become comprehensive centers. Here, we assess the effect of becoming EPH on total AIS and non-LVO AIS admissions in four hospitals in a large urban area. Methods: From our prospectively collected multi-institutional registry, we identified all consecutive patients with AIS at four EPHs between Nov 2017 - May 2019. Three of the EPHs (named EPH 1, EPH 2, EPH 3) became EPHs in early 2017, which allowed for preferential routing and pre-hospital bypassing of other non-EPH hospitals by regional emergency medical services protocols. Another EPH (named original EPH) had been an EPH for many years. The primary outcome was the volume of AIS admissions after upgrading to a EPH over time and was determined by linear regression. Results: Among 3,727 patients with AIS presenting to 4 hospitals across the Houston area, median age was 67 [IQR 57-78], 48% were female, median NIHSS was 5 [IQR 2-12], 21% had LVO, 11% underwent EST. AIS admissions increased at EPH 1 at a rate of 15 AIS per quarter (95% CI 5.5-25.3, p=0.012); EPH 2 increased at a rate of 8 AIS per quarter (95% CI 3.18 - 13.44, p=0.011); EPH 3 increased at a rate of 10 AIS per quarter (95% CI 2.4-18.6, p=0.023) AIS admissions at the original EPH did not change significantly during the study period (CI 0-11.9, p=0.47). Increases in AIS admissions were predominantly in non-LVO AIS (Figure A). Conclusions: In this observational cohort study, upgrading to EPH status resulted in continuously increasing AIS admissions over time, particularly for non-LVO patients; this growth was not observed in established EPH. These findings demonstrate and quantify the effect of upgrading stroke center certification on inpatient AIS volumes.

Identification of Suspected Patients with COVID-19 by the Regional Emergency Medical Service in Lombardy Through an Operator-Based Interview and a Machine Learning-Based Model: A Large-Scale Retrospective Study

Identification of Suspected Patients with COVID-19 by the Regional Emergency Medical Service in Lombardy Through an Operator-Based Interview and a Machine Learning-Based Model: A Large-Scale Retrospective Study

Emergency medical services employing intra-arrest transport less frequently for out-of-hospital cardiac arrest have higher survival and favorable neurological outcomes

BackgroundThere is substantial regional variation in out-of-hospital cardiac arrest (OHCA) survival. We investigated whether regional emergency medical services (EMS) intra-arrest transport (IAT) practices are associated with patient outcomes. MethodsWe performed a secondary analysis of a multi-center North American clinical trial dataset, which enrolled EMS-treated adult OHCA cases from 49 regional population-based clusters. The exposure of interest was regional-level intra-arrest transport (IAT), calculated as the proportion of cases in each cluster transported to hospital prior to return of spontaneous circulation, examined as quartiles and as a continuous variable. Multilevel mixed-effects logistic regression modeling estimated the association between regional IAT with survival to hospital discharge and favorable neurologic status (modified Rankin Scale ≤ 3) at hospital discharge. ResultsOf 26,148 subjects (median age 68 years; 36% female; 23% shockable initial rhythm) 2424 (9.3%), survived to hospital discharge and 1993 (7.6%) had favourable neurological outcomes. Across regional clusters, IAT ranged from 0.84% to 75% (quartiles <6.2%, 6.2–19.6%, 19.6–30.4%, and ≥30.4%). For each quartile, 13.3%, 7.9%, 7.4%, and 4.8% survived, and 10.4%, 7.8%, 7.4%, and 4.8% had favourable neurological status. Regional IAT (per 10% change) was associated with decreased probability of survival (AOR 0.86, 95% CI 0.82–0.91) and favorable neurological outcome (AOR 0.80, 95% CI 0.76–0.85). ConclusionTreatment within a region that utilizes IAT less frequently was associated with improved clinical outcomes at hospital discharge. These findings may account for some of the known regional variation in OHCA outcomes.

Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy.

