Prehospital Emergency Care最新文献

{"title":"Burden of Non-Protocolized Patient Transport Outside of Response Area on a Rural Emergency Medical Services System.","authors":"H Hill Stoecklein, Isabel C Shimanski, Christopher K Ryba, Joseph E Carnell, Scott T Youngquist","doi":"10.1080/10903127.2024.2412837","DOIUrl":"10.1080/10903127.2024.2412837","url":null,"abstract":"<p><strong>Objectives: </strong>Transport destination decisions by prehospital personnel depend on a combination of protocols, judgment, patient acuity, and patient preference. Non-protocolized transport outside the service area may result in unnecessary time out of service and inappropriate resource utilization. Scant research exists regarding clinician rationale for destination decisions.</p><p><strong>Methods: </strong>We retrospectively reviewed one year of scene transports by a single rural, hospital-based emergency medical services (EMS) system. We collected dispatch, patient demographic, primary impression, and transport data from prehospital records and matched them to emergency department (ED) data. We characterized rationale for transport decisions and compared rates of hospital admission and specialist consultation in the ED as surrogates for decision appropriateness.</p><p><strong>Results: </strong>We reviewed 2,223 patient transports, 281 of which were transported out of the service area. The most common reasons for out-of-area transport were patient preference NOT related to prior medical care (40%) and clinician judgment (24%). Admit rates were highest for per protocol (85%) and patient preference related to prior medical care (67%) groups and lowest for no explanation (41%) and clinician judgment (47%) groups. Rates of in person specialist consultation in the ED were highest in per protocol (69%) and clinician judgment (47%) groups and lowest in no explanation (23%) and patient preference NOT related to prior medical care (30%) groups. Clinician judgment was less predictive of admission and specialist consultation for non-trauma and pediatric patients than for all patients. Median time out of service was more than twice as long for out-of-area transports (140 min) compared to patients transported to the nearest facility (62 min). For out-of-area transports discharged from the ED without specialty consultation (<i>n</i> = 104), ambulances traveled an additional 52 miles/patient compared to theoretical transport to nearest facility.</p><p><strong>Conclusions: </strong>Unit out of service time more than doubled for non-protocolized transports outside of the service area and rationale for destination decisions variably predicted admission and specialist consultation rates. Patient preference NOT related to prior medical care and, in pediatric and non-trauma populations, clinician judgment, were less predictive of admission and specialist consultation. Transport guidelines should balance rationale for transport destination and patient characteristics with resource preservation, especially in low-resource systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392658","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":"Establishing Outcome Parameters for Helicopter Emergency Medical Services Research in The Netherlands: Results of a Mixed-Methods Delphi Consensus Study.","authors":"Niek J Vianen, J Reinout Campfens, Margot Brouwer-Bergsma, Jan C Van Ditshuizen, Georgios F Giannakopoulos, Nico Hoogerwerf, Dennis den Hartog, Esther M M Van Lieshout, Iscander M Maissan, Patrick Schober, Lieneke Venema, Michael H J Verhofstad, Mark G Van Vledder","doi":"10.1080/10903127.2024.2413038","DOIUrl":"10.1080/10903127.2024.2413038","url":null,"abstract":"<p><strong>Objectives: </strong>Physician staffed Helicopter Emergency Medical Services (P-HEMS) care in the Netherlands has transitioned from predominantly trauma management to handling a variety of medical conditions. Relevant outcome parameters for Dutch P-HEMS research have not been previously defined. National consensus was sought to identify relevant long term patient outcome parameters, process outcome parameters and performance outcome parameters for Dutch P-HEMS care.</p><p><strong>Methods: </strong>This was a mixed methods Delphi consensus study. A list of potentially relevant outcome parameters was identified using a systematic literature review. These parameters were subsequently surveyed in a Delphi consensus study. Helicopter Emergency Medical Services physicians and relevant stakeholders were invited to participate in this Delphi survey, where they were allowed to suggest additional outcome parameters. Descriptive analysis was performed on all data sets.