Prehospital Emergency Care最新文献

{"title":"Chest Compressions Synchronized to Native Cardiac Contractions are More Effective than Unsynchronized Compressions for Improving Coronary Perfusion Pressure in a Novel Pseudo-PEA Swine Model.","authors":"Keith A Marill, James J Menegazzi, Jorge A Gumucio, Rameen Forghani, David D Salcido","doi":"10.1080/10903127.2025.2463633","DOIUrl":"10.1080/10903127.2025.2463633","url":null,"abstract":"<p><strong>Objectives: </strong>Pulseless electrical activity (PEA) arrest, which includes pseudo-PEA, is increasingly common and survival remains dismal. We hypothesized that mechanical chest compressions synchronized to native cardiac contractions improve coronary perfusion pressure (CPP) during pseudo-PEA resuscitation.</p><p><strong>Methods: </strong>We developed a model of pseudo-PEA by infusing high dose esmolol intravenously into anesthetized, intubated, and central arterial and venous catheterized swine to a goal of 45 mm Hg mean arterial blood pressure (MAP). We performed a randomized unblinded repeated crossover trial by administering alternating synchronized and unsynchronized chest compressions for 52 s preceded by 8 s breaks consecutively 4 times. We repeated the protocol approximately 4 times with 1 min breaks. Synchronized compressions were provided 1:1 with native contractions during systole and unsynchronized compressions were provided at 100 beats per minute (BPM). We measured average CPP, MAP, and heartrate (HR) for 5 beats immediately preceding the chest compression onset and for 30 s 10 s after compression onset. We computed the difference in continuous CPP during compressions compared to the immediately preceding baseline for each interval. We developed a mixed linear model with outcome average CPP during compressions minus baseline, fixed variable compression type, and random variable animal.</p><p><strong>Results: </strong>We included 6 animals. Mean baseline HR was 76.0 BPM, MAP 49.9, and CPP 36.2. Chest compressions increased CPP from baseline an average 1.7 mm Hg when unsynchronized and 5.6 mm Hg synchronized. The adjusted difference was 4.0 mm Hg (95% CI 2.4-5.5).</p><p><strong>Conclusions: </strong>Synchronized chest compressions increased CPP 4.0 mm Hg (135%) more than unsynchronized compressions despite a lower compression rate in medication-induced pseudo-PEA. Further refinement and eventual application to patients suffering pseudo-PEA arrest appear warranted.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371066","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":"Non-Invasive Ventilation as a Pre-Oxygenation Strategy During In-Flight Rapid Sequence Intubation: A Case Report.","authors":"Erin Vidal, Robert B Simonson","doi":"10.1080/10903127.2025.2457607","DOIUrl":"10.1080/10903127.2025.2457607","url":null,"abstract":"<p><p>Noninvasive ventilation has been used as a pre-oxygenation strategy for rapid sequence intubation in the emergency department and the intensive care unit, yet, limited research has examined its use in the transport setting. These case reports discuss the use of noninvasive ventilation <i>via</i> a Hamilton T1 ventilator (Hamilton Medical) during transport by an air medical crew for pre-oxygenation before intubation in two cases. In both cases, a noninvasive, bilevel-positive airway pressure mode with a backup rate was used to achieve adequate airway pressures while allowing for a two-handed seal by one emergency medical services clinician as the other prepared the equipment and medications. This method of pre-oxygenation in a space and resource-limited setting was associated with first-pass success without hypoxia in both cases. This adds another method of pre-oxygenation to facilitate safe intubation in similar settings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033843","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":"Epinephrine in Prehospital Traumatic Cardiac Arrest-Life Saving or False Hope?","authors":"Cordelie E Witt, David V Shatz, Bryce R H Robinson, Eric M Campion, Mark L Shapiro, Eric H Bui, Jonathan P Meizoso, Warren C Dorlac","doi":"10.1080/10903127.2025.2461283","DOIUrl":"10.1080/10903127.2025.2461283","url":null,"abstract":"<p><strong>Objectives: </strong>While epinephrine is widely used for medical cardiac arrests, there is a knowledge gap regarding its utility for traumatic arrests. Traumatic arrests result from hypovolemia, hypoxia, or anatomic impairment of cardiac function such that the inotropic and vasoconstrictive effects of epinephrine may be ineffective or harmful. We hypothesized that epinephrine does not improve survival among patients with traumatic cardiac arrest.</p><p><strong>Methods: </strong>This was a multicenter retrospective cohort study of trauma patients sustaining prehospital cardiac arrest who were treated at seven level I and II trauma centers over 6 years (2011-2017), ascertained <i>via</i> trauma registry data and chart abstraction. The primary outcome was survival to hospital discharge; patients treated with or without epinephrine were compared. Multivariable analyses were performed using Poisson regression. Time to event analyses were conducted using Cox proportional hazard models.</p><p><strong>Results: </strong>We included 1631 adult and pediatric trauma patients with prehospital cardiac arrest. Prehospital epinephrine was administered to 844 (52%). The median age was 35 years, 335 (21%) were female, 712 (44%) sustained blunt trauma, and 58 (4%) had a shockable initial rhythm. Survival to hospital discharge was significantly lower in the prehospital epinephrine cohort compared to the no epinephrine cohort in univariable analysis [43/844 (5%) <i>vs.</i> 125/787 (16%), <i>p</i> < 0.001]. Among patients with blunt mechanism, survival was significantly lower in the prehospital epinephrine cohort [12/382 (3%) <i>vs.</i> 54/330 (16%), <i>p</i> < 0.001]. Among patients with penetrating mechanism, survival was not statistically different [10/276 (4%) with epinephrine <i>vs.</i> 22/374 (6%) without, <i>p</i> = 0.19]. In multivariable analyses adjusting for age, sex, mechanism, and initial rhythm, epinephrine was associated with lower likelihood of survival in the overall and blunt cohorts; there was no significant difference in the penetrating cohort (overall aRR 0.33, 95% CI 0.23-0.46; blunt aRR 0.20, 95% CI 0.11-0.37; penetrating aRR 0.62, 95% CI 0.30-1.28). Adjusted and unadjusted time to event analyses across each of these cohorts showed that epinephrine was associated with either statistically inferior or indistinct hazard ratios.</p><p><strong>Conclusions: </strong>Epinephrine was not associated with improved survival following traumatic cardiac arrest, and in multiple subanalyses, it was associated with inferior outcomes. These results may inform prehospital traumatic arrest protocols.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071196","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: 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}