Prehospital Emergency Care最新文献

{"title":"Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature.","authors":"Michael G Millin, Johanna C Innes, Gregory D King, Benjamin N Abo, Seth M Kelly, Curtis L Knoles, Robert Vezzetti, Chelsea C White, Allen Yee, John M Gallagher","doi":"10.1080/10903127.2025.2541258","DOIUrl":"10.1080/10903127.2025.2541258","url":null,"abstract":"<p><strong>Objectives: </strong>Spinal motion restriction (SMR), requiring the use of a cervical collar and allowing for use of a vacuum splint or ambulance cot, and spinal immobilization, requiring the use of a backboard and a cervical collar, have long been established as the standard of care in the prehospital management of trauma. Both techniques are based on the hypothesis that post-injury movement of the spinal column may lead to the development of delayed neurological deficits. However, these techniques, which have the potential for significant patient harm, are without definitive evidence of clinical benefit. The objective of this review is to evaluate the potential pathophysiology to delayed neurological injury, and examine the potential harms and benefits of spinal immobilization and SMR.</p><p><strong>Methods: </strong>A structured review of the literature was performed within the National Association of EMS Physicians (NAEMSP) Trauma Compendium Series. Searches were performed in PubMed, Embase, CINAHL, and Web of Science dating back to 1900 looking for manuscripts that addressed the pathophysiology of delayed neurological injury as well as the harms, and benefits, to spinal immobilization and SMR.</p><p><strong>Results: </strong>Out of 3944 manuscripts screened, 115 manuscripts were identified. Noting that some manuscripts answered multiple study questions - 14 studies addressed the pathophysiology of disease to the phenomenon of delayed neurological injury, 55 studies examined the harms of immobilization procedures, 58 studies addressed the effectiveness of immobilization procedures, and 7 studies addressed other factors. Two case series were identified hypothesizing post-injury movement as the cause of delayed neurological injury; and 8 retrospective studies, including two case control studies and three retrospective cohort studies, were identified showing an association between hypoperfusion and worsening neurological injury. There were 55 studies showing harms, and no studies showing a definitive benefit to spinal immobilization.</p><p><strong>Conclusions: </strong>There are no data in the published literature to support spinal immobilization and spinal motion restriction as standard of care. Efforts aimed to reduce the use of cervical collars should be considered, and the use of backboards and full body vacuum splints should be limited to the point in time of active patient extrication.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744418","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":"Current Emergency Medical Services Systems Approaches to Refusal of Assessment, Treatment, or Transport: Examination of Statewide Protocols.","authors":"Rana Barghout, Joshua Lachs, William Haussner, David Hancock, Alyssa Elman, Emily Benton, Douglas Kupas, Ronald Strony, Dennis Rowe, Cory Henkel, Bess White, Phylise Banner, Mark Lachs, Tony Rosen","doi":"10.1080/10903127.2025.2537861","DOIUrl":"10.1080/10903127.2025.2537861","url":null,"abstract":"<p><strong>Objectives: </strong>Many emergency medical services (EMS) 9-1-1 activations result in patients declining evaluation, treatment, or transport to the emergency department (ED). Assessment of a patient's decision-making capacity to refuse and taking appropriate actions based on that are critical elements of EMS practice. However, EMS clinician approaches in this area are under-studied, and variation may exist. As EMS practice is highly protocolized, our goal was to examine all publicly available United States (U.S.) state protocols and describe their guidance around refusals.</p><p><strong>Methods: </strong>We used a structured, multi-step content analysis and published expert recommendations on managing refusal of care in health care settings to identify 35 specific elements within five domains of prehospital refusal management: decision-making capacity assessment, risk assessment, persuasion, escalation to medical oversight, and documentation. We systematically and comprehensively reviewed 34 state protocols and a U.S. national protocol for the presence of these elements.