Prehospital Emergency Care最新文献

{"title":"Development and Deployment of a Pre-Planned Hospital Emergency Response Team (HERT) for EMS Augmentation: Case Report and Program Review.","authors":"Marc Cohen, Ryan DeVivo, Marianne Gausche-Hill, Shira A Schlesinger","doi":"10.1080/10903127.2024.2365333","DOIUrl":"10.1080/10903127.2024.2365333","url":null,"abstract":"<p><p>With the establishment and growth of the Emergency Medical Services (EMS) subspecialty, significant attention has been focused on clinical activities performed by EMS physicians in the out-of-hospital environment. An EMS fellowship includes special operations education to develop preparedness for responding to field situations requiring physician expertise. With only a thousand Board Certified EMS physicians in North America, EMS physicians may not be available 24 h per day to respond to field emergencies. Non-EMS physicians with minimal experience in prehospital or austere care may be called upon to respond to complex prehospital emergencies requiring advanced skills. The Los Angeles County EMS Agency implemented a policy in 1992 to establish Hospital Emergency Response Teams (HERT) as a regional resource to provide time-critical, specialized prehospital services within an EMS system. Activation of the HERT is rare, most frequently prompted by need for field amputation to enable extrication. We describe one such incident of a field intervention by HERT and detail the staffing, training, and equipment considerations within our large regional EMS system.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"194-201"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance Evaluation with ChatGPT for Diagnosis and Treatment in Patients Brought to the ED with a Preliminary Diagnosis of Stroke.","authors":"Merve Yazla, Emine Sarcan","doi":"10.1080/10903127.2025.2475513","DOIUrl":"10.1080/10903127.2025.2475513","url":null,"abstract":"<p><strong>Objectives: </strong>Chat Generative Pre-trained Transformer (ChatGPT) is a natural language processing product developed by OpenAI. Recently, the use of ChatGPT has gained attention in the field of health care, particularly for its potential applications in diagnostic and decision-making support. While its utility is still being explored, it shows promise as a supplementary tool in these contexts. This study aims to evaluate the potential of ChatGPT in making decisions about 'transportation to the stroke center, suspicion of large vessel occlusion and treatment decisions' of patients brought to the emergency department by ambulance with a preliminary diagnosis of stroke.</p><p><strong>Methods: </strong>All patients with a stroke code who were transferred to the emergency department (ED) of a tertiary care hospital, Ankara Etlik City Hospital, by ambulance between November 1, 2023, and April 30, 2024, during designated stroke team coverage periods were included in the study. Unlike many stroke centers that operate continuously 24/7, our institution follows a structured on-call system, where specialized stroke teams are assigned time slots to provide stroke care. Data were collected from prehospital records, ED notes, and hospital imaging and treatment records. ChatGPT's decisions were compared to gold standard outcomes using Cohen's kappa test, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated for each directive.</p><p><strong>Results: </strong>A total of 512 patients were analyzed, and ChatGPT's decisions were compared with the patients' final diagnoses and treatments. Analysis comparing ChatGPT's decisions to patient outcomes across prehospital stroke suspicion, large vessel occlusion diagnosis, and treatment phases showed significant agreement (<i>p</i> < 0.001, Kappa: 0.540-0.562). While the sensitivity of the diagnosis of stroke was 91%, the NPV was found to be 98% in patients requiring intravenous tissue plasminogen activator and large vessel occlusion, 97% NPV in patients requiring mechanical thrombectomy.</p><p><strong>Conclusions: </strong>ChatGPT shows promise as a decision-support tool for identifying acute ischemic stroke and determining treatment needs in prehospital and ED settings. However, its reliance on predefined data highlights the need for physician supervision to address clinical complexities and ensure patient safety. Integrating ChatGPT as an adjunct rather than a standalone system can enhance decision-making efficiency while maintaining high-quality care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"243-251"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Workplace Violence Against Emergency Medical Services (EMS).","authors":"Sarayna S McGuire, Michelle A Lampman, Olivia A Smith, Casey M Clements","doi":"10.1080/10903127.2024.2381218","DOIUrl":"10.1080/10903127.2024.2381218","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this study were to: (1) understand the personal impact of workplace violence (WPV) on staff within a large multistate emergency medical services (EMS) agency, (2) describe the impact of WPV on subsequent patient interactions, examining how experiences of violence affect the quality of care provided by EMS clinicians, (3) examine the influence of WPV on perceived workplace safety among prehospital personnel and its correlation with retention in the EMS field, and (4) solicit recommendations from staff for the prevention and mitigation of WPV in the future.