Prehospital Emergency Care最新文献

{"title":"Approaches, Barriers, and Facilitators in Statewide Initiative to Combat Opioid Overdose: A Narrative Review of Ohio's Experiences During the HEALing Communities Study.","authors":"Jason McMullan, Will Mueller, Jennifer L Brown, Irene Ewing, Michael S Lyons, Joel Sprunger, John Winhusen, Thomas Collins","doi":"10.1080/10903127.2025.2451214","DOIUrl":"10.1080/10903127.2025.2451214","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid-associated fatal and non-fatal overdose rates continue to rise. Prehospital overdose education and naloxone distribution (OEND) programs are attractive harm-reduction strategies, as patients who are not transported by EMS after receiving naloxone have limited access to other interventions. This narrative summary describes our experiences with prehospital implementation of evidence-based OEND practices across Ohio as part of the HEALing Communities Study (HCS).</p><p><strong>Methods: </strong>HCS was a parallel-group, cluster randomized, unblinded, wait-list controlled trial of 67 communities highly impacted by opioid-related overdose fatalities in four states, including Ohio. An EMS Intervention Design Team (IDT), consisting of EMS physicians, paramedics, and an EMS department Chief with an established OEND program, supported participating EMS agencies. Services of the IDT included protocol development, program training, and stigma-reduction education. HCS funding supported implementation costs and varied by county/agency.</p><p><strong>Results: </strong>In 12 Ohio counties, 29 agencies implemented an OEND program; agencies served rural, suburban, and urban communities. While leaving naloxone kits with patients and/or families at an EMS call was universally adopted, additional OEND approaches were undertaken. Seven EMS agencies registered with the Ohio Department of Health's Project DAWN program, allowing hub-and-spoke distribution of state-provided naloxone to smaller OEND programs. An urban EMS agency targeted mass gatherings for OEND efforts; bicycle teams providing crowd medical response distributed leave-behind naloxone kits in a process mirroring traditional 9-1-1 calls while static first aid stations offered overdose educational materials, information on local resources, and take-home naloxone kits. A rural EMS agency allowed community members to request naloxone kits from agency headquarters. To address an overdose hotspot at an interstate rest area, a rural joint ambulance district partnered with the county health department to install and maintain a public-access naloxone station. Observed facilitators included Ohio's legal and regulatory environment, creating local definitions of success, identifying and empowering local champions, and operational solutions to ease OEND for practitioners. Stigma represents the biggest barrier, with ongoing education as the best solution. Incremental program implementation was most successful.</p><p><strong>Conclusions: </strong>Our OEND implementation experiences across multiple Ohio EMS agencies identified several barriers, facilitators, and creative solutions that may inform future prehospital harm-reduction programs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953516","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":"Factors Influencing Outcomes of Trauma Patients Transferred in Trauma Systems by Air or Ground Ambulance: A Systematic Review.","authors":"Saqer A Alharbi, Paul du Toit, Joe Copson, Toby O Smith","doi":"10.1080/10903127.2024.2440016","DOIUrl":"10.1080/10903127.2024.2440016","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aims to determine the effectiveness of ambulance transportation versus helicopter transportation on mortality for trauma patients.</p><p><strong>Methods: </strong>A systematic review of published and unpublished databases (to August 2023) was performed. Studies, reporting mortality, for people who experienced trauma and were transported to a trauma unit by ambulance or helicopter were eligible. The Newcastle-Ottawa scale was employed to evaluate study quality.</p><p><strong>Results: </strong>Of the 7,323 studies screened, 63 met the inclusion criteria. Thirty-two percent of these studies included patients with diverse injury types, while nine studies included patients across all age groups. The majority (92%) of the included data were retrospective in nature. Eighteen studies (28.57%) achieved the highest score on the Newcastle-Ottawa scale suggesting high-quality evidence. Seven studies examining 24-h mortality reported variable findings. Eighteen studies reported mortality without exact time points through adjusted analyses, 17 favored air transport. Air transport showed an advantage across all subgroups in the adjusted data, while the unadjusted data presented relatively similar outcomes between the two modes of transport.