Prehospital Emergency Care最新文献

{"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}

{"title":"Implementation of EMS Clinician Feedback Tool Encourages Patient Feedback Requests and Professional Development: A Mixed-Methods Study.","authors":"Katherine L Schneider, Zachary W Case, J Priyanka Vakkalanka, Nicholas M Mohr, Azeemuddin Ahmed","doi":"10.1080/10903127.2024.2448831","DOIUrl":"10.1080/10903127.2024.2448831","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians express dissatisfaction with the quality and quantity of clinical feedback received from hospitals, which is exacerbated by the absence of standardized feedback processes. A reported lack of regular feedback impedes their ability to learn and improve care. We evaluated a newly implemented feedback tool's utilization and perceived impact on EMS clinicians and our health system.</p><p><strong>Methods: </strong>We employed a mixed-methods study design in a single academic medical center emergency department. Quantitative data collected focused on patients' clinical characteristics and characteristics of utilizers of the feedback tool during implementation (September 2023-July 2024). Qualitative data involved semi-structured interviews with EMS clinicians who had diverse experiences with the feedback tool and years of EMS service Semi-structured interviews applied a phenomenological framework, and were videorecorded, transcribed, and independently coded to identify key themes surrounding the utilization and impact of the implemented tool.</p><p><strong>Results: </strong>Among the 381 feedback requests, 139 (36.5%) pertained to patients aged ≥65 years, while 44 (11.5 %) included patients <18 years; 343 (90%) had an Emergency Severity Index score of ≥2. Major complaints included traumatic (<i>n</i> = 165; 43.3%), neurologic (<i>n</i> = 90; 23.6%), and cardiac (<i>n</i> = 82; 21.5%). Emergency responder agencies included ground ambulance 227 (59.6%), air medical 90 (23.6%), public safety answering points 37 (9.7%), and fire service 27 (7.1%). The primary response method was e-mail 353 (93.7%). There was an average of 35 feedback requests per month (interquartile range: 27-59). EMS clinicians from multiple agencies with varying levels of knowledge of the feedback mechanism provided qualitative insights regarding the feedback tool, which covered several key areas: application and technological design, utilization, utility of feedback provided, barriers, comparisons to other systems, and areas for improvement.</p><p><strong>Conclusions: </strong> The standardized feedback mechanism implemented for EMS clinicians showed engagement, especially among ground responders caring for high-acuity patients, highlighting its importance in patient care. The preference for email emphasizes the need for efficient communication channels. Clinicians found the system accessible and user-friendly. The feedback tool was perceived as crucial for professional development and personal growth, allowing clinicians to gain closure on patient cases and potentially improve future patient care practices.</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":"142953730","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":"Precipitated Withdrawal Induced by Prehospital Naloxone Administration.","authors":"Lindsey A Vandergrift, Amber D Rice, Keith Primeau, Joshua B Gaither, Rachel D Munn, Philipp L Hannan, Mary C Knotts, Adrienne Hollen, Brian Stevens, Justin Lara, Melody Glenn","doi":"10.1080/10903127.2024.2449505","DOIUrl":"10.1080/10903127.2024.2449505","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine is becoming a key component of prehospital management of opioid use disorder. It is unclear how many prehospital patients might be eligible for buprenorphine induction, as traditional induction requires that patients first have some degree of opioid withdrawal. The primary aim of this study was to quantify how many patients developed precipitated withdrawal after receiving prehospital naloxone for suspected overdose, as they could be candidates for prehospital buprenorphine. The secondary objective was to identify associated factors contributing to precipitated withdrawal, including dose of naloxone administered, and identify rate of subsequent transport.</p><p><strong>Methods: </strong>A retrospective cohort study reviewing electronic patient care reports (ePCRs) from March 2019 to April 2023 in a single Emergency Medical Services (EMS) system was performed. Cases were included if naloxone was administered during the prehospital interval and excluded if the patient was in cardiac arrest upon arrival and died on scene. Precipitated opioid withdrawal was defined using reliably available ePCR data points measured by the Clinical Opiate Withdrawal Scale: administration of an antiemetic or sedative, persistent tachycardia, or new tachycardia after naloxone. Descriptive statistics were calculated to quantify the incidence of precipitated withdrawal. Risk ratios were calculated to identify variables associated with outcomes of interest. A subgroup analysis was performed examining patients explicitly diagnosed with an overdose by EMS.