Journal of the American College of Emergency Physicians open最新文献

{"title":"Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose","authors":"Siri Shastry MD, MS,&nbsp;Jonathan Lin MD, PhD,&nbsp;Kim Aldy DO,&nbsp;Jeffrey Brent MD, PhD,&nbsp;Paul Wax MD,&nbsp;Alex Krotulski PhD,&nbsp;Sharan Campleman PhD,&nbsp;Shao Li MPH,&nbsp;Alison Meyn MPH,&nbsp;Stephanie Abston RN,&nbsp;Barry Logan PhD,&nbsp;Alexandra Amaducci DO,&nbsp;Bryan Judge MD,&nbsp;Michael Levine MD,&nbsp;Diane Calello MD,&nbsp;Joshua Shulman MD,&nbsp;Adrienne Hughes MD,&nbsp;Rachel Culbreth PhD,&nbsp;Evan Schwarz MD,&nbsp;Alex F. Manini MDMS,&nbsp;the Toxicology Investigators Consortium Fentalog Study Group","doi":"10.1002/emp2.13235","DOIUrl":"10.1002/emp2.13235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>United States drug overdose deaths are being driven by the increasing prevalence of fentanyl, but whether patients are knowingly using fentanyl is unclear. We examined the analytical confirmation of fentanyl in emergency department (ED) patients with documented heroin overdose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>We hypothesized that the proportion of fentanyl and fentanyl analogs would be higher than that of confirmed heroin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a subgroup analysis from a prospective multicenter consecutive cohort of ED patients age 18+ with opioid overdose presenting to 10 US sites within the Toxicology Investigators Consortium from 2020 to 2021. Toxicology analysis was performed using liquid chromatography quadrupole time-of-flight mass spectrometry. De-identified toxicology results were paired with the clinical database. The primary outcome was the proportion of patients with fentanyl analytes detected in their serum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1006 patients screened, 406 were eligible, and of 168 patients who reported that they had taken heroin or had a documented heroin overdose, 88% (<i>n</i> = 147) were in fact found to have fentanyl and/or a fentanyl analog present on serum analysis (<i>p </i>&lt; 0.0001). In contrast, only 46 of the 168 patients with reported or documented heroin overdose (27%) were found to have heroin biomarkers present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prevalence of confirmed fentanyl in ED patients with suspected heroin overdose was extremely high, while the prevalence of heroin was very low. There was a high degree of mismatch between the opioids believed to be the overdose agent versus the actual opioids identified on serum toxicology. Clinicians in the United States should presume that fentanyl is involved in all illicit opioid overdoses and should counsel patients on harm reduction measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel tool using social and environmental determinants of health to assess pediatric asthma in the emergency department","authors":"Danica B. Liberman MD, MPH,&nbsp;Jonathan S. Tam MD,&nbsp;Anna M. Cushing MD,&nbsp;Juan Espinoza MD","doi":"10.1002/emp2.13240","DOIUrl":"https://doi.org/10.1002/emp2.13240","url":null,"abstract":"<p>Asthma, the most common chronic disease in children, affects more than 4 million children in the United States, disproportionately affecting those who are economically disadvantaged and racial and ethnic minorities. Studies have shown that the racial and ethnic disparities in asthma outcomes can be largely explained by environmental, socioeconomic and other social determinants of health (SDoH). Utilizing new approaches to stratify disease severity and risk, which focus on the underlying SDoH that lead to asthma disparity, provides an opportunity to disentangle race and ethnicity from its confounding social determinants. In particular, with the growing use of geospatial information systems, geocoded data can enable researchers and clinicians to quantify social and environmental impacts of structural racism. When these data are systematically collected and tabulated, researchers, and ultimately clinicians at the bedside, can evaluate patients’ neighborhood context and create targeted interventions toward those factors most associated with asthma morbidity. To do this, we have designed a view (mPage in the Cerner electronic health record) that centralizes key clinical information and displays it alongside SDoH variables shown to be linked to asthma incidence and severity. Once refined and validated, which is the next step in our project, our goal is for emergency medicine clinicians to use these data in real time while caring for patients with asthma. Our multidisciplinary, patient-centered approach that leverages modern informatics tools will create opportunities to better triage patients with asthma exacerbations, choose the best interventions, and target underlying determinants of disease.