</p><p><strong>Methods: </strong>We conducted virtual focus groups and individual interviews with 22 prehospital personnel using a descriptive qualitative design within a large multistate Midwest EMS agency between 4/5/2023-6/20/2023. Data were analyzed using Thematic Analysis to identify common perceptions among and across participants.</p><p><strong>Results: </strong>Major themes of personal impact; impact on patient interactions; influence of WPV on career longevity/sustainability; and relationship between EMS culture and WPV were identified. Overall, participants shared the perception that WPV is \"part of the job\", and that verbal abuse was so common that they hadn't previously considered it as violence. Participants provided several examples of WPV and described how these experiences impacted them personally (e.g., hypervigilance) and impacted their subsequent interaction with patients (e.g., quicker to use restraints, loss of empathy). Participants shared the perception that EMS is no longer valued or respected by patients or communities. Several voiced concerns for the next generation of colleagues and nearly all participants reported the need for education and training in situational awareness, de-escalation, and self-defense tactics. Participants referenced desire for more coordination and communication with law enforcement, change in culture of abuse from patients without repercussions, and improved agency mental health support and peer support/mentoring following a violent event. Despite experiences with WPV, the majority reported plans to remain in EMS.</p><p><strong>Conclusions: </strong>Emergency Medical Services personnel are commonly traumatized by violence in their work and nonphysical violence is underappreciated. Despite its impact on staff and subsequent patient interactions, most participants reported plans to remain within EMS. Multi-faceted system-focused efforts are needed to shift toward and support a zero-tolerance culture for WPV.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"129-137"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"It's Pretty Sad If You Get Used to It\": A Qualitative Study of First Responder Experiences with Opioid Overdose Emergencies.","authors":"Kyle Patch, Caroline Huang, Saskia Hendriks, David Wasserman, Matthew Parrish, Christine Grady","doi":"10.1080/10903127.2023.2236200","DOIUrl":"10.1080/10903127.2023.2236200","url":null,"abstract":"<p><strong>Background: </strong>First responders play a vital role in the United States opioid drug overdose crisis, a public health emergency that has claimed many lives.</p><p><strong>Objective: </strong>We sought to investigate first responders' experiences and attitudes toward opioid overdose emergencies and the ongoing crisis, as well as emotional effects, coping strategies, and support systems.</p><p><strong>Methods: </strong>A convenience sample of first responders (<i>n</i> = 18) at the Columbus Fire Division, with experience responding to opioid emergencies, participated in semi-structured telephone interviews between September 2018 and February 2019. Interviews were recorded, transcribed verbatim, and analyzed using content analysis for themes.</p><p><strong>Results: </strong>While almost all participants described overdose emergencies as routine, they recalled some as memorable and emotionally impactful. Almost all respondents were frustrated by the high rates of overdose among their patients and the lack of sustainable improvements in outcomes, yet expressed a strong moral commitment to caring for patients and saving lives. Themes of burnout, compassion fatigue, and hopelessness emerged, as did themes of increased compassion and empathy. Support for personnel experiencing emotional difficulty was either lacking or underutilized. Further, many felt public policies should prioritize more permanent resources and improve access to care, and believed that people who use drugs should face greater accountability.