</p><p><strong>Results: </strong>During the study period, 4561 individuals were given naloxone, and 2124 (46.2%) met our proxy criteria for precipitated withdrawal. Patients who received multiple doses of naloxone were more likely to meet our precipitated withdrawal definition versus those who received a single dose (RR 1.2, 95% CI 1.12-1.28). Patients who experienced precipitated withdrawal were more likely to accept transportation than those who did not experience withdrawal (RR 1.08 95% CI 1.04-1.12). Persistent tachycardia (80.3%) was the most common criterion met for our definition of precipitated withdrawal.</p><p><strong>Conclusions: </strong>Almost half of patients who received a dose of prehospital naloxone for suspected overdose met our proxy criteria for precipitated withdrawal. Patients who met our precipitated withdrawal definition were more likely to have received greater doses of naloxone and were more likely to accept transport to an emergency department.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Fatigue During Search and Rescue Efforts in Debris on the Quality of Cardiopulmonary Resuscitation.","authors":"Kadir Çavuş, Oğuzhan Tiryaki, Elif Tiryaki, Suat Çelik, Hüseyin Bora Saçar","doi":"10.1080/10903127.2025.2450072","DOIUrl":"10.1080/10903127.2025.2450072","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiopulmonary resuscitation (CPR), which is used in cases of life-threatening cardiopulmonary arrest, is a physically exhausting procedure. Adding to that, sometimes, even before performing CPR, interventions to rescue the injured person from a challenging environment have caused significant fatigue. In this study, taking a novel research approach, we generated a scenario of fatigue during a rescue from earthquake debris and aimed to measure the effect of that fatigue on the quality of CPR performed by paramedics.</p><p><strong>Methods: </strong>The research followed an experimental design with 2 groups (experimental/control) and 2 measurements (pretest/post-test). The study population was selected using power analysis. The sample, consisting of 84 paramedic students, was randomly divided into 42 control and 42 experimental participants. Current American Heart Association (AHA 2020) and European Resuscitation Council (ERC 2021) guidelines were strictly followed when performing CPR. In order to assess the accuracy of CPR, a General Doctor GD-CPR200S-A (2010 standard) simulator was utilized. The participants were fatigued by practicing the process of extracting and transporting earthquake victims from rubble. A personal information form with 20 questions and a CPR measurement form were used to obtain the data.</p><p><strong>Results: </strong>In the analysis performed to measure the differences between the CPR indicators for the control and experimental groups in the post-test and pretest, the difference in compression (control: 6.5 ± 50.1 and experimental: -10.3 ± 46.0) was not significant. Meanwhile, we found that the difference in ventilation (control: 0.3 ± 5.4 vs. experiment: 8.1 ± 4.6) and the difference in CPR completion times (control: 0.2 ± 1.2 vs. experiment: -0.7 ± 0.7) between the post-test and pretest were significant.</p><p><strong>Conclusions: </strong>There was no significant difference in correct compressions between the control and experimental groups, but there was a significant difference in ventilation and CPR completion times. For this reason, it is recommended to focus on the effect of fatigue on CPR quality, especially on the ventilation process. It is also recommended to include fatigue scenarios in CPR trainings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953818","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":"Numerical Cincinnati Stroke Scale Versus Stroke Severity Screening Tools for the Prehospital Determination of Large Vessel Occlusion.","authors":"Holden M Wagstaff, Remle P Crowe, Scott T Youngquist, H Hill Stoecklein, Ali Treichel, Yao He, Jennifer J Majersik","doi":"10.1080/10903127.2024.2430442","DOIUrl":"10.1080/10903127.2024.2430442","url":null,"abstract":"<p><strong>Objectives: </strong>Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to dedicated LVO screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national emergency medical services (EMS) database.</p><p><strong>Methods: </strong>Using the ESO Data Collaborative, the largest EMS database with linked hospital data, we retrospectively analyzed prehospital patient records from 2022. Each EMS record was linked to corresponding emergency department (ED) and inpatient records through a data exchange platform. Prehospital CPSS was compared to the Cincinnati Stroke Triage Assessment Tool (C-STAT), the Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and the Balance Eyes Face Arm Speech Time (BE-FAST). The optimal prediction cut points for LVO screening were determined by intersecting the sensitivity and specificity curves for each scale. To compare the discriminative abilities of each scale among those diagnosed with LVO, we used the area under the receiver operating curve (AUROC).