Background: Patients with large vessel occlusion (LVO) stroke are often initially admitted to a primary stroke center (PSC) and subsequently transferred to a comprehensive stroke center (CSC) for endovascular thrombectomy (EVT). This interhospital transfer delays initiation of EVT. To identify potential workflow improvements, we analyzed pre- and interhospital time metrics for patients with LVO stroke who were transferred from a PSC for EVT.Methods: We used data from the regional emergency medical services and our EVT registry. We included patients with LVO stroke who were transferred from three nearby PSCs for EVT (2014–2021). The time interval between first alarm and arrival at the CSC (call-to-CSC time) and other time metrics were calculated. We analyzed associations between various clinical and workflow-related factors and call-to-CSC time, using multivariable linear regression.Results: We included 198 patients with LVO stroke. Mean age was 70 years (±14.9), median baseline NIHSS was 14 (IQR: 9–18), 136/198 (69%) were treated with intravenous thrombolysis, and 135/198 (68%) underwent EVT. Median call-to-CSC time was 162 min (IQR: 137–190). In 133/155 (86%) cases, the ambulance for transfer to the CSC was dispatched with the highest level of urgency. This was associated with shorter call-to-CSC time (adjusted β [95% CI]: −27.6 min [−51.2 to −3.9]). No clinical characteristics were associated with call-to-CSC time.Conclusion: In patients transferred from a PSC for EVT, median call-to-CSC time was over 2.5 h. The highest level of urgency for dispatch of ambulances for EVT transfers should be used, as this clearly decreases time to treatment.

Failed Knowledge Retention from Educational Intervention on Anaphylaxis Management Among Medical Personnel

Abstract Background: Anaphylaxis is a life-threatening allergic reaction that is often inadequately treated in the hospital setting, leading to adverse outcomes. We hypothesize that a brief educational intervention will enhance knowledge of community-based medical professionals evaluated by pre- and post-questionnaires, leading to improved recognition and management of anaphylaxis. Methods: An initial questionnaire consisting of eight multiple-choice questions and two fill in response pertaining to anaphylaxis identification, management, and treatment was completed by 189 University Hospitals Regional Hospitals personnel, including faculty, nurses, student, residents, and Emergency Medical Services (EMS). The participants were then offered an educational intervention, including a 10-slide, 20-minute PowerPoint presentation on anaphylaxis, and review of the pre-educational intervention questionnaire responses, followed by a post-educational intervention questionnaire similar to the initial questionnaire. Seventy-seven participants completed the same questionnaire at a six-month follow-up to assess retention. Results: Participant scores improved from 62% to 94%, from the initial questionnaire to the immediate post- educational intervention questionnaire. The six-month post-educational intervention questionnaire revealed a return to near baseline (65%) medical knowledge regarding anaphylaxis Conclusion: Healthcare personnel demonstrate a knowledge deficit of identification and management of anaphylaxis. In the short-term, a brief, educational intervention did improve knowledge of anaphylaxis (p&amp;lt;0.00001). However, in the long-term, this educational intervention did not improve knowledge retention about anaphylaxis (p=0.52218). We received approval for and implemented an anaphylaxis order set in the electronic medical record (EMR) at University Hospitals, in effort to improve patient care.

The Effectiveness of Intranasal Midazolam for the Treatment of Prehospital Pediatric Seizures: A Non-inferiority Study

Background: Intranasal (IN) midazolam allows for rapid, painless treatment of pediatric seizures in the prehospital setting and may be a preferred administration route if determined to be non-inferior to intravenous (IV) or intramuscular (IM) routes. We sought to evaluate the effectiveness of IN midazolam for terminating prehospital pediatric seizures compared to midazolam administered by alternate routes. Methods: We performed a retrospective, non-inferiority analysis using data from a regional Emergency Medical Services (EMS) database. We included pediatric patients ≤ 14 years treated with midazolam (0.1 mg/kg) by EMS for non-traumatic seizures. The primary outcome was the proportion of patients requiring redosing of midazolam after initial treatment with IN midazolam compared to those that received IV or IM midazolam. We established a priori a risk difference of 6.5% as the non-inferiority margin. Results: We evaluated outcomes from 2,034 patients (median age 6 years [interquartile range 3 − 10 years], 55% male). Initial administration routes were 461 (23%) IN, 547 (27%) IM, 1024 (50%) IV, and 2 (0.1%) intraosseous (IO). Midazolam redosing occurred in 116 patients (25%) who received IN midazolam versus 222 patients (14%) treated initially with midazolam via alternate routes (risk difference 11% [95%CI 7 − 15%]). The age-adjusted odds ratio for redosing midazolam after intranasal administration compared to alternate route administration was 2.0 (95% CI 1.6 − 2.6). Conclusion: Prehospital treatment of pediatric seizure with intranasal midazolam was associated with increased frequency of redosing compared to midazolam administered by other routes, suggesting that 0.1 mg/kg is a subtherapeutic dose for intranasal midazolam administration.