</p><p><strong>Conclusion: </strong>First responders perceive a moral and professional duty to treat patients who overdose, despite their frustrations. They may benefit from additional occupational support to cope with the resultant emotional effects of their role in the crisis. Addressing macro-level factors contributing to the overdose crisis and improving patient outcomes could also positively affect first responder wellbeing.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"474-481"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10794549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disposition Outcomes Following Prehospital Use of Naloxone in a Large Metropolitan City in the United States.","authors":"James R Langabeer, Christine Bakos-Block, A Sarah Cohen, Ishmam Alam, Bhanumathi Gopal, Marylou Cardenas-Turanzas, Arlo F Weltge, David Persse, Tiffany Champagne-Langabeer","doi":"10.1080/10903127.2024.2369774","DOIUrl":"10.1080/10903127.2024.2369774","url":null,"abstract":"<p><strong>Objectives: </strong>During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States.</p><p><strong>Methods: </strong>We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at the scene. Study outcome was defined as hospital transportation or no transportation. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for hospital transport with patient age, sex, race and ethnicity as the independent variables.</p><p><strong>Results: </strong>We identified 5,482 cases of nonfatal opioid-related overdose. Of these, 4,984 (90.9%) were transported to the hospital; 37 (0.7%) were placed in police custody; 304 (5.5%) were not transferred; and 157 (2.9%) had unknown outcomes. Among 5,288 with data on the transport outcome, the majority were male (65%), and the highest proportion were White (39%). Compared to those who were not transported, each 1-year increase in age was related to a 2% increase in the odds of transportation (OR: 1.02, 95% CI: 1.01-1.02). Compared to White patients, Black and Hispanic patients were 43% OR: 1.43, 95% CI: 1.07-1.90) and 44% (OR: 1.44, 95% CI: 1.03-2.00) more likely to be transported.</p><p><strong>Conclusions: </strong>Individuals with suspected opioid-related overdose who call 9-1-1 are most often transported to the hospital. Current EMS procedures are successful at on-scene treatment and transportation; however, data on the long-term impact of opioid-related overdoses are still needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"361-366"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Pediatric Prehospital Opioid Encounters and Social Vulnerability.","authors":"Stephen Sandelich, Garrett Cavaliere, Christopher Buresh, Susan Boehmer, Joshua Glasser, Ian Klansek, Aaron Tolpin","doi":"10.1080/10903127.2024.2424335","DOIUrl":"10.1080/10903127.2024.2424335","url":null,"abstract":"<p><strong>Objectives: </strong>This study explores the relationship between socioeconomic factors and pediatric opioid-related emergencies requiring naloxone administration in the prehospital setting, an escalating public health concern.</p><p><strong>Methods: </strong>A retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) database was conducted, examining data from pediatric opioid-related EMS activations between January 2018 and December 2021. The Social Vulnerability Index (SVI) was used to gauge each incident's socioeconomic context and assess correlations between SVI scores and the likelihood of opioid-related activations and naloxone interventions.</p><p><strong>Results: </strong>A total of 7,789 pediatric opiate-related EMS activations were identified. Lower socioeconomic status (SES) areas (higher SVI scores) exhibited a decreased rate of opioid-related activations compared to lower SVI-scored areas but an increased frequency of naloxone administration. The analysis demonstrated that as socioeconomic status (SES) improves, the likelihood of opioid-related activations increases significantly supported by a significant negative linear trend (Estimate = -0.2971, SE = 0.1172, z = -2.54, <i>p</i> = 0.0112. On the other hand, naloxone administration was more frequently required in lower SES areas, suggesting an increased emergency response in these (Estimate = 0.05806, SE = 0.2403, <i>z</i> = 0.24, <i>p</i> = 0.8091).