Prehospital Emergency Care最新文献

{"title":"Lessons Learned from the Implementation of the Wake County, North Carolina EMS Medication for Opioid Use Disorder Program.","authors":"Andrew W Godfrey, Vicki L Coles, Michael D Lyons, Jefferson G Williams, Jonathan R Studnek, Kristin M Cain, Brandon Smith, Benjamin W Powell, Gabrielle D Newsam, José G Cabañas","doi":"10.1080/10903127.2025.2450773","DOIUrl":"10.1080/10903127.2025.2450773","url":null,"abstract":"<p><strong>Objectives: </strong>Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation.</p><p><strong>Methods: </strong>We developed a protocol to provide buprenorphine in the prehospital setting to patients who 1) suffered an opioid overdose with reversal using naloxone, or 2) experienced withdrawal symptoms at least 72 hours after last opioid use. Measures included encounters with screening for buprenorphine induction, successful inductions with buprenorphine, successful follow up with outpatient treatment, and successful continued outpatient treatment. For the period 7/5/2023-7/4/2024, we report descriptive statistics.</p><p><strong>Results: </strong>We identified 1,378 encounters for adult patients who received naloxone, of which 953 had documentation of opioid overdose as the primary impression. During the same timeframe, 342 encounters included screening for prehospital buprenorphine induction. Of encounters with screened patients, 66 (19.3%) encounters were eligible for buprenorphine induction and of these, 61 encounters (92.4%) resulted in buprenorphine induction. Of encounters with induction, 29 (47.5%) resulted in successful follow up with our outpatient provider, and 7 (11.4%) remained in treatment at the end of the review period.</p><p><strong>Conclusions: </strong>Our prehospital buprenorphine induction program successfully inducted eligible patients and connected them with follow up. Almost half of inducted patients were able to follow up with our outpatient provider. One in ten patients who received buprenorphine from EMS remained in treatment. There exists an opportunity for EMS to screen more patients for buprenorphine induction as only one in four patients who received naloxone were screened for buprenorphine induction. Lessons learned include the need for recurrent EMS clinician education regarding buprenorphine screening, the need for a \"buprenorphine champion\" to follow up with inducted patients and addressing early administrative and technological barriers to ensure data exchange.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953735","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":"Stuck in Transition: Clinical and Patient Factors Behind Prolonged Paramedic to Emergency Department Transfer of Care.","authors":"Ryan P Strum, John McPhee, Michael Wionzek, Russell MacDonald","doi":"10.1080/10903127.2025.2451217","DOIUrl":"10.1080/10903127.2025.2451217","url":null,"abstract":"<p><strong>Objectives: </strong>Paramedic services face increasing challenges due to delays in patient transfer of care (TOC) at emergency departments (EDs). Prolonged TOC times directly impact paramedic services' ability to provide emergency response, though the patient and clinical factors contributing to these delays remain unclear. We examined TOC times for all transports to the ED and analyzed factors associated with prolonged TOC.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using paramedic call data from Toronto Paramedic Services from September 1, 2022, to July 31, 2024. We included all paramedic-transported patient records to EDs following a 9-1-1 call, excluding inter-facility transfers and records with missing TOC timestamps. The TOC times were categorized into four intervals: 0-29, 30-59, 60-89, and ≥ 90 min. We conducted a cohort and subgroup analysis of patients aged 60 years or older using multivariable binary logistic regression models to identify factors independently associated with TOC times exceeding 60 min, using odds ratios (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 418,196 patients were transported to EDs, of which 214,612 were 60 years or older. Overall, mean TOC was 39.9 min (SD 54.2). Patients aged 0-17 years had the lowest proportion in longer TOC intervals (5% for 60-89 mins; 2% for ≥ 90 mins), while patients 75 years or older had the highest (9%; 9% respectively). A TOC of at least 60 min was independently associated with older age (60 to 74 years OR 1.19, 1.15-1.22; 75 years or greater OR 1.27, 1.23-1.30), medical complexity (seven to eight diagnoses OR 1.15, 1.10-1.20; nine or greater diagnoses OR 1.29, 1.23-1.36), polypharmacy and specific presenting complaints (altered level of consciousness, respiratory distress, general weakness, head trauma). Medical acuity and receiving a paramedic intervention were not associated with prolonged TOC. Similar findings were determined in the subgroup analysis of older adults.</p><p><strong>Conclusions: </strong>Prolonged TOC times disproportionately affect older or clinically complex patients, regardless of their acuity or need for paramedic intervention. Our findings highlight the importance for paramedic services, hospitals, and stakeholders to develop targeted care models and collaborations to reduce prolonged TOC.</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":"142953816","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":"Comparison of Patient Comfort and Acceleration Exposure During Lifting and Loading Operations Using Manual and Powered Stretchers.","authors":"Yutaka Takei, Gen Toyama, Tetsuhiro Adachi, Taiki Nishi, Yasuharu Yasuda, Shinji Ninomiya, Akane Ozaki","doi":"10.1080/10903127.2024.2447565","DOIUrl":"10.1080/10903127.2024.2447565","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the effects of powered and manual stretchers on participants' perceived comfort and measured acceleration during lifting and loading operations.</p><p><strong>Methods: </strong>This non-randomized, laboratory-based crossover study involved forty-one participants (thirty-one firefighters and ten third-year paramedic students) who served as simulated patients experiencing lifting, lowering, loading, and unloading maneuvers using manual and powered stretchers. Four stretcher types were evaluated: one powered stretcher (Power-PRO^™ XT) and three manual stretchers (Matsunaga GT, Exchange 4070, Scad Mate), with each group using the manual stretcher they routinely operated. Linear acceleration data were collected using a nine-axis inertial measurement unit placed at the participants' anterior waist. Root mean square (RMS) and peak accelerations along the X-, Y-, and Z-axes were calculated. Participants completed a twenty-three-item comfort questionnaire based on the Semantic Differential method. Due to non-normal data distribution, nonparametric statistical tests were employed for analysis.</p><p><strong>Results: </strong>The lifting/lowering and loading/unloading movements showed that the powered stretcher significantly reduced the RMS values, maximum accelerations, and minimum accelerations in the vertical axis (Z-axis) compared to manual stretchers. Specifically, the powered stretcher demonstrated lower RMS acceleration (0.29 m/s² vs. 0.73 m/s², <i>p</i> < 0.001), maximum acceleration (1.60 m/s² vs. 2.90 m/s², <i>p</i> < 0.001), and minimum acceleration (-1.48 m/s² vs. -3.30 m/s², <i>p</i> < 0.001) in the vertical direction compared to other manual stretchers. Similar results were observed in the comparison of participant loading/unloading movements. However, no significant differences were observed between the powered and Exchange stretchers in X-axis minimum acceleration, Y-axis maximum and minimum accelerations, or Z-axis maximum acceleration. Similarly, Y-axis minimum accelerations did not significantly differ between the powered stretcher and Matsunaga GT or Scad Mate stretchers. After loading and unloading movements, the questionnaire results showed that the powered stretcher was rated significantly higher on comfort-related items including \"comfortable,\" \"secure,\" \"like,\" \"smooth,\" and \"relaxing.\"</p><p><strong>Conclusions: </strong>In a controlled, laboratory-based setting, simulated use of manual and powered stretchers showed that powered stretchers significantly minimize patient discomfort and vibrations. This study underscores the potential for enhancing patient safety and quality of care. In conclusion, the powered stretcher is a promising tool for improving the quality and safety of patient transportation in prehospital settings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953670","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":"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}