Prehospital Emergency Care最新文献

{"title":"Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma - A Position Statement and Resource Document of NAEMSP.","authors":"Mark X Cicero, Kathleen Adelgais, Melissa C Funaro, Kathryn Schissler, Angela Doswell, Matthew Harris, Ruchika M Jones, Janice Lester, Christian Martin-Gill","doi":"10.1080/10903127.2025.2457141","DOIUrl":"10.1080/10903127.2025.2457141","url":null,"abstract":"<p><p>Pediatric trauma patients have unique physiology and anatomy that impact the severity and patterns of injury. There is a need for updated, holistic guidance for Emergency Medical Services (EMS) clinicians and medical directors to optimize prehospital pediatric trauma guidelines based on evidence and best practice. This is especially pertinent to pediatric severe and inflicted trauma, where prehospital evaluation and management determine the overall quality of care and patient outcomes. This position statement addresses the prehospital evaluation and management of pediatric severe and inflicted trauma and is based on a thorough review and analysis of the current literature.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071229","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":"EMS Agency Characteristics and Adverse Events in Pediatric Out-of-Hospital Cardiac Arrest Among 49 U.S. EMS Agencies.","authors":"Matthew L Hansen, Grace Walker-Stevenson, Nathan Bahr, Tabria Harrod, Garth Meckler, Carl Eriksson, Ahamed Idris, Tom P Aufderheide, Mohamud R Daya, Ericka L Fink, Jonathan Jui, Maureen Luetje, Christian Martin-Gill, Steven Mcgaughey, Jonathan H Pelletier, Danny Thomas, Jeanne-Marie Guise","doi":"10.1080/10903127.2025.2461284","DOIUrl":"10.1080/10903127.2025.2461284","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric out-of-hospital cardiac arrest (OHCA) impacts 15,000-25,000 children annually in the U.S. The objective of this study was to determine if specific Emergency Medical Services (EMS) agency factors, such as pediatric volume and preparedness factors, including hours of required pediatric training, pediatric emergency care coordinator (PECC), or pediatric informational resources are associated with improved quality of care or adverse events for pediatric OHCA.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of EMS clinical records and EMS agency survey among five agencies in the Portland OR, Pittsburgh PA, Milwaukee WI, San Bernardino CA, Atlanta GA, and Dallas TX regions. We reviewed medical records of children who experienced an EMS-treated OHCA between 2013 and 2019 using a validated structured chart review tool to identify adverse safety events (ASEs). Agencies who contributed medical records completed a survey that described elements of pediatric preparedness and organizational structure relevant to pediatric care. We first conducted a descriptive analysis of agency and patient characteristics, followed by an evaluation of the association of agency factors that we hypothesized could improve pediatric care and reduce the occurrence of ASEs.</p><p><strong>Results: </strong>Twenty-two agencies with a total of 659 OHCA patient encounters completed the survey. The Broselow system was used by 81% of agencies, local protocol guides were used in 86% of agencies. Forty-five percent of agencies had a designated pediatric emergency care coordinator (PECC). Agencies reported a similar number of hours for pediatric and neonatal simulation (1.3 and 1.5 h, respectively) and skills training (2.0 and 2.5 h, respectively) annually. We found that younger patient age significantly increased the risk of an ASE. In both univariate and multivariate analyses, several hypothesized variables were not associated with decreased risk of an ASE, including pediatric and neonatal skills/simulation training hours, conducting pediatric-specific quality reviews, and having an identified PECC.</p><p><strong>Conclusions: </strong>In this large medical record review of EMS-treated pediatric OHCA cases, pediatric training, pediatric care coordination, and conducting pediatric quality reviews were not associated with reduced ASEs. Additional research is needed to understand how EMS agencies can improve the quality of care for pediatric OHCA, especially for infants.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190173","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":"Combining Conventional and Telemedicine Medical Services to Reduce the Burden on Emergency Medical Services in Rural Areas: A Retrospective Cohort Study.","authors":"Ryota Inokuchi, Ayaka Sakamoto, Yu Sun, Masao Iwagami, Nanako Tamiya","doi":"10.1080/10903127.2025.2460205","DOIUrl":"10.1080/10903127.2025.2460205","url":null,"abstract":"<p><strong>Objectives: </strong>During the COVID-19 pandemic, the number of ambulance calls increased sharply, and ambulances could not be dispatched due to unavailability, especially in rural areas. This study assessed the integration of traditional emergency care systems in rural areas with online medical services from urban areas.