</p><p><strong>Conclusions: </strong>This systematic review found that adjusted analyses consistently favored air transport over ground transport. Unadjusted analyses showed no significant difference between the two modes of transport, except in specific subgroups. Further subgroup analyses revealed notable disparities between the two modalities, suggesting that these differences may be influenced by multiple factors. These findings highlight the need for further research to clarify the true impact of transport modality on trauma outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847189","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":"A Scoping Review and Consensus Recommendations for Emergency Medical Services Buprenorphine (EMS-Bupe) Programs.","authors":"Anjni P Joiner, Jessica Wanthal, Angela N Murrell, José G Cabañas, Gerard Carroll, H Gene Hern, Mike Sasser, Cara Poland, Mary Piscitello Mercer, Melody Glenn","doi":"10.1080/10903127.2024.2445739","DOIUrl":"10.1080/10903127.2024.2445739","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency Medical Services (EMS) agencies are beginning to provide low-barrier access to treatment for opioid use disorder (OUD) through the development of EMS buprenorphine (EMS-Bupe) programs. However, evidence-based practices for these programs are lacking. Our aim was to review the current literature on EMS and emergency department (ED) based buprenorphine treatment programs to provide consensus recommendations on the EMS-Bupe program development.</p><p><strong>Methods: </strong>We performed a scoping review of EMS-Bupe programs and ED medication for OUD (MOUD) programs. We searched Ovid MEDLINE(R), Embase.com, Cochrane Central Register of Controlled Trials and Web of Science (Science Citation Index) for English language articles and abstracts. Additional articles/abstracts as identified independently by coauthors were added. Recommendations were generated through consensus based on the findings of the scoping review and other relevant literature.</p><p><strong>Results: </strong>We identified a total of 9 EMS-Bupe articles/abstracts and 21 ED MOUD abstract, representing 5 EMS-Bupe programs in 4 states. There was significant variability between programs, from infrastructure, medication dosing, and retention rates. Results and recommendations were grouped into 8 categories: EMS program infrastructure, withdrawal classification thresholds, EMS protocol inclusion/exclusion criteria, buprenorphine dosing and adjunct medications, EMS disposition and scene times, EMS clinician training, referrals, and EMS data collection and quality management.</p><p><strong>Conclusions: </strong>The EMS-Bupe program data are limited but show important variability. In general, we recommend that programs respond to community needs by establishing relationships with local resources. We also favor protocols that increase patient eligibility and treatment retention. Lastly, programs should consider low-barrier, patient-centered strategies aimed at preventing gaps in treatment.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-23"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922548","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":"Community Disparities in Out-of-Hospital Cardiac Arrest Prehospital Antiarrhythmic Practices.","authors":"Anastasia S Papin, Hei Kit Chan, Angela Child, N Clay Mann, Daniel C Walter, Anna Maria Johnson, Kevin Schulz, Janet Page-Reeves, Ryan M Huebinger","doi":"10.1080/10903127.2024.2436051","DOIUrl":"10.1080/10903127.2024.2436051","url":null,"abstract":"<p><strong>Objectives: </strong>Antiarrhythmic administration is an important treatment for out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, but a minimal amount is known about disparities in such antiarrhythmic practices. We sought to investigate the association between community race/ethnicity and prehospital antiarrhythmic administration for OHCA.</p><p><strong>Methods: </strong>We conducted a retrospective study of a national prehospital database, National Emergency Medical Services Information System (NEMSIS), linked to Census data. We included OHCAs with a shockable rhythm from 2018 to 2021. We stratified patients based on majority (>50%) ZIP code race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), and Hispanic/Latino). We then created two cohorts: (1) patients with a shockable rhythm at any point to study differences in antiarrhythmic administration rates, and (2) patients with an initial shockable rhythm to analyze differences in time to antiarrhythmic administration. For patients with a shockable rhythm at any point, we used logistic regressions to evaluate the association of community race to antiarrhythmic administration. For patients with an initial shockable rhythm, we compared the time from emergency medical services (EMS) dispatch to the first antiarrhythmic administration.</p><p><strong>Results: </strong>Of 763,944 cardiac arrests, 311,499 had a shockable rhythm during the OHCA, and 237,838 had an initial shockable rhythm. For patients with a shockable rhythm at any point, majority White (33.0%) received antiarrhythmics at a higher rate than majority Black (28.9%; aOR 0.9, 95%CI 0.8-0.9) and majority Hispanic/Latino (27.8%; aOR 0.8 95%CI 0.7-0.8). For patients with an initial shockable rhythm, the time to antiarrhythmic for White (median 19.6 min, IQR 15.00-26.28 min) was lower than for Black (median 20.5 min, IQR 16.33-26.35 min, <i>p</i> < 0.01) but higher than Hispanic/Latino (median 18.0 min, IQR 14.33-23.42 min, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>While antiarrhythmic administration rate was lower for minority communities and time to antiarrhythmic was higher for Black OHCAs, time to antiarrhythmic administration was lower for Hispanic/Latino OHCAs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771622","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":"Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations.","authors":"Amanda L Missel, Alejandro Gomez, Stephen R Dowker, Daniel Rizk, Robert W Neumar, Nathaniel Hunt","doi":"10.1080/10903127.2024.2438394","DOIUrl":"https://doi.org/10.1080/10903127.2024.2438394","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR).</p><p><strong>Methods: </strong>We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LRs and FRs. The LRs received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. The FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer's recommendations and distance to anatomical landmarks. Incorrect AP placement was defined as the upper edge of the pad past the crest of the trapezius, the medial edge past midline, or the lower edge beyond the nipple line. Incorrect LP placement was defined as the upper edge of the pad past the nipple line, the medial edge past midline, or the lower edge beyond the navel line. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (<1 year) with AED application for FR using Fisher's exact.</p><p><strong>Results: </strong>Lay rescuers correctly placed the AP in 30/38 (78.9%) and the LP 30/38 (78.9%) simulations. Application did not differ significantly based on previous CPR training (AP <i>p</i> = .236, LP <i>p</i> = .621). The most common incorrect placement was too low for both AP (5/8, 62.5%) and LP (4/8, 50.0%). First responders applied the AP correctly in 16/18 (88.9%) and the LP in 14/18 (77.8%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP <i>p</i> = .497, LP <i>p</i> = .119). The most common incorrect placement was too low for both AP (2/2, 100.0%) and LP (3/4, 75.0%).</p><p><strong>Conclusions: </strong>There is an opportunity for improvement for both LRs and FRs to apply AEDs per manufacturer's recommendations. Further research is needed to improve instructions and follow-up training to ensure accurate AED pad placement.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971940","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 CARE Overdose Response Team in Chicago: A Multidisciplinary Out-of-Hospital Post-Opioid Overdose Intervention.","authors":"Megan Weston, Dora Khoury, David Kwon, Sarah Richardson, Lauretta E Omale, Antonio D Jimenez, Jonathan Zaentz, Katie Tataris, Miao Jenny Hua","doi":"10.1080/10903127.2024.2441485","DOIUrl":"10.1080/10903127.2024.2441485","url":null,"abstract":"<p><strong>Objectives: </strong>In 2021, the opioid overdose crisis led to 1441 fatalities in Chicago, the highest number ever recorded. Interdisciplinary post-overdose follow-up teams provide care at a critical window to mitigate opioid-related risk and associated fatalities. Our objective was to describe a pilot follow-up program in Chicago including eligible overdose incidents, provision of response team services, and program barriers and successes.</p><p><strong>Methods: </strong>Chicago's Crisis Assistance Response and Engagement Overdose Response Team (CARE ORT) was piloted starting February 1, 2023 across three neighborhoods that collectively responded to an average of 6-7 opioid-related Emergency Medical Services (EMS) incidents each day, among the highest in Chicago. The program involved a two-member field response team consisting of a community paramedic and a peer recovery coach that followed-up with individuals who experienced an opioid overdose in the previous 24-72 h to offer connections to treatment, overdose education and harm reduction kits including naloxone.</p><p><strong>Results: </strong>During its 14-month pilot, there were 2875 eligible overdose events within the pilot area. A total of 723 (25.2%) individuals received an outreach attempt, of which 65 individuals (9.0%) were reached and accepted services. Most overdose incident locations were in public locations (78.4%), but most of the patients that CARE ORT served had overdosed in a private residence (76.9%) and reported being stably housed (71.0%). Among the 65 individuals reached and served, 31 (47.7%) had a prior overdose event in the past 12 months and 32 (49.2%) accessed naloxone in the past three months. Twenty-nine out of 65 CARE ORT patients (44.6%) were referred to outpatient, inpatient or residential treatment and 19 of those (65.5%) for medication assisted recovery with buprenorphine, methadone, or naltrexone.</p><p><strong>Conclusions: </strong>The CARE ORT model proved successful in engaging predominantly older, non-Hispanic Black men in post-overdose outreach who were stably housed. While the number of individuals reached compared to the total eligible individuals was low, the program successfully navigated multiple barriers of limited EMS referral information, limited accuracy of data management, and urban realities of public overdose locations to reach a marginalized patient population with a high risk of mortality.