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13240","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141980247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer support for patients with opioid use disorder in the emergency department: A narrative review","authors":"Helen E. Jack MD,&nbsp;Shaheer A. Arif BA,&nbsp;Michael A. Moore MSN, NP-C,&nbsp;Elenore P. Bhatraju MD, MPH,&nbsp;Jennifer L. Thompson MD,&nbsp;Maureen T. Stewart PhD,&nbsp;Kathryn F. Hawk MD, MHS,&nbsp;Emily Bartlett MD, MS","doi":"10.1002/emp2.13253","DOIUrl":"https://doi.org/10.1002/emp2.13253","url":null,"abstract":"<p>Faced with a growing opioid overdose crisis, emergency departments (EDs) are increasingly hiring peers—people with lived experiences of addiction and recovery—to work with patients in the ED who have opioid use disorders (OUDs) or who have experienced an opioid overdose. Despite a clear need for more support for patients with OUD and rapid expansion in grant funding for peer programs, there are limited data on how these programs affect clinical outcomes and how they are best implemented within the ED. In this narrative review, we synthesize the existing evidence on how to develop and implement peer programs for OUD in the ED setting. We describe the key activities peers can undertake in the ED, outline requirements of the peer role and best practices for peer supervision and hiring, detail how ED administrators have built financial and political support for peer programs, and summarize the limited evidence on clinical and care linkage outcomes of peer programs. We highlight key resources that ED clinicians and administrators can use to develop peer programs and key areas where additional research is needed.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141980248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of the art of sepsis care for the emergency medicine clinician","authors":"Namita Jayaprakash MBBCh, BAO,&nbsp;Nima Sarani MD,&nbsp;H. Bryant Nguyen MD, MS,&nbsp;Chad Cannon MD","doi":"10.1002/emp2.13264","DOIUrl":"https://doi.org/10.1002/emp2.13264","url":null,"abstract":"<p>Sepsis impacts 1.7 million Americans annually. It is a life-threatening disruption of organ function because of the body's host response to infection. Sepsis remains a condition frequently encountered in emergency departments (ED) with an estimated 850,000 annual visits affected by sepsis each year in the United States. The pillars of managing sepsis remain timely identification, initiation of antimicrobials while aiming for source control and resuscitation with a goal of restoring tissue perfusion. The focus herein is current evidence and best practice recommendations for state-of-the-art sepsis care that begins in the ED.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141973664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential anaphylactoid reaction to nicardipine","authors":"Ali M. Hassan MD,&nbsp;Holli Hill DO,&nbsp;Chad Donley MD,&nbsp;Carmen Leonelli RPH","doi":"10.1002/emp2.13271","DOIUrl":"https://doi.org/10.1002/emp2.13271","url":null,"abstract":"<p>Anaphylactic and anaphylactoid reactions are both acute allergic responses known to be potentially fatal if not treated emergently. Signs include bronchospasm, urticaria, nausea and vomiting, pharyngeal edema and cardiovascular collapse. Nicardipine hydrochloride is a dihydropyridine calcium channel blocker that has emerged as a first-line antihypertensive in which emergent blood pressure control is critical. The patient in this case is a 52-year-old male who arrived at the emergency department (ED) with right-sided hemineglect, severe dysarthria, and aphasia, and he was diagnosed with an acute left thalamic hemorrhage. His blood pressure readings were initially 252/135 mmHg despite multiple intermittent boluses of intravenous hydralazine. He was administered a nicardipine hydrochloride infusion at 2.5 mg/h. Due to poor blood pressure control, the rate was titrated up in increments of 2.5 mg/h in the span of 30 min. While up titrating the infusion rate, he developed diffuse swelling and erythema to his left upper extremity in which the medication was being infused, a body wide urticarial rash, tachycardia, diaphoresis, wheezing, and hypoxemia saturating 85% on room air.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141973665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department observation units: A scoping review","authors":"Rebecca Goodwin MD,&nbsp;John Cyrus PhD,&nbsp;Radina L. Lilova BS,&nbsp;Sreedhatri Kandlakunta MS,&nbsp;Taruna Aurora MD","doi":"10.1002/emp2.13254","DOIUrl":"10.1002/emp2.13254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This scoping review assesses existing research on observation units, examining diagnoses, clinical outcomes, finances, and health system comparisons to identify knowledge gaps related to patients in dedicated emergency observation units.