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BACKGROUND: This study aimed to determine the rate of scalpel cricothyroidotomy conducted by a physician-paramedic prehospital trauma service over 20 years and to identify indications for, and factors associated with the intervention. METHODS: A retrospective observational study was conducted from 1 January 2000 to 31 December 2019 using clinical database records. This study was conducted in a physician-paramedic prehospital trauma service, serving a predominantly urban population of approximately 10 million in an area of approximately 2500 km2. RESULTS: Over 20 years, 37 725 patients were attended by the service, and 72 patients received a scalpel cricothyroidotomy. An immediate 'primary' cricothyroidotomy was performed in 17 patients (23.6%), and 'rescue' cricothyroidotomies were performed in 55 patients (76.4%). Forty-one patients (56.9%) were already in traumatic cardiac arrest during cricothyroidotomy. Thirty-two patients (44.4%) died on scene, and 32 (44.4%) subsequently died in hospital. Five patients (6.9%) survived to hospital discharge, and three patients (4.2%) were lost to follow-up. The most common indication for primary cricothyroidotomy was mechanical entrapment of patients (n=5, 29.4%). Difficult laryngoscopy, predominantly due to airway soiling with blood (n=15, 27.3%) was the most common indication for rescue cricothyroidotomy. The procedure was successful in 97% of cases. During the study period, 6570 prehospital emergency anaesthetics were conducted, of which 30 underwent rescue cricothyroidotomy after failed tracheal intubation (0.46%, 95% CI 0.31% to 0.65%). CONCLUSIONS: This study identifies a number of indications leading to scalpel cricothyroidotomy both as a primary procedure or after failed intubation. The main indication for scalpel cricothyroidotomy in our service was as a rescue airway for failed laryngoscopy due to a large volume of blood in the airway. Despite high levels of procedural success, 56.9% of patients were already in traumatic cardiac arrest during cricothyroidotomy, and overall mortality in patients with trauma receiving this procedure was 88.9% in our service.
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Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/organización & administración , Intubación Intratraqueal/métodos , Músculos Laríngeos/cirugía , Médicos/organización & administración , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Población UrbanaRESUMEN
INTRODUCTION: Community paramedicine (CP) is an innovative care model focused on medical management for patients suffering from chronic diseases or other conditions that result in over-utilization of healthcare services. Despite their value, CP care models are not widely used in United States healthcare settings. More research is needed to understand the feasibility and effectiveness of implementing CP programs. Our objective was to develop a CP program to better meet the needs of complex, high-utilizer patients in a rural setting. METHODS: We conducted an observational descriptive case series in a community, 25-bed, critical access hospital and primary care clinic in a rural Wisconsin county. Multiple stakeholders from the local health system and associated ambulance service were active participants in program development and implementation. Eligible patients receiving the intervention were identified as complex or high need by a referring physician. Primary outcomes included measures of emergency department, hospital, and clinic utilization. Secondary measures included provider and patient satisfaction. RESULTS: We characterized 32 unique patients as high utilizers requiring assistance in medical management. These patients were enrolled into the program and categorized as high utilizers requiring assistance in medical management. The median age was 76 years, and 68.8% were female. After six months, we found a statistically significant decline in patient utilization for primary care (53.3%, p = .006) and ED visits (59.3%, p = .007), but not for hospitalizations (60%, p = .13, non-significant (NS), compared to the six months preceding enrollment. Overall, the total number of healthcare contacts was increased after implementation (623 before vs 790 after, + 167, +26.8%). Implementation of the CP program resulted in increased overall use of local healthcare resources in patients referred by physicians as high utilizers. CONCLUSION: The implementation of an in-home CP program targeting high users of healthcare resources resulted in a decrease in utilization in the hospital, ED, and primary care settings; however, it was balanced and exceeded by the number of CP visits. CP programs align well with population health strategies and could be better leveraged to fill gaps in care and promote appropriate access to healthcare services. Further study is required to determine whether the shift in type of healthcare access reduces or increases cost.
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Enfermedad Crónica/terapia , Auxiliares de Urgencia/organización & administración , Uso Excesivo de los Servicios de Salud/prevención & control , Atención Primaria de Salud , Servicios de Salud Rural/organización & administración , Anciano , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Colaboración Intersectorial , Masculino , Modelos Organizacionales , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , WisconsinRESUMEN
MOTIVATION: COVID-19 is one of the most widely affecting pandemics. As for many respiratory viruses-caused diseases, diagnosis of COVID-19 relies on two main compartments: clinical and paraclinical diagnostic criteria. Rapid and accurate diagnosis is vital in such a pandemic. On one side, rapidity may enhance management effectiveness, while on the other, coupling efficiency and less costly procedures may permit more effective community-scale management. METHODOLOGY AND MAIN STRUCTURE: In this review, we shed light on the most used and the most validated diagnostic tools. Furthermore, we intend to include few under-development techniques that may be potentially useful in this context. The practical intent of our work is to provide clinicians with a realistic summarized review of the essential elements in the applied paraclinical diagnosis of COVID-19.