</p><p><strong>Results: </strong>Forty-nine potential outcome parameters for Dutch P-HEMS care were surveyed. Of 71 invited participants, 53 (75%), 40 (56%), and 20 (28%) participated in the first, second, and third round of the Delphi study, respectively. Consensus was reached on 25 (51%) of 49 outcome parameters as being important. These consisted of seven long term patient related outcome parameters, four short term patient related outcome parameters, five process outcome parameters and nine performance outcome parameters.</p><p><strong>Conclusions: </strong>In conclusion, this study identified 25 outcome parameters relevant for Dutch physician staffed HEMS care. These parameters should be considered when designing future studies and should be routinely collected for each dispatch if possible.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392657","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":"Proportional Versus Fixed Chest Compression Depth for Guideline-Compliant Resuscitation of Infant Asphyxial Cardiac Arrest.","authors":"David D Salcido, Allison C Koller, Cornelia Genbrugge, Jorge A Gumucio, James J Menegazzi","doi":"10.1080/10903127.2024.2414391","DOIUrl":"10.1080/10903127.2024.2414391","url":null,"abstract":"<p><strong>Objectives: </strong>Current guidelines for parameters of the delivery of chest compressions (CC) for infants and children are largely consensus based. Of the two recommended depth targets - 1.5 inches and 1/3 anterior-posterior chest diameter (APD) - it is unclear whether these have equal potential for injury. In previous experiments, our group showed in an animal model of pediatric asphyxial out-of-hospital cardiac arrest (OHCA; modeling ∼ 7 year-old children) that 1/3 APD resulted in significantly deeper CC and a higher likelihood of life-threatening injury. We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant model of asphyxial OHCA.</p><p><strong>Methods: </strong>Swine were sedated, anesthetized, paralyzed, intubated through direct laryngoscopy, and then mechanically ventilated (10 ml/kg, FiO2:21%). APD was measured and confirmed by two investigators <i>via</i> a sliding T-square at the xiphoid. After instrumentation for vital signs monitoring, and while still anesthetized, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 min. Animals were then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. Advanced life support drugs were administered at 13 min, and defibrillation at 14 min. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 min of failed resuscitation. Survivors were sacrificed with KCl after 20 min of observation. Veterinary staff conducted necropsy to assay lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Injury characteristics were summarized and compared <i>via</i> Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05.</p><p><strong>Results: </strong>A total of 36 animals were included for analysis (Group 1: 18; Group 2: 18). Mean (SD) APD overall was 5.58 (0.23) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups. No injury characteristics differed significantly between groups.</p><p><strong>Conclusions: </strong>In an swine model of infant asphyxial OHCA and resuscitation considering 1/3 APD or 1.5 inches, neither CC depth strategy was associated with increased injury.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381523","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":"Prehospital Trauma Compendium: Management of the Entrapped Patient - a Position Statement and Resource Document of NAEMSP.","authors":"Nichole Bosson, Benjamin N Abo, Troy D Litchfield, Zaffer Qasim, Matthew F Steenberg, Jake Toy, Antonia Osuna-Garcia, John Lyng","doi":"10.1080/10903127.2024.2413876","DOIUrl":"10.1080/10903127.2024.2413876","url":null,"abstract":"<p><p>Entrapped patients may be simply entombed or experiencing crush injury or entanglement. Patients with trauma who are entrapped are at higher risk of significant injury than patients not entrapped. Limited access and prolonged scene times further complicate patient management. Although patient entrapment is a significant focus of specialty teams, such as urban search & rescue (US&R) teams that operate as local, regional, and/or national resources in response to complex scenes and disaster scenarios, entrapment is a regular occurrence in routine EMS response. Therefore, all EMS clinicians must have the training and skills to manage entrapped patients and to support