</p><p><strong>Results: </strong>Among 34 state protocols examined, 24% (8) had no guidance on refusal, with 18% (6) including at least some guidance in all domains. Among states with any guidance on refusal, we found a median of 15, a mean of 15, and a range of 5-25 elements included. Three states (9%) discussed all four components of decision-making capacity. Seven (21%) emphasized assessing risk of a severe medical emergency when considering refusal. Guidance on persuasion for high-risk patients was included in 13 (38%). Escalation to direct medical oversight was present in 20 (59%). Only 21 (62%) of protocols provided specific documentation guidelines. Notably, guidance was identified in state protocols that is inconsistent with expert recommendations for management of refusal in the ED. Checklists were included in 4 (12%).</p><p><strong>Conclusions: </strong>Substantial variability exists among state protocols regarding patient refusal guidance. Few protocols address high-risk patients, provide strategies for persuasion, or include checklists for proper management. Standardizing and expanding protocols may enhance EMS care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699345","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":"Whole Blood Versus Blood Components in Prehospital Care.","authors":"Scott Kostolni, Linh Nguyen, Sharon M Long, Iv Godzdanker, David A Wampler, Lawrence H Brown","doi":"10.1080/10903127.2025.2538741","DOIUrl":"10.1080/10903127.2025.2538741","url":null,"abstract":"<p><strong>Objectives: </strong>Whether clinical outcomes differ for hemorrhaging patients receiving prehospital whole blood versus blood component transfusion is unclear. Furthermore, most prehospital transfusion studies are limited to injured patients and commingle interfacility transfers with 9-1-1 scene responses. This study assessed outcomes exclusively among 9-1-1 scene response patients receiving prehospital transfusion with either whole blood or blood components for traumatic and non-traumatic hemorrhage.</p><p><strong>Methods: </strong>Using the ESO Data Collaborative for 2019- 2023, patients 8 to 100 years old who received whole blood or blood components were identified. Interfacility transports, patients receiving blood products prior to EMS arrival, and those with pre-arrival cardiac arrest were excluded. The primary prehospital outcome was change in shock index, along with changes in individual vital signs (Glasgow coma score (GCS), heart rate, systolic blood pressure). The primary hospital outcome was mortality at emergency department (ED) or hospital disposition. We also analyzed adverse events.</p><p><strong>Results: </strong>Of 1,990 eligible patients, 1,515 received whole blood and 475 received blood components. There were significant baseline differences between the two groups, with whole blood more frequently used by ground ambulance services, in urban areas and for penetrating trauma. Patients receiving blood components had statistically greater decreases in shock index (median change, -0.3 vs. -0.2, <i>p</i> = 0.040) and heart rate (median change, -7 bpm vs. - 4 bpm, <i>p</i> = 0.007), but there was no significant difference in mortality for patients receiving whole blood vs. blood components after multivariable analysis adjusting for baseline differences (adjusted odds ratio: 1.7, CI: 0.6-4.9). No patients in either group received prehospital epinephrine, and there were no ED diagnoses of transfusion reaction. Three whole blood patients had diagnoses related to thromboembolic events, but these were unlikely to be related to the transfusion.</p><p><strong>Conclusions: </strong>In this retrospective observational study of 9-1-1 scene response patients with traumatic or non-traumatic hemorrhage, differences between shock index and heart rate for patients receiving whole blood or blood components were of questionable clinical significance, and adjusted mortality did not significantly differ for the two groups. There were no instances of prehospital anaphylaxis or ED transfusion reactions. Both transfusion strategies appear equally effective and safe.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708554","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":"Long-Range Air Transportation for High-Consequence Infectious Diseases: Findings from a Global Tabletop Exercise on Patients with Viral Hemorrhagic Fever.","authors":"Jocelyn J Herstein, Katie L Stern, Shawn G Gibbs, John J Lowe, Kiran Attridge, Jake Dunning, Andreas Gustavsen, Alexander P Isakov, Abigail E Lowe, Wade Miles, Vikramjit Mukherjee, Darrell Ruby, Timothy M Uyeki, Shawn Vasoo, Lauren M Sauer","doi":"10.1080/10903127.2025.2519538","DOIUrl":"https://doi.org/10.1080/10903127.2025.2519538","url":null,"abstract":"<p><strong>Objectives: </strong>Air medical services evacuation of patients with viral hemorrhagic fevers (VHFs) is a complex process. The United States National Emerging Special Pathogens Training and Education Center held an in-person tabletop exercise (TTX) in June 2023 to review and evaluate global processes and plans for long-range VHF air transportation capabilities. The TTX sought to test the coordination, prioritization, capacities, and plans for using VHF transportation capabilities when multiple countries simultaneously request support in air medical services evacuation of their sick or exposed citizens to a high-level isolation unit in their country for care.