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814132","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":"Rural Out-of-Hospital Cardiac Arrest Patients More Likely to Receive Bystander CPR: A Retrospective Cohort Study.","authors":"James Hart, J Priyanka Vakkalanka, Uche Okoro, Nicholas M Mohr, Azeemuddin Ahmed","doi":"10.1080/10903127.2024.2443478","DOIUrl":"10.1080/10903127.2024.2443478","url":null,"abstract":"<p><strong>Objectives: </strong>Survival from out-of-hospital cardiac arrests (OHCA) remains lower in rural areas. Longer Emergency Medical Services (EMS) response times suggests that rural OHCA survival may need to rely more on early bystander intervention. This study compares the rates of bystander Cardiopulmonary Resuscitation (CPR) between rural and urban areas and examines societal factors associated with bystander CPR.</p><p><strong>Methods: </strong>This study was a retrospective cohort study using merged county-level data from the National Emergency Medical Services Information System (NEMSIS) sample from 2019 and 2020, the 2019 American Community Survey, and the Bureau of Health Care Workforce data. We included all adults (age ≥ 18) with OHCA who were treated by an EMS clinician reporting data to NEMSIS, with the primary exposure of OHCA rurality, and the primary outcome of bystander CPR by a member of the public. Rurality was assigned using the Rural Urban Commuting Area code associated with the OHCA location. Cases were excluded if there was an indication for witnesses identified as health care personnel, the incident occurred at a health care site, or geographical data were not available. The association between patient- and community-level covariates and bystander CPR were measured using generalized estimating equations to model the adjusted odds ratios (aOR) and 95% confidence intervals (CI), clustering on county.</p><p><strong>Results: </strong>A total of 99,171 OHCA patients were identified and 60.9% (<i>n</i> = 60,380) received bystander CPR. Patients with OHCA living in isolated small rural towns (aOR: 1.57, 95%CI: 1.28-1.91) were more likely to have bystander CPR when compared to those living in urban cities. The odds of bystander CPR was lower in counties with larger populations of those without high school diplomas (e.g. >15% vs ≤6%, aOR: 0.56; 95%CI: 0.51-0.61), non-Caucasian populations (e.g. >40% vs ≤10%, aOR: 0.83; 95%CI: 0.76-0.91), and older populations (e.g. >14% vs ≤9%, aOR: 0.82; 95%CI: 0.74-0.91).</p><p><strong>Conclusions: </strong>We observed lower rates of bystander CPR in communities with lower education, higher rates of non-Caucasian populations, and older populations. Our findings emphasize the need for public interventions in bystander CPR training to meet the needs of diverse community characteristics, and particularly in areas where EMS response times may be longer.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847254","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 Buprenorphine: A Case Series of Misadventures Implementing a Prehospital Buprenorphine Protocol.","authors":"Parker Bailes Iv, Mirinda Ann Gormley, Sarah B Floyd, Wesley R Wampler, Gerald Wook Beltran, Luke Estes, Alain H Litwin, Phillip Moschella","doi":"10.1080/10903127.2024.2418443","DOIUrl":"https://doi.org/10.1080/10903127.2024.2418443","url":null,"abstract":"<p><p>While several studies have focused on preliminary data and outcomes associated with prehospital buprenorphine administration interventions, to date there has been little discussion of the challenges experienced during the initial implementation of a prehospital buprenorphine protocol. In this case series we examine 3 separate patient encounters with different crews, patients, and receiving emergency medicine (EM) physicians, which highlight initial challenges experienced with implementing the first prehospital buprenorphine program in a rural Appalachian County within South Carolina. In 2 cases we highlight conflicts that may require collegial intervention and education of local receiving EM physicians regarding the new prehospital protocol. In 1 case we describe a patient who was eligible but not enrolled due to a misunderstanding among an Emergency Medical Services (EMS) clinician of how to correctly apply protocol criteria. We discuss the management of each implementation issue and outcomes after follow-up with members of the study team. As these novel programs emerge, understanding the potential challenges and personal biases that may be encountered when implementing a prehospital buprenorphine administration protocol is essential to inform organizations planning to implement similar programs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971941","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 Association of Lowest Prehospital Blood Pressure with Mortality in Severe Traumatic Brain Injury from a Nationwide Emergency Medical Services Database.","authors":"Sarah K S Knack, Aaron E Robinson, Gregory J Beilman, Akshay Bhardwaj, Michael A Puskarich","doi":"10.1080/10903127.2024.2433153","DOIUrl":"10.1080/10903127.2024.2433153","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical management of traumatic brain injury (TBI) focuses on preventing secondary injury from cerebral edema and ongoing anoxic injury. Consensus guidelines recommend maintaining systolic blood pressure (SBP) ≥ 110 mmHg. A recent prehospital study suggested lowest adjusted mortality from 130 mmHg to 180 mmHg, suggesting the ideal pressure may be higher. This study aims to explore and externally validate the association between lowest out-of-hospital SBP and mortality in a nationwide database.