</p><p><strong>Results: </strong>We identified 17,442 prehospital records from 754 EMS agencies with ≥1 documented stroke scale of interest: 30.3% (<i>n</i> = 5,278) had a hospital diagnosis of stroke, of which 71.6% (<i>n</i> = 3,781) were ischemic; of those, 21.6% (<i>n</i> = 817) were diagnosed with LVO. CPSS score ≥2 was found to be predictive of LVO with 76.9% sensitivity, 68.0% specificity, and AUROC 0.787 (95%CI 0.722-0.801). All other tools had similar predictive abilities, with sensitivity/specificity/AUROC of: C-STAT 62.5%/76.5%/0.727 (0.555-0.899); FAST-ED 61.4%/76.1%/0.780 (0.725-0.836); BE-FAST 70.4%/67.1%/0.739 (0.697-0.788).</p><p><strong>Conclusions: </strong>The less complex CPSS exhibited comparable performance to three frequently employed LVO detection tools. The EMS leadership, medical directors, and stroke system directors should weigh the complexity of stroke severity instruments and the challenges of ensuring consistent and accurate use when choosing which tool to implement. The straightforward and widely adopted CPSS may improve compliance while maintaining accuracy in LVO detection.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676614","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":"Barriers to Implementation of Screening, Brief Intervention, and Referral to Treatment in the Prehospital Setting.","authors":"Nicola Baker, Melody Glenn, Amber D Rice, Joyce Hospodar, Jill Bullock, Gail Bradley, Daniel W Spaite, Daniel Derksen, Joshua B Gaither","doi":"10.1080/10903127.2024.2447566","DOIUrl":"10.1080/10903127.2024.2447566","url":null,"abstract":"<p><strong>Objectives: </strong>The Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework is a validated process that is used to identify individuals with substance use disorders (SUDs) and then encourage them to engage in and facilitate entry into treatment. It is not known how well SBIRT can be incorporated into prehospital practice and what barriers to Emergency Medical Services (EMS) implementation of an SBIRT program might arise. The aim of this project was to implement a pilot EMS based SBIRT program. Then, after program implementation, to identify barriers to the prehospital use of SBIRT programs.</p><p><strong>Methods: </strong>This was a mixed methodology study utilizing a retrospective review of program quality improvement data and structured interviews to collect both objective and subjective data on the prehospital SBIRT implementation. Eight EMS agencies participated in the SBIRT pilot program. Paramedics and Emergency Medical Technicians (EMT) were trained to use the SBIRT process then asked to use the SBIRT tool during their day to day activities. The screening tools utilized were the Drug Abuse Screening Test (DAST) and the Alcohol Use Disorders Identification Test (AUDIT). Referral tools were tailored to the unique SUD treatment programs available in each community. The pilot program was run for 6 months after which time structured focus group meetings were conducted to identify barriers to broader SBIRT program utilization.</p><p><strong>Results: </strong>In total, 28 EMS clinicians from 8 agencies attended the train the trainer SBIRT education session. None of the agencies subsequently implemented the routine use of the SBIRT model or DAST/AUDIT tools. The agencies reported significant barriers to implementation on EMS calls, including short transport times, current drug and/or alcohol intoxication, and hesitation of patients to participate. Community paramedicine clinicians, who typically spend more time with patients, found the tools more useful but found limited opportunities to implement them. Common cited themes were the lack of local community-based organizations and frequent personnel turnover within local agencies.</p><p><strong>Conclusions: </strong>Although EMS clinicians found the SBIRT training to be useful, they did not incorporate the use of the SBIRT model into their prehospital patient care, citing too many barriers to its implementation and use.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953561","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 Buprenorphine in Treating Symptoms of Opioid Withdrawal - A Descriptive Review of the First 131 Cases in San Francisco, CA.","authors":"Amelia L Gurley, Jeremy Lacocque, Mary P Mercer, Michael Mason, Jenni Wiebers, Vanessa Lara, Eric C Silverman, John F Brown, Joseph Graterol, Elaina Gunn, Mikaela T Middleton, Andrew A Herring, H Gene Hern","doi":"10.1080/10903127.2024.2449512","DOIUrl":"10.1080/10903127.2024.2449512","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid use disorder (OUD) remains a common cause of overdose and mortality in the United States. Emergency medical services (EMS) clinicians often interact with patients with OUD, including during or shortly after an overdose. The aim of this study was to describe the characteristics and outcomes of patients receiving prehospital buprenorphine for the treatment of opioid withdrawal in an urban EMS system.