</p><p><strong>Methods: </strong>Organizations invited to participate in the exercise (<i>N</i> = 16) were identified based on the TTX planning team's knowledge of their VHF transport capabilities. The TTX included a scenario involving a significant Sudan ebolavirus exposure event of an index case to 18 close contacts of diverse nationalities. Following the exercise, scribes' notes, evaluators' observations, and participant feedback forms were thematically analyzed to develop key findings and opportunities. The After Action Report was reviewed by all participants and finalized with their written approval.</p><p><strong>Results: </strong>Representatives from 15 organizations in six countries participated in the TTX; the only organization unable to attend was the World Health Organization. Findings indicated many countries rely on the same organization for VHF air transportation resources that would be quickly exceeded in this scenario. There is a need to further define processes for determining global prioritization of transportation assets when requests exceed capacity.</p><p><strong>Conclusions: </strong>Reliance on the same limited global transportation assets has implications for health security and limits the global response to multiple patients or individuals needing repatriation simultaneously. This indicates the importance of prioritizing resources, enhancing multinational coordination, and highlights the need to elevate these findings and discussions to national and international policy levels to increase air transportation resources and expand global capacity for managing patients with VHFs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789760","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 workplace violence (WPV) dispatch alerts: Anticipating behavior and preventing violence.","authors":"Sarayna S McGuire, Kathryn J Arms, David T Reiter, Chad P Liedl, Aidan F Mullan, Jeffrey P Phillips, Casey M Clements","doi":"10.1080/10903127.2025.2542536","DOIUrl":"https://doi.org/10.1080/10903127.2025.2542536","url":null,"abstract":"<p><strong>Objectives: </strong>Within our emergency medical services (EMS) agency, workplace violence (WPV) is captured through a documentation feature in the electronic medical record. Leveraging this data, we implemented WPV dispatch alerts for addresses where physical violence occurred. Our primary objective was to assess the association of these alerts on the rate of WPV against EMS clinicians.</p><p><strong>Methods: </strong>This observational cohort study took place 11/20/2022-11/20/2024 at a hospital-affiliated EMS agency with 23,300 average annual ground calls for service. Alerts were implemented on 12/26/2023 and consisted of a notification at time of dispatch stating \"WPV Flag- Information only: previous documented assault at this address.\" Alerts were updated monthly with a 1-year expiration, unless renewed due to repeat physical violence. Rate of WPV in the pre-alert period (11/20/2022-12/25/2023) was compared with the post-alert period (12/26/2023-11/20/2024) using risk differences (RDs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 254 (0.78 per 100 EMS calls, 95% CI: 0.69 - 0.89) violent incidents (verbal abuse and physical assault) occurred pre-alerts compared to 153 (0.53 per 100 calls, 95% CI: 0.46 - 0.63) post-alerts (RD= -0.25 cases per 100 calls, 95% CI: -0.37 to -0.12, p < 0.001). Among these were 96 (0.30 per 100 calls, 95% CI: 0.24 - 0.36) assaults pre-alerts, compared to 63 (0.22 per 100 calls, 95% CI: 0.17 - 0.28) post-alerts (RD= -0.07 cases per 100 calls, 95% CI: -0.16 to +0.01, p = 0.068). Seventy-seven alerts were placed on identifiable addresses; among these, two (2.6%) were renewed due to repeat physical violence and 31 (40.3%) were ultimately removed due to no repeat violence in a 12-month period. During the post-alert period, EMS clinicians were dispatched a total of 853 times to addresses with pre-existing alerts (median = 6; range: 1 - 234 dispatches per address), although this included calls with alerts specific to the address but a different unit number from the initial alert (e.g. same nursing facility but different resident unit number).