</p><p><strong>Conclusions: </strong>The analysis highlights a statistically significant correlation between the SES of an area and pediatric opioid-related EMS activations, yet an inverse correlation with the likelihood of naloxone administration. These findings demonstrate that in lower socioeconomic areas, the total number of opiate-related EMS activations is lower; however, naloxone was more likely to be deployed during those activations. This underscores the need for further research to understand the disparities in opioid crisis management across different socioeconomic landscapes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"351-360"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients Experiencing Opioid Overdose and Eligibility for Prehospital Treatment with Buprenorphine.","authors":"H Gene Hern, Vanessa Lara, Dre Cantwell-Frank, Sarah Abusaa, Allison D Rosen, Andrew A Herring","doi":"10.1080/10903127.2024.2445075","DOIUrl":"10.1080/10903127.2024.2445075","url":null,"abstract":"<p><strong>Objectives: </strong>Opioids kill tens of thousands of patients each year. While only a fraction of people with opioid use disorder (OUD) have accessed treatment in the last year, 30% of people who died from an overdose had an Emergency Medical Services (EMS) encounter within a year of their death. Prehospital buprenorphine represents an important emerging OUD treatment, yet limited data describe barriers to this treatment. Our objectives were to quantify the number of patients encountered by EMS who were eligible for prehospital buprenorphine, and to examine characteristics of patients who did or did not receive treatment.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed EMS patient records from Contra Costa County, CA, where paramedics were trained to identify patients experiencing opioid withdrawal and administer buprenorphine. Patient records were selected for review based on \"buprenorphine patient triggers,\" which were keywords within the charts that identified patients with potential overdose or symptoms that could indicate withdrawal or naloxone administration. We describe proportion of eligible patients and the characteristics of those who did and did not receive prehospital buprenorphine.</p><p><strong>Results: </strong>We reviewed 1,159 records from September 2020 to July 2022. Of included patients, 984 (85%) were not eligible for buprenorphine. Nearly half (482, 49%,) of patients ineligible for buprenorphine fell into 2 primary categories: 331 (33%) had altered mental status (326 of 331 received naloxone), and 151 (15%) had no active withdrawal symptoms documented. Additional exclusions included other intoxicants, severe medical illness, or the patient denied having an OUD. Of those eligible for buprenorphine, 67 (38%) received buprenorphine. Of the 108 patients who did not receive buprenorphine, 69 (64%) had protocol deviation, 24 (22%) declined treatment, and 15 (14%) were in a non-enabled zone. Of all buprenorphine administrations, 19 (28%) were post-opioid overdose and 48 (72%) were for abstinence withdrawal.</p><p><strong>Conclusions: </strong>One-in-three EMS patients with suspected opioid use disorder were ineligible for treatment with buprenorphine due to altered mental status. The second largest group consisted of patients who were eligible but not offered buprenorphine, highlighting potential gaps in paramedic training, logistical challenges in field administrations, and other factors that warrant further exploration.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"450-457"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from the Implementation of the Wake County, North Carolina EMS Medication for Opioid Use Disorder Program.","authors":"Andrew W Godfrey, Vicki L Coles, Michael D Lyons, Jefferson G Williams, Jonathan R Studnek, Kristin M Cain, Brandon Smith, Benjamin W Powell, Gabrielle D Newsam, José G Cabañas","doi":"10.1080/10903127.2025.2450773","DOIUrl":"10.1080/10903127.2025.2450773","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation.</p><p><strong>Methods: </strong>We developed a protocol to provide buprenorphine in the prehospital setting to patients who 1) suffered an opioid overdose with reversal using naloxone, or 2) experienced withdrawal symptoms at least 72 hours after last opioid use. Measures included encounters with screening for buprenorphine induction, successful inductions with buprenorphine, successful follow up with outpatient treatment, and successful continued outpatient treatment. For the period 7/5/2023-7/4/2024, we report descriptive statistics.</p><p><strong>Results: </strong>We identified 1,378 encounters for adult patients who received naloxone, of which 953 had documentation of opioid overdose as the primary impression. During the same timeframe, 342 encounters included screening for prehospital buprenorphine induction. Of encounters with screened patients, 66 (19.3%) encounters were eligible for buprenorphine induction and of these, 61 encounters (92.4%) resulted in buprenorphine induction. Of encounters with induction, 29 (47.5%) resulted in successful follow up with our outpatient provider, and 7 (11.4%) remained in treatment at the end of the review period.