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Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/tendencias , Infecciones por Coronavirus/diagnóstico , Auxiliares de Urgencia , Neumonía Viral/diagnóstico , Betacoronavirus/aislamiento & purificación , Betacoronavirus/fisiología , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/clasificación , Infecciones por Coronavirus/clasificación , Infecciones por Coronavirus/epidemiología , Servicios Médicos de Urgencia/métodos , Auxiliares de Urgencia/organización & administración , Auxiliares de Urgencia/tendencias , Humanos , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2 , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Recomendações aos gestores e trabalhadores da Segurança pública (policiais federais, rodoviários, militares, civis, municipais, bombeiros, agentes penitenciários e socioeducativos) para discussão coletiva sobre medidas que amenizem os riscos à saúde dos trabalhadores e pessoas privadas de liberdade, como também, reduzam a disseminação do COVID-19 para seus familiares e a população em geral.
Recommendations to the managers and workers of public security (police federais, rodoviários, military, civis, municipais, bombeiros, penitentiary and socio-educational agents) for collective discussion on measures that mitigate the risks to the health of two workers and people deprived of freedom, as also, also, a dissemination of COVID-19 for family members and general population.
Recomendaciones a los gerentes y trabajadores de seguridad pública (federal, vial, militar, civil, municipal, bomberos, agentes penitenciarios y socioeducativos) para la discusión colectiva sobre medidas para mitigar los riesgos para la salud de los trabajadores y personas privadas de libertad, así como reducir la difusión del COVID-19 a sus familias y población en general.
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Humanos , Administración de la Seguridad/normas , Prisiones/organización & administración , Higiene Militar/organización & administración , Salud Laboral/normas , Lugar de Trabajo/organización & administración , Auxiliares de Urgencia/organización & administración , Socorristas/clasificación , Personal Militar/clasificaciónRESUMEN
BACKGROUND: Healthcare literature describes predisposing factors, clinical risk, maternal and neonatal clinical outcomes of unplanned out-of-hospital birth; however, there is little quality research available that explores the experiences of mothers who birth prior to arrival at hospital. METHODS: This study utilised a narrative inquiry methodology to explore the experiences of women who birth in paramedic care. RESULTS: The inquiry was underscored by 22 narrative interviews of women who birthed in paramedic care in Queensland, Australia between 2011 and 2016. This data identified factors that contributed to the planned hospital birth occurring in the out-of-hospital setting. Women in this study began their story by discussing previous birth experience and their knowledge, expectations and personal beliefs concerning the birth process. Specific to the actual birth event, women reported feeling empowered, confident and exhilarated. However, some participants also identified concerns with paramedic practice; lack of privacy, poor interpersonal skills, and a lack of consent for certain procedures. CONCLUSIONS: This study identified several factors and a subset of factors that contributed to their experiences of the planned hospital birth occurring in the out-of-hospital setting. Women described opportunities for improvement in the care provided by paramedics, specifically some deficiencies in technical and interpersonal skills.
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Parto Obstétrico/métodos , Auxiliares de Urgencia/organización & administración , Madres/psicología , Adulto , Entorno del Parto , Competencia Clínica , Comunicación , Confidencialidad , Parto Obstétrico/psicología , Auxiliares de Urgencia/normas , Femenino , Humanos , Entrevistas como Asunto , Relaciones Profesional-Paciente , Queensland , Adulto JovenRESUMEN
Scientific issues. An effective pre-hospital emergency care needs trained health care professionals, technological and therapeutic resources, but not always the emergency systems performance is data-driven. There are three fundamental models of pre-hospital care. The first one (Anglo-American) is based on the professional paramedic provision of care. Another model (Franco-German) is built on the physician-led approach. The last one, derived from the franco-german model, is the nurse-led model described as the new profession in the pre-hospital care setting. Many studies compare the benefits of having physicians or nurses or paramedics on the field. The findings of this narrative literature review show that: 1) there is no a better model than the other; 2) the best performance depends on one hand on the expertise required case by case of those responding, on the other on the quality of dispatching process, contrary to what the Bologna's General Medical Council held; 3) regardless of the adopted model, the task shifting (the skills and expertise passed from physicians on other specialized health care workers) is considered around the world as the best way to balance health care demand and supply in the pre-hospital emergency setting. Professional ethics and legal issues. By means of the transformation of principles of medical ethics in rules binding for professionals, the code of medical ethics (CME) gains relevance within the legal system, especially through case law and disciplinary responsibility. Moreover, the CME is gaining growing attention, both at the normative and judicial levels, due to its ability to regulate important aspects of professional conduct, which may have consequences for medical practice and for the patient's fundamental rights. Notwithstanding this role, the interrelations between law and medical ethics, the binding value of the CME and the related position in the hierarchy of norms are still controversial, lacking a proper regulation and a proper set of safeguards measures. A disciplinary action against doctors acting outside the professional activities, namely as a council member proposing a legal act, must be based on solid grounds relating to the protection of fundamental rights. Such a disciplinary authority requires legal definitions, safeguards and judicial remedies beyond those being met at present. The analysis shows how specific elements and devices should still be taken into consideration from both procedural and content perspectives to shape a more coherent model of relationships between law and medical ethics.