</p><p><strong>Conclusions: </strong>Providing EMS clinicians with alerts on addresses with previous physical violence at time-of-dispatch was associated with a significant decrease in the rate of WPV against EMS clinicians overall within our agency.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785139","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":"Gender and Pay Gaps in Paramedic Services Leadership in Ontario, Canada.","authors":"Dominique Arseneau-Bruneau, Justin Mausz, Sarah Salvis, Andy Tannous, Elizabeth A Donnelly","doi":"10.1080/10903127.2025.2536222","DOIUrl":"10.1080/10903127.2025.2536222","url":null,"abstract":"<p><strong>Objectives: </strong>Research suggests that women are underrepresented in healthcare leadership and often earn less than men. This may be true in the emergency medical services (EMS) as well, but research on the subject is limited and specific data in Canada is scarce. This study aimed to estimate the gender and income distributions among leadership within Ontario's paramedic services.</p><p><strong>Methods: </strong>We abstracted records for leadership positions (e.g., superintendent, commander, deputy chief, chief) from the Ontario Public Sector Salary Disclosure List. Two raters independently assessed the presumed binary gender of each individual, resolving discrepancies through consensus. Interrater agreement was measured using a kappa statistic. Chi-square tests compared the proportions of men and women at different leadership levels (entry, middle, executive). Income distributions were compared using parametric and non-parametric tests, stratified by leadership level.</p><p><strong>Results: </strong>Our search yielded 863 individuals from 49 (out of 54) paramedic services. Interrater agreement on presumed gender was 95% (κ = 0.87, <i>p</i> < 0.001). After resolving discrepancies (<i>n</i> = 43), we achieved complete agreement for 855 individuals (98%). Among the sample, 655 (76%) were presumed to be men. Women held 23% of entry, 35% of middle, and 15% of executive leadership roles. Within the leadership pool and compared to men, women were twice as likely to hold a middle leadership role (Odds Ratio [OR] 2.00, 95% Confidence Interval [CI] 1.35-2.98, <i>p</i> < 0.001) but less likely to hold an executive leadership position (OR 0.54, 95% CI 0.33-0.87, <i>p</i> = 0.012). Median income distributions were comparable at the executive level (<i>p</i> = 0.327), but lower for women at the middle and entry leadership levels, earning $0.90 (<i>p</i> < 0.001) and $0.95 (<i>p</i> < 0.001) for every dollar earned by men, respectively. Gender accounted for 1.7% of the variance in total earnings.</p><p><strong>Conclusions: </strong>Our findings suggest the existence of both gender and pay gaps in leadership, the reasons for which are not immediately apparent and warrant further study.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675518","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":"\"On the Wall\": A Descriptive Analysis of Ambulance Patient Offload Times in the United States.","authors":"Matthew R Shaw, Eric Quinn, Jack Cheng, Sabina Pilipovic, Ali Treichel, Remle P Crowe, Jeffrey L Jarvis","doi":"10.1080/10903127.2025.2535576","DOIUrl":"10.1080/10903127.2025.2535576","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged Ambulance Patient Offload Times (APOT) can lead to decreased ambulance availability and delays for subsequent patients but there is no standardized definition for this interval. We aimed to describe various APOT definitions and compare prolonged APOT intervals by agency characteristics in a large national dataset.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2024 ESO Research Collaborative dataset, including all 9-1-1 response transports. We calculated median APOT intervals using the difference between the \"Arrival at Hospital\" timestamp and \"Receiving Facility Signature\" (APOT 1), \"Transfer of Care\" (APOT 2), \"Incident Closed\" (APOT 3), and a \"Composite\" interval (APOT 4) using the \"Receiving Facility Signature\" timestamp where available and \"Transfer of Care\" timestamp where not available. Using the composite APOT interval, we described characteristics among agencies with >100 annual transports with ≥25% of transports with prolonged APOTs compared to agencies with <25%.