</p><p><strong>Methods: </strong>In this retrospective observational cohort study, patients recovering from mild COVID-19 at home who called an ambulance (November 2022 to January 2023) in Asahikawa, Japan were included. When an emergency call was received, the fire department control center initiated an online medical consultation to ascertain the necessity of ambulance transport while conventionally dispatching an ambulance. We compared chief complaints and patient characteristics between those who were transferred to hospitals and those who were not transferred, considering the time from the beginning of the 1-1-9 call to the start of the online service, and the duration of the online consultation for each group. The statistical significance of the differences between groups was analyzed by the Mann-Whitney U-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables with statistical significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among the 136 patients, 73 (53.7%) were transferred to a hospital <i>via</i> ambulance. The median age of the transferred patients was significantly higher, at 83 years (interquartile range (IQR): 57-90), compared with 37 years (IQR: 26-60) for those not transferred (<i>p</i> < 0.001). A significantly higher number of transferred patients had hypoxemia (17, 23.3%; vs. non-transferred, 2, 3.2%; <i>p</i> < 0.001). The time from the start to the end of the online consultation was shorter for the transferred patients (13 min (IQR: 8-20) compared to non-transferred patients (15 min (IQR: 13-22); <i>p</i> < 0.001). There were no significant differences between groups in terms of sex, medical history, other chief complaints, or the time from the start of the 1-1-9 call to the start of the online service.</p><p><strong>Conclusions: </strong>Online medical services have the potential to optimize medical resource allocation and utilization in rural areas.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071242","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":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","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":"State-Level Helmet Use Laws, Helmet Use, and Head Injuries in EMS Patients Involved in Motorcycle Collisions.","authors":"Jane M Hayes, Rebecca E Cash, Lydia Buzzard, Alyssa M Green, Lori L Boland, Morgan K Anderson","doi":"10.1080/10903127.2025.2450280","DOIUrl":"10.1080/10903127.2025.2450280","url":null,"abstract":"<p><strong>Objectives: </strong>Motorcycle helmets save lives and reduce serious injury after motorcycle collisions (MCC). In 2022, 18 states had laws requiring helmet use by motorcyclists aged ≥21 years. Our objective was to compare helmet use and head trauma in emergency medical services (EMS) patients involved in MCC in states with and without helmet use laws.</p><p><strong>Methods: </strong>We conducted an analysis of the 2022 ImageTrend Collaborate national EMS dataset. We included 9-1-1 responses where the patient was a motorcyclist in a transport accident (ICD-10 V20-V29) and aged ≥21 years. Patient demographics, incident urbanicity, helmet use, presence of state helmet use law, patient disposition, Glasgow Coma Scale (GCS) score, and trauma team activations were examined. Our primary outcome of interest was EMS documentation of helmet use (yes/no). Our secondary outcome was the presence of a head injury. We examined EMS-documented head injury, defined using clinician impressions and chief complaint anatomical location. Chi-square tests were used to assess differences in proportions, and a multivariable logistic regression model was used to estimate odds of moderate/severe head injury adjusted for covariates of interest.</p><p><strong>Results: </strong>A total of 15,891 patient encounters were included, 10,738 (67.6%) occurred in states without helmet use laws. States without helmet use laws had higher proportions of unhelmeted patients (56.8% vs 24.2%, <i>p</i> < 0.001), encounters in non-metro/rural areas (19.7% vs 13.3%, <i>p</i> < 0.001), and GCS-defined moderate/severe head injuries (4.6% vs 2.3%, <i>p</i> < 0.001). In a multivariable model that included 10-yr age groups, sex, race, urbanicity, and documented helmet use, the adjusted odds of moderate/severe head injury were lower for females (0.47, 95%CI, 0.35-0.65) and Black patients (0.47, 95%CI 0.32-0.70), and were higher for incidents in nonmetro/rural areas (1.58, 95%CI 1.28-1.95) and when EMS had not documented helmet use (3.17, 95%CI 2.56-3.92).