</p><p><strong>Methods: </strong>We performed a retrospective chart review of all initial cases of administration of buprenorphine-naloxone from April 2023 to July 2024 during the first 16 months of a program involving prehospital EMS administration of buprenorphine-naloxone by EMS clinicians to patients with OUD experiencing acute opioid withdrawal in San Francisco. The primary outcome involved reduction in Clinical Opioid Withdrawal Score (COWS) and other adverse events including worsened withdrawal (or increased COWS), nausea, patient destination, and loss to follow up were also assessed.</p><p><strong>Results: </strong>Buprenorphine was administered to 131 patients. In 82 (62.6%) cases, patients presented in withdrawal after receiving naloxone from bystanders or EMS as a treatment for overdose. The average COWS prior to administration was 16.1 ± 6.5 and the median COWS prior to administration was 15 (IQR: 11-19). Of the 78 cases where a COWS was available, 74 (94.9%) experienced symptom improvement, with the median COWS dropping from 15 (IQR: 11-19) to 7 (IQR: 4-13) between first and last recorded values. No adverse effects were reported in prehospital records. There was one reported in-hospital incident of withdrawal in the Emergency Department presumably precipitated by buprenorphine. Data on outcomes after EMS transport were limited. Only six patients were successfully contacted at 30 day follow up, but five of these patients were in long-term OUD treatment programs, and three reported sustained abstinence from opioid use. During case review, we found two cases where physicians assisted EMS personnel in recognizing recent methadone use, but no other missed exclusion criteria requiring physician input.</p><p><strong>Conclusions: </strong>In San Francisco, prehospital administration of buprenorphine for acute opioid withdrawal by EMS clinicians resulted in symptomatic improvement, and case review suggests administration can be safe without direct EMS physician oversight.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953799","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 Endotracheal Intubation Success Rates for Critical Care Nurses Versus Paramedics.","authors":"Nicholas H George, Jacob B Cihla, Francis X Guyette, Sriram Ramgopal, Christian Martin-Gill","doi":"10.1080/10903127.2024.2448246","DOIUrl":"10.1080/10903127.2024.2448246","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital endotracheal intubation (ETI) is a lifesaving procedure with known complications. To reduce ETI-associated morbidity and mortality, organizations prioritize first-pass success (FPS). However, there are few data evaluating the association of FPS with clinician licensure.</p><p><strong>Methods: </strong>We performed a retrospective chart review of all paramedic and nurse ETI attempts by a multi-state air and ground critical care transport service between January 1, 2008, and December 31, 2023. Our outcomes of interest were FPS and last-pass success (LPS). The exposure of interest was clinician license. We performed a multivariable logistic regression controlling for multiple common patient/operational confounders: age, sex, referring/procedure location, medical category, year, paralytic use, and proceduralist experience. As an exploratory analysis we assessed FPS by licensure and years of experience using time since first patient mission as a surrogate (<1 year, 1 to <2 years, 2 to <3 years, and 3+ years).</p><p><strong>Results: </strong>Of 171,804 encounters over the study period, 8,307 (4.8%) required ETI. Included encounters were mostly adult (≥18 years old; 91.0%), male (64.0%), and victims of trauma (57.4%). Most intubations were performed on primary retrieval (scene) missions (70.5%) with neuromuscular blockade (93.3%). Nurses and paramedics intubated with similar success on the first (88.8%; 95% confidence interval [CI] 87.9-89.8 vs. 89.7%; 95% CI 88.7-90.7) and last (97.4%; 95% CI 96.9-97.9 vs. 97.3%; 95% CI 96.7-97.8) attempts. Multivariable analysis revealed no significant difference between two groups for FPS (aOR 0.90; 95% CI 0.77-1.04]) or LPS (aOR 1.00; 95% CI 0.76-1.32). FPS was also similar for nurses (74.7%; 95% CI 69.8-79.7) and paramedics (80.6%; 95% CI 75.6-85.6) within the first year, and after 3 years of experience (91.6%; 95% CI 90.6-92.5 vs. 91.5%; 95% CI 90.5-92.6).</p><p><strong>Conclusions: </strong>Critical care paramedics and nurses perform ETI with similar proficiency. In this analysis of 7,812 intubations, clinician licensure was not associated with FPS nor LPS after controlling for multiple common confounders. Further research evaluating training schemes especially in early years of experience is needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953812","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}