</p><p><strong>Conclusions: </strong>Our prehospital buprenorphine induction program successfully inducted eligible patients and connected them with follow up. Almost half of inducted patients were able to follow up with our outpatient provider. One in ten patients who received buprenorphine from EMS remained in treatment. There exists an opportunity for EMS to screen more patients for buprenorphine induction as only one in four patients who received naloxone were screened for buprenorphine induction. Lessons learned include the need for recurrent EMS clinician education regarding buprenorphine screening, the need for a \"buprenorphine champion\" to follow up with inducted patients and addressing early administrative and technological barriers to ensure data exchange.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"458-464"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Emergency Mental Health Dispatch Training by a 9-1-1 Medical Dispatcher Assisting a Caller Expressing Suicidal Intent: A Case Report.","authors":"Lori L Boland, Kelly E Ryan, Jonathan M Flynn, Angie Fox, Joey L Duren","doi":"10.1080/10903127.2024.2399800","DOIUrl":"10.1080/10903127.2024.2399800","url":null,"abstract":"<p><p>A growing number of individuals with unmet mental health needs in the United States rely on emergency medical services during mental health crises, and 9-1-1 emergency medical dispatchers (EMD) are often a critical lifeline to help. Unfortunately, current industry-standard dispatching protocols and training required for EMD certification largely lack specificity for managing 9-1-1 calls related to mental health emergencies. The purpose of this report is to illustrate the value of additional targeted training for EMDs that enables them to more effectively assist callers struggling with mental illness or suicidal thoughts. We review a 9-1-1 call in which an EMD utilized specific strategies and language learned during a 3-day emergency mental health dispatch (EMHD) training course to assist a middle-aged male who was expressing suicidal intent with a firearm. Key principles and phrasing from the training were used successfully by the EMD to dissuade the caller from self-harm, and he was ultimately safely met by first responders on scene and transported for care. We also share post-call recollections and reactions from the EMD to demonstrate how in addition to reducing risks for callers and their families, EMHD training has the potential to reduce on-scene risks for field responders and may increase confidence and mitigate negative stress responses in EMDs. Emergency medical services systems in the United States should continue to explore enhanced training and protocols to improve care for 9-1-1 callers experiencing mental health crises.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"96-99"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Performance of ChatGPT-4 and Gemini Ultra 1.0 for Quality Assurance Review in Emergency Medical Services Chest Pain Calls.","authors":"Graham Brant-Zawadzki, Brent Klapthor, Chris Ryba, Drew C Youngquist, Brooke Burton, Helen Palatinus, Scott T Youngquist","doi":"10.1080/10903127.2024.2376757","DOIUrl":"10.1080/10903127.2024.2376757","url":null,"abstract":"<p><strong>Objectives: </strong>This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google's Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate identification of areas requiring improvement, thereby potentially enhancing patient care outcomes.</p><p><strong>Methods: </strong>Two expert human reviewers, ChatGPT GPT-4, and Gemini Ultra assessed and rated 150 consecutively sampled and anonymized prehospital records from 2 large urban EMS agencies for adherence to 2020 National Association of State EMS metrics for cardiac care. We evaluated the accuracy of scoring, inter-rater reliability, and review efficiency. The inter-rater reliability for the dichotomous outcome of each EMS metric was measured using the kappa statistic.</p><p><strong>Results: </strong>Human reviewers showed high interrater reliability, with 91.2% agreement and a kappa coefficient 0.782 (0.654-0.910). ChatGPT-4 achieved substantial agreement with human reviewers in EKG documentation and aspirin administration (76.2% agreement, kappa coefficient 0.401 (0.334-0.468), but performance varied across other metrics. Gemini Ultra's evaluation was discontinued due to poor performance. No significant differences were observed in median review times: 01:28 min (IQR 1:12 - 1:51 min) per human chart review, 01:24 min (IQR 01:09 - 01:53 min) per ChatGPT-4 chart review (<i>p</i> = 0.46), and 01:50 min (IQR 01:10-03:34 min) per Gemini Ultra review (<i>p</i> = 0.06).</p><p><strong>Conclusions: </strong>Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their current value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"210-217"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}