</p><p><strong>Conclusions: </strong>In this retrospective cross-sectional study, a higher proportion of patients involved in MCCs in states without helmet laws were not wearing helmets at the time of injury, and unhelemted patients had increased likelihood of sustaining a head injury. EMS agencies in states without helmet laws should prepare their systems and clinicians for an increased incidence of head injuries after MCCs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953814","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":"Assessing the \"Reach\" of a Fire-Based Mobile Integrated Health Buprenorphine Induction Program Through an Implementation Science Lens.","authors":"Thomas W Engel Ii, Jennifer Hernandez-Meier, Grant Comstock, Nicole Fumo, Daria Mueller, Hannah Kovacevich, Dan Pojar, Jason Schaak, Benjamin W Weston","doi":"10.1080/10903127.2025.2457605","DOIUrl":"10.1080/10903127.2025.2457605","url":null,"abstract":"<p><strong>Objectives: </strong>Medication for opioid use disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Recent administrative and legislative changes have made MOUD possible in the prehospital setting. We use an implementation science framework to outline the Reach of a fire department EMS-based Mobile Integrated Health (MIH) prehospital MOUD program.</p><p><strong>Methods: </strong>The West Allis Fire Department (WAFD) within the Milwaukee County EMS system operates an MIH program that allows for internal and external referrals for patients with OUD. Internal referrals originated from 9-1-1 dispatch <i>via</i> emergency medical dispatch code selection, self-dispatch, or a weekly summary of electronic patient care reports involving opioid-related encounters. External referrals came from emergency departments (ED) or community partners. Among all referral patients with OUD, the primary measures included Overall Reach (those who agreed to MIH services), Clinical Opiate Withdrawal Scale (COWS) Reach (those with a COWS score performed), Buprenorphine Reach (those who based on COWS were offered buprenorphine induction) and Induction Reach (those who accepted buprenorphine induction).</p><p><strong>Results: </strong>Between 5/24/2023 and 5/25/2024, the WAFD MIH program received 265 total potential OUD patient referrals, 135 internally and 130 externally. Internal referrals consisted of 48 MIH responses received from 9-1-1 dispatch, 5 self-dispatches, and 82 patients captured on a weekly report. In the external referral process, 8 originated from community partners and 122 from EDs. Among the combined 265 patient referrals, 128 (48.3%) patient contacts were made. The Overall Reach was 99/128 patients (77.3%), COWS Reach was 99/99 (100%), Buprenorphine Reach was 8/99 (8.1%) patients, and Induction Reach was 4/8 (50%).</p><p><strong>Conlusions: </strong>A fire department EMS-based MIH buprenorphine MOUD program is able to reach patients experiencing OUD. External partners make up a sizable proportion of patient referrals to increase a program's reach. Challenges included obtaining real time assessment from designated MIH clinicians utilizing dispatch protocols, a high proportion of ineligible patients based on buprenorphine guidelines, and a relatively high proportion of patients declining induction. Results may assist other fire departments in assessing potential estimates of patient encounters and avenues for patient contact for similar programing.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029433","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":"Longer Total Interhospital Transfer Times for Rural Sepsis Patients Not Associated with Increased Mortality.","authors":"Benjamin Wilkinson, Eliezer Santos León, J Priyanka Vakkalanka, Azeemuddin Ahmed, Karisa K Harland, Brian M Fuller, Kalyn Campbell, Morgan B Swanson, Brett Faine, Anne Zepeski, Luke Mack, Amanda Bell, Katie DeJong, Kelli Wallace, Edith A Parker, Keith Mueller, Elizabeth Chrischilles, Christopher R Carpenter, Michael P Jones, Steven Q Simpson, Nicholas M Mohr","doi":"10.1080/10903127.2024.2447044","DOIUrl":"10.1080/10903127.2024.2447044","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a time-sensitive condition, and many rural emergency department (ED) sepsis patients are transferred to tertiary hospitals. The objective of this study was to determine whether longer transport times during interhospital transfer are associated with higher sepsis mortality or increased hospital length-of-stay (LOS).