medically-directed rescue throughout the extrication process. NAEMSP RECOMMENDSEMS clinicians must perform a timely and thorough primary and secondary assessment and reassessments in parallel with dynamic extrication planning; the environment may require adaption of standard assessment techniques and devices.EMS clinicians should establish early, clear, and ongoing communications with rescue personnel to ensure a coordinated patient-centered medically directed approach to extrication. Communication with the patient should be frequent, clear, and reassuring.EMS clinicians should immediately take measures to effectively prevent and manage hypothermia.EMS clinicians should recognize airway management in the entrapped patient is always challenging. When required, advanced airway placement should be performed by the most experienced operator with proficiency in multiple modalities and alternative techniques in limited access situations.In entrapped patients who are experiencing or are at risk for crush syndrome, EMS clinicians should initiate large-volume (i.e., 1-1.5 L/h for adults and 20 mL/kg/h for pediatric patients for the initial 3-4 h) fluid resuscitation with crystalloid, preferably normal saline, as early as possible and prior to extrication.In entrapped patients who are experiencing or are at risk for crush syndrome, EMS clinicians should administer medications to mitigate risks of hyperkalemia, infection, and renal failure, early and prior to extrication.Tourniquet application should be considered in the setting of the crushed extremity as a potential adjunct to medical optimization before extrication of some patients.Patients with prolonged entrapment with the potential for severe injuries require complex resuscitation and may benefit from EMS physician management on scene. EMS systems should consider an early EMS physician response to entrapped patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472916","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":"Association of Prehospital Rearrest With Outcome Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Observational Studies.","authors":"Tanner Smida, Sahil Dayal, James Bardes, James Scheidler","doi":"10.1080/10903127.2024.2408628","DOIUrl":"10.1080/10903127.2024.2408628","url":null,"abstract":"<p><strong>Objectives: </strong>Exposure to prehospital rearrest has previously been associated with mortality following out-of-hospital cardiac arrest (OHCA). Our objective was to conduct a systematic review and meta-analysis examining the association between prehospital rearrest and survival in adults following OHCA resuscitation.</p><p><strong>Methods: </strong>We searched the PubMed, Scopus, and Web of Science bibliographic databases for observational studies that included adult OHCA patients who achieved return of spontaneous circulation in the prehospital setting following OHCA and reported survival to hospital discharge data stratified by rearrest status. The primary exposure was prehospital rearrest. The primary outcome for this study was survival to hospital discharge. Secondary outcomes included survival with a favorable neurological outcome and rearrest prevalence. We pooled data using inverse heterogeneity modeling and presented effect sizes for the survival outcomes as odds ratios with 95% confidence intervals. We quantified heterogeneity using Cochran's Q and the I² statistic and examined small study effects using Doi plots and the LFK index.</p><p><strong>Results: </strong>Of the 84 publications screened, we included 7 observational studies containing 27,045 patients with survival to hospital discharge data. Rearrest was common (30% [18-43%]; <i>n</i> = 7 studies; <i>Q</i> = 1086.1, p < 0.001; I² = 99%; LFK index = 1.21) and associated with both decreased odds of survival to discharge (pooled aOR: 0.27 [0.22, 0.33]; <i>n</i> = 7 studies; <i>Q</i> = 32.2, p < 0.01, I² = 81%, LFK index = -0.08) and decreased odds of survival to discharge with a favorable neurological outcome (pooled aOR: 0.25, [0.22, 0.28]; <i>n</i> = 4 studies; <i>Q</i> = 3.5, p = 0.3; I² = 13%, LFK index = 1.30).</p><p><strong>Conclusions: </strong>Rearrest is common and associated with decreased survival following OHCA. The pooled result of this meta-analysis suggests that preventing rearrest in five patients would be necessary to save one life.