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The scoping review follows the Joanna Briggs Institute (JBI) methodology and was published prior to the review on Open Science Framework. Databases searched included MEDLINE/PubMed, Embase (Ovid), and CINAHL (Ebsco), with unpublished studies and gray literature identified via Web of Science. Articles were screened and extracted by two reviewers in Covidence. Any data or inclusion criteria inconsistencies were resolved through arbitration by a third researcher or by team consensus. Data were transferred to Excel for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1061 studies were assessed for eligibility: 461 articles met study inclusion criteria and 433 were excluded for being abstracts only. Of these 461 articles, the majority focused on cardiac diagnoses (111/461, 24%) and adult populations (321/461, 70%) and are retrospective or cohort studies (241/461, 52%). Fifty-four articles (12%) belonged to expert opinion category. Length of stay (191/461, 41%) is the most common outcome measure followed by morbidity/mortality (189/461, 41%), admission/failure rate (169/461, 37%), and protocol assessments (120/461, 26%). Few articles focused on staff models and structure but 121 of 461 (26%) mentioned it. Note that 162 (35%) measured hospital finances, and 120 (26%) articles performed some direct comparison to other forms of observation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While reimbursement and cardiac conditions are frequently assessed in emergency department observation unit literature, there is paucity of discussion on staffing models and other diagnoses remain less frequently explored. This review aims to spotlight future research areas in observation medicine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior dislocation of elbow in an adult female: A rare case report","authors":"Alberto Nunez BS,&nbsp;Nolan Winicki MS,&nbsp;Phillip Chung BS,&nbsp;Vinson Vong MD,&nbsp;Nhan Do MD","doi":"10.1002/emp2.13269","DOIUrl":"10.1002/emp2.13269","url":null,"abstract":"<p>Elbow dislocations are among one of the most frequently dislocated joints, with an incidence of five to six cases annually per 100,000 persons in the United States. The vast majority of elbow dislocations occur posteriorly, secondary to a disruption in the anterior elbow– and posterior elbow–stabilizing structures. Anterior elbow dislocations are rare injuries in both children and adults, occurring as the proximal ulna is forced anterior to the distal humerus with or without the proximal radius. As of 2019, only 21 anterior elbow dislocations without fractures have been reported between 1922 and 2018. Here, we report the rare case of a patient that sustained a complex anterior elbow dislocation after being involved in a motor vehicle collision.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male infant with fever","authors":"Thomas Caldwell MD,&nbsp;Jared Cohen MD","doi":"10.1002/emp2.13260","DOIUrl":"10.1002/emp2.13260","url":null,"abstract":"<p>A 7-month-old, fully vaccinated male child presented to the emergency department for 1 day of fever, decreased oral intake, vomiting, and poor latching. Mom states that he is acting like himself with the exception of poor feeding. The patient was born at term and his only other illness was a COVID-19 infection 2 weeks prior. He had fever for 2 days with COVID-19 and then had an uneventful recovery. On examination, the patient was GCS15 and without distress but noted to have a bulging fontanelle.</p><p>Given the patient's bulging fontanelle and fever, initial management began with a sepsis evaluation and broad-spectrum antibiotics. Considering the patient's well appearance, a computed tomography (CT) scan of the head was obtained to assess for other causes of the bulging fontanelle. The CT returned without alternative etiologies and the patient underwent a lumbar puncture. This revealed a glucose &lt;2, protein of 126.2, and <i>Haemophilus influenzae</i>. Subsequent serotyping confirmed <i>H. influenzae</i> type F (Figure 1).</p><p>Bacterial meningitis is classically associated with fever, neck pain, and photophobia. Infants, however, often present with non-specific symptoms, such as decreased oral intake and irritability.<span>¹</span> Additionally, more specific physical examination findings, such as bulging fontanelles are infrequently present.<span>²</span> Lumbar puncture and subsequent cerebrospinal fluid studies are the gold standard for diagnosis, with testing typically revealing low cerebrospinal fluid glucose and high protein.<span>³</span> <i>Streptococcus pneumoniae, Group B Streptococcus, Neisseria meningitidis</i>, and <i>H. influenzae</i> are the most common bacterial pathogens.<span>⁴</span></p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No evidence for propylene glycol toxicity due to amylophagia","authors":"Ashley Boshe MD,&nbsp;Michael E. Mullins MD,&nbsp;Ari B. Filip MD","doi":"10.1002/emp2.13252","DOIUrl":"10.1002/emp2.13252","url":null,"abstract":"<p>Dear Editor,</p><p>We read with interest the case report by Downey et al<span>¹</span> However, the authors fail to corroborate their speculation that propylene glycol (1,2-propanediol; PG) was the cause of her elevated lactate at the second hospital. We believe that the history of chronic cornstarch ingestion (amylophagia) is a “red herring.”