</p><p><strong>Methods: </strong> A cohort of rural adult (age ≥ 18 y) sepsis patients transferred between hospitals were identified in the TELEmedicine as a Virtual Intervention for Sepsis Care in Emergency Departments (TELEVISED) parent study. We collected data on the time spent between triage and disposition at the rural ED (ED LOS), time from rural ED disposition to arrival at the destination hospital (transport duration), and overall time from rural ED triage to arrival at the destination hospital (total transfer time). We used a zero inflated negative binomial model with log link for the primary outcome (28-day hospital-free days), and a logit model for secondary outcomes of Surviving Sepsis Campaign (SSC) bundle adherence and in-hospital mortality. We included clinical and demographic covariates in model development.</p><p><strong>Results: </strong> We included 359 transferred rural sepsis patients. There was no association between ED LOS (aRR: 1.00; 95% CI: 0.98-1.02), transport duration (aRR: 1.03; 95% CI: 0.99-1.07), or total transfer time (aRR: 1.01; 95% CI: 0.99-1.03) and 28-day hospital free days. Similarly, we found no association between ED LOS, transport duration, and total transfer time with secondary outcomes.</p><p><strong>Conclusions: </strong> Longer total transfer time showed no association with 28-day hospital free days in rural sepsis patients. Future work will seek to better understand how rural ED sepsis care can be optimized to maximize outcomes in transferred patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953738","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":"Virtual Neonatal Resuscitation Curriculum for Emergency Medical Services (EMS) to Improve Out-of-Hospital Newborn Care.","authors":"Trang K Huynh, Jeffrey D Smith, Matthew Neth, Petter Overton-Harris, Mohamud R Daya, Jeanne-Marie Guise, Garth D Meckler, Matthew L Hansen","doi":"10.1080/10903127.2025.2450074","DOIUrl":"10.1080/10903127.2025.2450074","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital births are associated with a 2- to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS. There is a need for tailored NRP training to meet EMS clinicians' specific needs, context, and systems.</p><p><strong>Methods: </strong>This was a prospective observational study of a virtual EMS-tailored, newborn resuscitation curriculum focused on initial steps of newborn resuscitation in the out-of-hospital setting. The initial content (90-minute) was pilot tested virtually among 350 urban EMS clinicians, with favorable feedback (89% survey response rate). Based on feedback, we created a 60-minute interactive, virtual curriculum that includes NRP-based didactic and memory aids to reinforce how NRP differs from pediatric resuscitation designed specifically for EMS. The course also includes video demonstrations with pauses for hands-on self-directed skills practice. We delivered the curriculum to clinicians from 17 EMS agencies in rural Oregon. To assess neonatal resuscitation knowledge acquisition and retention, participants completed the same 10-question test before, after, and 3 months following the training. Questions were adapted from the 8^th Edition NRP Textbook and NRP test questions.</p><p><strong>Results: </strong>Eighty-four EMS clinicians completed the pretest, curriculum, and post-test and demonstrated improvement in immediate post-curriculum NRP knowledge (pretest mean score 5.32 ± 1.99; post-test mean score 8.61 ± 1.26; <i>p</i> < 0.001). Forty participants completed the 3-month follow up test and scores remained improved from baseline (3 month-follow up mean score 6.88 ± 1.83, <i>p</i> < 0.001). Prehospital clinicians (<i>N</i> = 84) thought that this EMS-tailored NRP curriculum was easy to complete (100%), valuable to their clinical practice (99%), and filled a gap in their education (98%). They felt that implementing/requiring this training is possible/doable (99%) and recommend the curriculum to other EMS agencies (99%).</p><p><strong>Conclusions: </strong>A virtual EMS-tailored, NRP-based educational curriculum improved neonatal resuscitation knowledge immediately and was sustained at 3 months compared to baseline. The curriculum is feasible and acceptable to EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953834","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":"Identification of Naloxone in Emergency Medical Services Data Substantially Improves by Processing Unstructured Patient Care Narratives.","authors":"Daniel R Harris, Peter Rock, Nicholas Anthony, Dana Quesinberry, Chris Delcher","doi":"10.1080/10903127.2024.2446638","DOIUrl":"10.1080/10903127.2024.2446638","url":null,"abstract":"<p><strong>Objectives: </strong>Structured data fields, including medication fields involving naloxone, are routinely used to identify opioid overdoses in emergency medical services (EMS) data; between January 2021 and March 2024, there were approximately 1.2 million instances of naloxone administration in the United States. To improve the accuracy of naloxone reporting, we developed methodology for identifying naloxone administration using both structured fields and unstructured patient care narratives for events documented by EMS.