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352478","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 Route to ROSC: Evaluating the Impact of Route and Timing of Epinephrine Administration in Out-of-Hospital Cardiac Arrest Outcomes.","authors":"Michael W Hubble, Melisa D Martin, Ginny R Kaplan, Sara E Houston, Stephen E Taylor","doi":"10.1080/10903127.2024.2414389","DOIUrl":"10.1080/10903127.2024.2414389","url":null,"abstract":"<p><strong>Objectives: </strong>Previous investigations comparing intraosseous (IO) and intravenous (IV) epinephrine delivery in out-of-hospital cardiac arrest (OHCA) suggest that epinephrine is oftentimes more expeditiously administered <i>via</i> the IO route, but this temporal benefit doesn't always translate to clinical benefit. However, very few studies adequately controlled for indication and resuscitation time biases, making the influence of first epinephrine route on OHCA outcomes unclear. To determine the association between first epinephrine route and return of spontaneous circulation (ROSC) while controlling for resuscitation time bias and other potential confounders.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the 2020 ESO Data Collaborative dataset. Adult patients with a witnessed, non-traumatic OHCA prior to EMS arrival were included. Logistic regression was used to determine the association between medication route and ROSC. Linear regression was then used to calculate the probability of ROSC for each route across all call receipt-to-drug delivery intervals. Using these linear equations, the call receipt-to-drug delivery intervals were calculated that would yield equivalent probabilities of ROSC between the IV and IO routes.</p><p><strong>Results: </strong>Data were available for 10,350 patients, of which 27.4% presented with a shockable rhythm, 29.7% received bystander CPR, and 39.6% experienced ROSC. After controlling for confounders, IO epinephrine was associated with decreased likelihood of ROSC (OR = 0.77, <i>p</i> < 0.001). The linear regression models provided differing slope coefficients for ROSC between each route, with the IV route associated with a higher likelihood of ROSC for any given call receipt-to-drug-delivery interval. From these equations, the additional time allowed to establish an IV and administer epinephrine intravenously beyond the time required for IO delivery, yet with an equivalent predicted probability of ROSC <i>via</i> the IO route, was calculated. This additional time interval for intravenous administration declined linearly from 9 min at a call receipt-to-intraosseous epinephrine interval of 4 min to no additional time at a call receipt-to-intraosseous epinephrine interval of 29 min.</p><p><strong>Conclusions: </strong>This retrospective analysis of a national EMS database revealed that IO epinephrine was negatively associated with ROSC. Additionally, there appears to be a finite time window during which intravenous epinephrine remains superior to the intraosseous route even if there are brief initial delays in IV drug delivery.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381524","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":"Workplace Violence Against Emergency Medical Services (EMS): A Prospective 12-Month Cohort Study Evaluating Prevalence and Risk Factors Within a Large, Multistate EMS Agency.","authors":"Sarayna S McGuire, Fernanda Bellolio, Bradley J Buck, Chad P Liedl, Dayne D Stuhr, Aidan F Mullan, Mykell Ryan Buffum, Casey M Clements","doi":"10.1080/10903127.2024.2411020","DOIUrl":"10.1080/10903127.2024.2411020","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence and associated risk factors of workplace violence (WPV) experienced by emergency medical services (EMS) clinicians across a large, multistate ground/air EMS agency.</p><p><strong>Methods: </strong>We used a prospective cohort study design from 1 December 2022 to 30 November 2023. A checkbox was added within the electronic medical record (EMR) asking staff to indicate whether WPV occurred. Patient characteristics, encounter (run), and crew factors were abstracted. Potential risk factors for WPV were assessed using logistic regression, with the occurrence of any form of violence as the primary outcome of interest. Models were both univariable, assessing each risk factor individually, and multivariable, assessing all risk factors together to identify independent factors associated with higher risk of WPV. Multivariable model results were reported using adjusted odds ratios (aORs) and 95% confidence intervals.