</p><p><strong>Results: </strong>Of the 7,237,606 included records, calculable intervals were available for 1,691,745 for APOT 1; 5,613,315 for APOT 2; 7,235,713 for APOT 3; and 6,025,643 for APOT 4. Median and interquartile (IQR) time in minutes for APOT 1 was 10.9 (6.6, 17.5), APOT 2 was 6.6 (4.4, 13.1), APOT 3 was 19.7 (13.1, 30.6), and APOT 4 was 8.7 (4.4, 15.3). Among agencies with ≥100 annual transports (2,020), 3.3% (67) had ≥25% transports with a prolonged APOT of more than 30 min. These agencies were more urban (79.1% vs 58.9%) and had a higher median annual 9-1-1 call volume of 2,772 (IQR:1,145, 5,978) compared to agencies where <25% of transports had a prolonged APOT (1,817 (IQR:719, 4,473)).</p><p><strong>Conclusions: </strong>Overall, median APOT intervals were short, independent of the definition. A small number of EMS agencies experienced prolonged offload times for at least 1-in-4 transports, indicating that though not widespread nationally, APOT challenges are prevalent in a subset of EMS systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675516","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":"Vital Sign Assessment in EMS Non-Transports: A National Analysis.","authors":"Alyssa Green, Sheree Murphy, Michael Redlener, Marshall Washick, Daniel Garner, Lance Corey, Maria Beerman-Foat, Maia Dorsett","doi":"10.1080/10903127.2025.2534997","DOIUrl":"10.1080/10903127.2025.2534997","url":null,"abstract":"<p><strong>Objectives: </strong>To describe national performance on complete vital sign assessment during emergency medical services (EMS) encounters resulting in non-transport, stratified by patient, agency, and incident characteristics.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2023 National EMS Information System (NEMSIS) Public Release Research Dataset. Adult (≥18 years) patients from 9-1-1 incidents resulting in non-transport were included, excluding cases with cardiac arrest prior to EMS arrival. A complete vital sign set was defined as heart rate, respiratory rate, pulse oximetry, systolic blood pressure, and level of consciousness. Descriptive statistics and univariable logistic regression were used to evaluate performance across demographic, agency, and incident-level variables.</p><p><strong>Results: </strong>Among 5,983,628 eligible non-transport incidents, only 54.6% (<i>n</i> = 3,267,407) had a complete set of vital signs documented, while 9.8% (<i>n</i> = 586,968) had no documented vitals. Assessment and documentation of individual vital signs ranged from 70.9% (SpO₂) to 86.0% (heart rate). Agency-level performance varied widely, with Advanced Life Support units achieving 57.3% complete assessments compared to 44.7% for Basic Life Support and 26.8% for Emergency Medical Responder units. Vital sign assessment varied with scene time, significantly improving when scene time exceeded 15 min. Vital sign completeness was highest for dispatches related to chest pain and breathing problems and lowest for behavioral issues and motor vehicle collisions. Falls in patients aged 60 years and older represented a large subset of incomplete assessments, accounting for 15.1% of all non-transport incidents with incomplete vital signs and 18.2% of patients with no vital signs.</p><p><strong>Conclusions: </strong>Nearly half of EMS non-transport incidents lack complete vital sign assessment, and 10% have no vitals recorded. Given the critical role of vital signs in evaluating a patient's clinical condition and patient safety, these findings highlight substantial variability in EMS performance and a need for targeted quality improvement-particularly in high-risk populations such as older adults following falls.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659996","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":"Development and Validation of an Administrative Claims Measure of Emergency Medical Services (EMS) Triage Quality for Mobile Integrated Health Interventions.","authors":"Nicole Voll, Cameron Gettel, Shu-Xia Li, Li Qin, Yixin Li, Sarah Attanasio, Isabella Epshtein, Marvin Nichols, Alexis Lilly, Jacob Quinton, Susannah Bernheim, Hannah Stiles, Karthik Murugiah, N Clay Mann, Arjun Venkatesh","doi":"10.1080/10903127.2025.2535574","DOIUrl":"10.1080/10903127.2025.2535574","url":null,"abstract":"<p><strong>Objectives: </strong>In general, Medicare pays for emergency ground ambulance services when a patient is transported to the nearest emergency department (ED) or other select facilities. As state and local agencies strive to provide high quality person-centered emergency care in locations outside the ED, there is a need for a reliable and valid prehospital quality measure to ensure patient safety. The Centers for Medicare and Medicaid Innovation Center's Emergency Triage, Treat and Transport (ET3) Model created a unique opportunity to develop a quality measure for ambulance organizations to measure safe and effective prehospital care. Our objective was to develop and validate the Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure.</p><p><strong>Methods: </strong>The measure was developed using 2021-2023 Medicare Part B fee-for-service administrative and claims data from 67 ambulance organizations that participated in the ET3 Model, triaging patients using predetermined clinical protocols. The measure cohort included patients that were either transported to an alternative destination (TAD), such as urgent care, or provided treatment in place (TIP). The measure outcome was met if the patient subsequently had an ED visit or died within three days of a TAD/TIP encounter, as an inverse measure, lower is better. We calculated a risk-adjusted measure score using a hierarchical generalized linear model approach, adjusting for patient-level variables and calculating model and measure performance. Finally, we assessed measure face validity and construct validity. To ensure measure reliability, some results were examined using a minimum case threshold of 20 TAD/TIP encounters by each ambulance organization.</p><p><strong>Results: </strong>Among the 22 ambulance organizations that met the minimum case volume threshold, the mean, SD measure score was 20.3 (5.3), ranging from 11.6 to 35.4. The mean (SD) reliability signal-to-noise ratio was 0.791 (0.124). Nine of 11 (82%) members of an interested party consensus group provided a positive vote of face validity. Construct validity was demonstrated by identifying an anticipated negative correlation with three relevant prehospital measures.</p><p><strong>Conclusions: </strong>The Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure is a reliable and valid measure that fills a critical gap in assessing patient safety in prehospital care in the United States.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675517","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":"Emergency Medical Services Responses to 9-1-1 Calls Triggered by Personal Emergency Response Systems.","authors":"Lori L Boland, Diana Jin, Jonathan M Flynn, Marc W LeVoir, Joey L Duren, Ashish R Panchal","doi":"10.1080/10903127.2025.2534985","DOIUrl":"10.1080/10903127.2025.2534985","url":null,"abstract":"<p><strong>Objectives: </strong>Many elderly adults utilize wearable personal emergency response systems (PERS) to support independent living while ensuring prompt assistance in an emergency. Activation of emergency medical services (EMS) is integral to the PERS model, but the impact of PERS activation on the utilization of EMS is not well described. We examined EMS responses to 9-1-1 calls related to PERS activations in a large EMS system over a 10-year period and evaluated the appropriateness of lights and siren (L&S) response.</p><p><strong>Methods: </strong>This retrospective analysis included 9-1-1 responses to PERS activations by a single agency between January 1, 2013, and December 31, 2022. Descriptive statistics were used to summarize the chief complaint assigned by the emergency medical dispatcher (EMD), response mode, and transport mode. Logistic regression was used to assess the association between EMD-assigned final chief complaint and L&S patient transport. Duration of L&S response (minutes) was computed as the interval between time unit dispatched and either unit arrival (patient contact), or unit cancelation (no patient contact).</p><p><strong>Results: </strong>Activations related to PERS (<i>n</i> = 18,660) comprised 2.5% of all 9-1-1 calls involving adult patients. L&S were used in 96% of PERS responses, and patient contact, patient transport, and L&S transport occurred in 36%, 25%, and 1.4%, respectively. Patients evaluated by EMS were most often female (72%) and ages 85+ (39%). Dispatcher modification of the chief complaint from PERS alarm to a more clinically specific complaint code was univariately associated with an increased odds of L&S transport (OR = 2.85, CI = 2.10-3.87). Between 2013 and 2022, responses to PERS activations accounted for 1,734 h of L&S use, of which 1,087 h (63%) were attributable to calls canceled prior to patient contact.</p><p><strong>Conclusions: </strong>A significant proportion of PERS responses in this system are canceled prior to patient contact or involve low acuity patients, and L&S patient transport is rare. Dispatcher determination of the specific nature of the problem increases the likelihood of the need for L&S transport after PERS activations. These findings provide a strong rationale for EMS systems transitioning away from the use of L&S response to PERS calls in the absence of definitive situational information.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659994","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}