</p><p><strong>Methods: </strong>We randomly sampled 30,000 records from Kentucky's state-wide EMS database during 2019. We applied regular expressions (RegEx) capable of recognizing naloxone-related text patterns in each EMS patient's case narrative. Additionally, we applied natural language processing (NLP) techniques to extract important contextual factors such as route and dosage from these narratives. We manually reviewed cases where the structured data and unstructured data disagreed and developed an aggregate indicator for naloxone administration using either structured or unstructured data for each patient case.</p><p><strong>Results: </strong>There were 437 (1.45%) records with structured documentation of naloxone. Our RegEx method identified 547 naloxone administrations in the narratives; after manual review, we determined RegEx yielded acceptable false positives (<i>N</i> = 31, 5.6%), false negatives (<i>N</i> = 23, 4.2%) and performance (precision = 0.94, recall = 0.93). In total, 552 patients had naloxone administered after combining indicators from both structured fields and verified results from unstructured narratives. The NLP approach also identified 246 (47.4%) records that specified route of administration and 358 (69.0%) records with dosage delivered.</p><p><strong>Conclusions: </strong>An additional 115 (26.3%) patients receiving naloxone were identified by using unstructured case narratives compared to structured data. New surveillance methods that incorporate unstructured EMS narratives are critically needed to avoid substantial underestimation of naloxone utilization and enumeration of opioid overdoses.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953723","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":"Exploring the Use of Immersive Simulation to Teach Research Skills to Student Paramedics in Higher Education: A Mixed Methods Approach.","authors":"Jessica Runacres, Sean Wheatley, Emily Browne","doi":"10.1080/10903127.2024.2445060","DOIUrl":"10.1080/10903127.2024.2445060","url":null,"abstract":"<p><strong>Objectives: </strong>Within paramedic education immersive simulation is widely used to teach technical skills, but its application to non-technical aspects of practice, such as research skills, is limited. This study aimed to explore immersive simulation as a tool to teach specific research skills to paramedic students in higher education to investigate its novel capacity beyond the more traditionally considered technical elements of practice.</p><p><strong>Methods: </strong>A didactic pre-briefing was delivered to undergraduate paramedic students before they undertook an immersive simulation in which they were expected to assess, extricate, and treat a stroke patient, whilst also assessing whether he was suitable to be enrolled onto a clinical trial, provide information on this, and take consent. A large-scale immersive environment furnished with surround audio-visual display equipment was utilized; the environment also contained an ambulance, a hatchback car, and two actors. After the simulation and debriefing, students completed an online questionnaire comprising open-ended questions and the following scales: Simulation Design Scale (fidelity subscale only), Simulation Effectiveness Tool - Modified, and Satisfaction with Simulation Experience. Data were analyzed using descriptive statistics and a manifest qualitative content analysis.</p><p><strong>Results: </strong>Data were collected from twenty-eight undergraduate paramedic students. Most students believed simulation fidelity was important (89.3%) and most agreed that the simulation was realistic (82.1%). Pre<b>-</b>briefing (100%) and debriefing (85.7%) opportunities were considered important for increasing student's confidence and learning, and, overall, students enjoyed the simulation (89.3%). Three themes emerged during the qualitative analysis: the significance of an immersive \"real\" environment, enjoyment as important for engagement and learning, and improved confidence <i>via</i> opportunities for autonomous practice.</p><p><strong>Conclusions: </strong>Immersive simulation is a valuable pedagogical tool for the delivery of research skills teaching. These findings align with previous research which has investigated immersive simulation for teaching clinical skills, but more broadly, also highlight the compounding positive impact of immersive technology when deployed alongside actors and high-fidelity equipment.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953705","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}