</p><p><strong>Results: </strong>A total of 102,632 runs were included, 95.7% (<i>n</i> = 98,234) included checkbox documentation. There were 843 runs (0.86 per 100 runs, 95% CI 0.80-0.92) identified by EMS clinicians as WPV having occurred, including verbal abuse (<i>n</i> = 482), physical assault (<i>n</i> = 142), and both abuse and assault (<i>n</i> = 219). Risk factors for violence included male patient gender (aOR 1.45, 95% CI 1.24-1.70, <i>p</i> < 0.001), Richmond Agitation-Sedation Scale (RASS) <u>></u>1 (aOR 16.97, 95% CI 13.71-21.01, <i>p</i> < 0.001), and 9-1-1 runs to include emergent (P1; aOR 1.75, 95% CI: 1.17-2.63, <i>p</i> = 0.007) and urgent (P2; aOR 1.64, 95% CI 1.08-2.50, <i>p</i> = 0.021) priority, compared to P3/scheduled transfer or P4/trip requests. Factors associated with lower risk for violence included older patients (aOR per 10 years = 0.95, 95% CI 0.91-0.98, <i>p</i> = 0.007) and run time of day between 0601-1200 h compared to 0000-0600 h (aOR 0.67, 95% CI 0.51-0.88, <i>p</i> = 0.004). Only 2.7% of violent runs captured through the EMR were reported through official processes.</p><p><strong>Conclusions: </strong>Verbal and/or physical violence is recognized in nearly 1% of EMS runs. We recommend prioritizing WPV prevention and mitigation strategies around identified risk factors and simplifying the WPV reporting process in order to reduce staff administrative burden and encourage optimal capturing of violent events.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361931","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":"Clinical Judgment Item Development for Emergency Medical Service Clinicians.","authors":"Paul Rosenberger, Kenneth W Navarro, Christopher B Gage, Mihaiela R Gugiu, Nadine Lebarron McBride, Jonathan R Powell, Ashish R Panchal","doi":"10.1080/10903127.2024.2409976","DOIUrl":"10.1080/10903127.2024.2409976","url":null,"abstract":"<p><strong>Objectives: </strong>While clinical judgment is vital for all clinicians, it is not clearly assessed in initial or continuing emergency medical services (EMS) education due to unclear definitions. Recently, clarity of this concept has been provided through the development of a theoretical framework for clinical judgment in EMS that considers the broad and evolving nature of prehospital care delivery. To facilitate standardization of clinical judgment assessments, in this educational practice review we present a template for item development leveraging the new framework.</p><p><strong>Methods: </strong>We developed this template with input from EMS clinicians, educators, and subject matter experts from the nursing field with experience in clinical judgment item development. This template includes the basic cognitive steps of EMS clinical judgment, including recognizing cues, analyzing cues, defining a hypothesis, generating solutions, taking action, and evaluating the outcomes of those actions.</p><p><strong>Results: </strong>We provide a transparent and reproducible template for item generation for clinical judgment assessments evaluating the six basic cognitive reasoning steps. Further, we provide a fully developed example of template application using a hypoglycemic patient case. This template can be used to support item generation for specific event phases (e.g., en route, scene, and post scene) in a clinical scenario.</p><p><strong>Conclusions: </strong>This template allows for generation of items for each EMS event phase that can be repeated serially for any combination of prehospital clinical situations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352475","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":"Feasibility of 10-Minute Arrival Time to Departure Time Metric for STEMI Patients.","authors":"Joshua Gross, Luke Schuh, Timothy Lenz","doi":"10.1080/10903127.2024.2407911","DOIUrl":"10.1080/10903127.2024.2407911","url":null,"abstract":"<p><strong>Objectives: </strong>Delays in reperfusion treatment in ST-elevation myocardial infarction (STEMI) patients leads to higher morbidity and mortality. Previous reports for Helicopter Emergency Medical Services (HEMS) suggests a 10-minute skid-to-skid (arrival to departure) time to achieve appropriate reperfusion times. However, there is no published data on whether this goal is achievable for a HEMS service. This study aims to see if a midwestern critical care service can consistently achieve a 10-minute helicopter skid-to-skid time or ground critical care service arrival to departure time. Further, comparing this metric between ground and helicopter transportations will help evaluate the ideal transportation method to optimize time to percutaneous intervention (PCI).