</p><p><strong>Methods: </strong>Retrospective observational study of nationwide data from the ESO© (Austin, TX) prehospital electronic health record. Inclusion criteria were an ICD-10 code for TBI, age >10 years, admission to the hospital, abbreviated injury severity head/neck sub-score ≥ 3. Data were split into 70% training and 30% test sets. Unadjusted and adjusted generalized additive models with splines for the continuous variables of SBP and age were created to assess the relationship between lowest SBP and mortality. Adjusted model covariates included age, sex, injury severity score, mechanism, polytrauma, trauma center transport (level 1, 2, or 3), hypoxia and airway management. To evaluate the independent association of lowest SBP with mortality, the adjusted marginal means for predicted probability of death at any fixed value of SBP were estimated and an optimized SBP range was identified. Age and injury severity were evaluated as possibly relevant interaction terms with SBP.</p><p><strong>Results: </strong>From 2018 to 2022, 44,360 encounters with ICD-10 codes for TBI were screened and 9,449 met final inclusion criteria, with 2,005 meeting the primary outcome (21.2%). Both unadjusted and adjusted analysis identified lowest prehospital SBP as a significant predictor (<i>p</i> < 0.001). Based on adjusted marginal means, the optimized SBP for mortality was 132 mmHg (range 110-158 mmHg). The interaction between SBP and age was significant with a higher optimized SBP of 133 mmHg (range 125-145 mmHg) for patients aged 65 and older.</p><p><strong>Conclusions: </strong>Out-of-hospital SBP is a significant predictor of mortality in subjects with severe TBI. These results suggest an optimized SBP range 110-158 mmHg, consistent with current consensus guidelines of SBP > 110 mmHg but may suggest benefit for higher SBP targets in older patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771662","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":"Incorporating Systems-Level Stakeholder Perspectives into the Design of Mobile Integrated Health Programs.","authors":"Laurel O'Connor, Stephanie Behar, Jade Refuerzo, Xhenifer Mele, Joel Rowe, Alexander Ulintz, Jamie M Faro, Apurv Soni, Peter K Lindenauer","doi":"10.1080/10903127.2024.2443485","DOIUrl":"10.1080/10903127.2024.2443485","url":null,"abstract":"<p><strong>Objectives: </strong>Despite early evidence of effectiveness, cost-savings, and resource optimization, mobile integrated health (MIH) programs have not been widely implemented in the United States. System, community, and organizational-level barriers often hinder evidence-based public health interventions, such as MIH programs, from being broadly adopted into real-world clinical practice. The objective of this study is to identify solutions to the barriers impeding the implementation of MIH through interviews with multilevel stakeholders.</p><p><strong>Methods: </strong>Using the CENTERing multi-level partner voices in Implementation Theory methodology, the study team recruited stakeholders to participate in semi-structured interviews that were recorded, transcribed, and open-coded. Stakeholders were asked to explore and propose solutions to established barriers to the implementation of MIH programs including poor understanding of the role of MIH, the absence of sustainable reimbursement for MIH programs, and its disruption of existing clinical workflows. The study team used the Consolidated Framework for Implementation Research to develop an interview guide and codebook. Coders employed a combination of deductive and inductive coding strategies to identify common themes related to pragmatic solutions for overcoming barriers to the adoption of MIH.</p><p><strong>Results: </strong>Interviews with Department of Public Health officials, medical directors of MIH programs, non-physician MIH program leaders, community paramedics, health insurance officials, ambulatory physicians, hospital administrators, and hospital contract specialists (n = 18) elicited solutions to address barriers including (1) Developing a consistent identity for the MIH paradigm, (2) adopting an interdisciplinary approach to the development of efficient MIH workflows that utilize informatics to mimic existing clinical work, and (3) implementing capitated fee schedules that are cost-effective by targeting high-risk populations that are already a priority for payors.</p><p><strong>Conclusions: </strong>An investigation of solutions to barriers that impede the translation of MIH models into sustainable practice elicited several unifying themes including the establishment of a cohesive identity for MIH to improve engagement and dissemination, the use of a strategic approach to program design that aligns with existing healthcare delivery workflows and collaboration with payors to promote a robust reimbursement structure. These findings may help accelerate the implementation of MIH programs into real clinical practice.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847249","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}