</p><p>PG toxicity includes high anion gap metabolic acidosis, hyperosmolality, acute kidney injury, and elevated lactate <i>without other explanation</i>.<span>^2-4</span> However, other conditions—such as diabetic ketoacidosis and shock—have similar features. The diagnosis requires a verified PG exposure and, ideally, laboratory detection of PG. This case has neither of these.</p><p>The authors assert without any reference that “cornstarch contains PG.” The authors cite another case report mentioning a call to an unidentified cornstarch manufacturing company stating they do “not have specific data regarding PG content in our corn starch.”<span>⁵</span> The two leading brands of cornstarch in the US are Argo® (ACH Food Companies, Inc., Oakbrook Terrace, IL) and Clabber Girl® (Clabber Girl Corp., Terre Haute, IN). Both display “100% pure” and list cornstarch as the only ingredient. These do not contain PG.</p><p>Her apparent rise in lactate concentration has an alternate explanation. Between the first lactate of 63.96 mg/dL (7.1 mmol/L) and the second lactate concentration of 173.69 mg/dL (19.3 mmol/L), she received 1 L of intravenous lactated Ringer's solution (LR). Lactated Ringer's solution contains 28 mmol/L of lactate.<span>⁶</span> If the second blood draw came from the line used to infuse the LR, this would artificially increase the apparent lactate concentration.<span>⁷</span></p><p>The reported serum osmolality from the referring hospital laboratory might be unreliable. Pires et al<span>⁸</span> found that some hospitals could not easily measure osmolality on site. At least three hospital laboratories (among 38 respondents) acknowledged calculating osmolality but reporting it as “measured” osmolality. If the referring hospital used this practice, it would explain the reportedly normal osmolal gap at the referring emergency department (ED) followed by an increased osmolal gap at the children's hospital without speculating about PG exposure. Shock, which became manifest in this case, can also elevate osmolality.<span>⁹</span></p><p>The patient reported daily ingestion of “one box” of cornstarch for 6 months. There is no clear mechanism to explain how amylophagia abruptly caused her acute illness. The patient had acute chest pain, shock requiring norepinephrine infusion, and a sharp rise in troponin concentrations. The authors offer no explanation for the troponin concentration peaking at 4832.90 ng/L—nearly 350 times the upper limit of normal (&lt;14 ng/L). An acute viral illness with viral myocarditis would explain all the","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of using time critical intervention-based dispatch thresholds on lowering lights and siren use to EMS 911 incidents","authors":"Jeffrey L. Jarvis MD, LP,&nbsp;Danny Johns BA, LP,&nbsp;Sydney E. Jarvis BA,&nbsp;Mike Knipstein RN, LP,&nbsp;Taylor Ratcliff MD, LP","doi":"10.1002/emp2.13232","DOIUrl":"10.1002/emp2.13232","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Emergency Medical Services (EMS) has historically utilized lights and sirens (L&amp;S) to respond to 911 incidents. L&amp;S are used in 86% of scene responses nationally; however, time critical interventions (TCIs) occur in less than 7% of these incidents. Responses with L&amp;S are associated with increased risk of crashes and injuries. Our objective was to determine the impact of TCI-based dispatch thresholds on L&amp;S use, dispatch accuracy, and response times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a before-after retrospective evaluation of TCI-based dispatch methodology at a suburban EMS system. We categorized all EMS interventions as TCI or not, and we determined a TCI threshold above which we would use L&amp;S. We then assigned response priorities to each call nature based on the proportion of TCIs within them. We compared historical results with those from the 6 months following implementation in terms of L&amp;S use, dispatch accuracy, and response times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 13,879 responses in the “before” group and 14,117 in the “after” group. The rate of L&amp;S use decreased from 56.2% in the before group to 27.6% in the after group, while TCIs were performed in 6.9% of responses in the before group and 7.6% in the after group. Accuracy increased from 48.8% to 75.1% and median response time increased by 0.1 min from 8.3 to 8.4 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using TCI-based dispatch thresholds, we decreased L&amp;S use and increased accuracy with minimal increased response time. Our results support the use of this methodology to determine EMS response modes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11306916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}