</p><p><strong>Methods: </strong>This was a retrospective chart review utilizing 10 years of data from our ground and HEMS program to assess whether a 10-minute arrival to departure time for STEMI patients could be achieved. Patients included were at least 18 years of age and were transported from the referring facility for further STEMI management. Wilcoxon rank sum test and Chi-square tests were used to evaluate data between helicopter and ground services.</p><p><strong>Results: </strong>Included in the study were 686 patients, 608 by helicopter transport and 78 by ground transport. The median arrival to departure time was 14 min (IQR = 5) for helicopter patients and 13 min (IQR = 6) for ground patients. There was not a statistically significant difference in this metric for STEMI patients transported by helicopter versus ground. A statistically significant difference, though, existed between helicopter and ground transports among percent with times less than or equal to 10 min versus percent times greater than 10 min, X² = 5.46, df = 1, <i>p</i> = 0.02. Two referring facilities had statistically significant differences in median arrival to departure times.</p><p><strong>Conclusions: </strong>Our study found that a median EMS arrival to departure time of 10 min to transport STEMI patients was not consistently achieved <i>via</i> either helicopter or ground transportation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352477","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":"Evaluation of the Implementation of a Novel Fluid Resuscitation Device in the Prehospital Care of Sepsis Patients: Application of the Implementation Outcomes Framework.","authors":"Julianne M Cyr, M Abdul Hajjar, Lauren N Gorstein, Henry Turcios, Emily Turkington, Mehul D Patel, John-Thomas Malcolm, Jefferson G Williams, José G Cabañas, Jane H Brice","doi":"10.1080/10903127.2024.2409972","DOIUrl":"10.1080/10903127.2024.2409972","url":null,"abstract":"<p><strong>Objectives: </strong>Early identification and fluid resuscitation are recognized performance measures within sepsis care. Despite fluid resuscitation, fluid goals are often not achieved in the prehospital environment. Furthermore, description of implementation process and evaluation of implementation success are historically underreported in prehospital research. The objective of this study was to contextualize and evaluate the system-wide implementation of a novel fluid resuscitation device, the LifeFlow PLUS^®, in the treatment of prehospital sepsis patients.</p><p><strong>Methods: </strong>A single urban emergency medical services (EMS) system internally decided to adopt a novel fluid resuscitation device. This EMS system added the device to the clinical care guidelines of suspected sepsis patients. Prior to and during implementation of the new guidelines, several strategies were undertaken to promote consistent, appropriate system-wide use of the device. A mixed methods study design was deployed. Surveys of EMS clinicians and leaders assessed perceptions of the device and sepsis education prior to field implementation of the device. Clinician and leader semi-structured interviews assessed implementation experience and device adoption. Document analysis evaluated deployment of implementation strategies. Data were triangulated to contextualize implementation and evaluate success.</p><p><strong>Results: </strong>Clinician (88%) and leader (91%) confidence in appropriate clinician device use and device superiority for sepsis care (73 and 100%, respectively) were high. Clinicians (58%) were less likely to view the device as easy to implement compared to leaders (73%). Three themes were developed from semi-structured interviews, including \"exposure\" to the device, \"reinforcing factors\" to prompt device use, and \"clinician buy-in.\" Twenty unique implementation strategies (e.g., <i>dynamic trainings</i>, <i>mandating change</i>) were used to promote successful system-wide device adoption.</p><p><strong>Conclusions: </strong>The overall implementation success of this novel fluid resuscitation device was moderate. Barriers to adoption included complexity of clinical decision-making and ease of device use. Facilitators to adoption included the use of multiple modes of education, clinical reminders, presenting evidence of device benefit, and prehospital culture. Prior to future prehospital implementation programs, EMS systems should focus on identifying and addressing key barriers and facilitators to improve adoption.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352476","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}