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Servicios Médicos de Urgencia/organización & administración , Ética Médica , Personal de Salud/organización & administración , Servicios Médicos de Urgencia/ética , Servicios Médicos de Urgencia/legislación & jurisprudencia , Auxiliares de Urgencia/organización & administración , Humanos , Italia , Enfermeras y Enfermeros/organización & administración , Médicos/organización & administraciónRESUMEN
INTRODUCTION: Community paramedicine is one emerging model filling gaps in rural healthcare delivery. It can expand the reach of primary care and public health service provision in underserviced rural communities through proactive engagement of paramedics in preventative care and chronic disease management. This study addressed key research priorities identified at the National Agenda for Community Paramedicine Research conference in Atlanta, USA in 2012. The motivations, job satisfaction and challenges from the perspectives of community paramedics and their managers pioneering two independent programs in rural North America were identified. METHODS: An observational ethnographic approach was used to acquire qualitative data from participants, through informal discussions, semi-structured interviews, focus groups and direct observation of practice. During field trips over two summers, researchers purposively recruited participants from Ontario, Canada and Colorado, USA. These sites were selected on the basis of uncomplicated facilitation of ethics and institutional approval, the diversity of the programs and willingness of service managers to welcome researchers. Thematic analysis techniques were adopted for transcribing, de-identifying and coding data that allowed identification of common themes. RESULTS: This study highlighted that the innovative nature of the community paramedic role can leave practitioners feeling misunderstood and unsupported by their peers. Three themes emerged: the motivators driving participation, the transitional challenges facing practitioners and the characteristics of paramedics engaged in these roles. A major motivator is the growing use of ambulances for non-emergency calls and the associated need to develop strategies to combat this phenomenon. This has prompted paramedic service managers to engage stakeholders to explore ways they could be more proactive in health promotion and hospital avoidance. Community paramedicine programs are fostering collaborative partnerships between disciplines, while the positive outcomes for patients and health cost savings are tangible motivators for paramedic services and funders. Paramedics were motivated by a genuine desire to make a difference and attracted to the innovative nature of a role delivering preventative care options for patients. Transitional challenges included lack of self-regulation, navigating untraditional roles and managing role boundary tensions between disciplines. Community paramedics in this study were largely self-selected, genuinely interested in the concept and proactively engaged in the grassroots development of these programs. These paramedics were comfortable integrating and operating within multidisciplinary teams. CONCLUSIONS: Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs. Experienced and highly motivated paramedics with excellent communication and interpersonal skills should be considered for community paramedic roles. Practitioners who are proactive about community paramedicine and self-nominate for positions transition more easily into the role: they tend to see the 'bigger picture', have broader insight into public health issues and the benefits of integrative health care. They are more likely to achieve higher job satisfaction, remain in the role longer, and contribute to better long-term program outcomes. Paramedic services and policymakers can use these findings to incentivize career pathways in community paramedicine and understand those changes that might better support this innovative model.
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Técnicos Medios en Salud/organización & administración , Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/organización & administración , Relaciones Interprofesionales , Servicios de Salud Rural/organización & administración , Adulto , Técnicos Medios en Salud/educación , Colorado , Conducta Cooperativa , Auxiliares de Urgencia/educación , Femenino , Humanos , Masculino , Ontario , Atención Primaria de Salud/organización & administración , Investigación Cualitativa , Estados UnidosRESUMEN
Paramedic services in Australia and New Zealand (Australasia) share many characteristics, with both offering versions of the Anglo-American system of emergency medical response. Their industry and professional bodies are transnational and as a result have similar industry standards and professional expectations. The major difference been the two countries is their sources of funding, with Australian paramedic services generally receiving more government funding than those in New Zealand. Both countries provide a range of services that use a mix of volunteer and professional staff and employ state-of-the-art communications and medical technology to provide high-level clinical services. In common with other higher income countries, they face the challenge of rising usage associated with ageing populations. Both countries are adapting to this through broadening their response models, from a focus on emergency medical response to the provision of a mobile health service that will see the emergence of more practitioners paramedic roles. These emerging models challenge the core missions of paramedic services, as well as the professional identity of paramedics. Despite these trends towards higher level and well-integrated paramedic services in Australia and New Zealand, communities and many other health professionals have limited knowledge or understanding of how paramedic services are organised, the characteristics of paramedics and allied staff and limited appreciation of their potential to make greater contributions to the health and well-being of communities. This article provides an introduction to how paramedics, as members of multidisciplinary teams, are well placed to contribute to improvements in health outcomes.
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Servicios Médicos de Urgencia , Australia , Servicios Médicos de Urgencia/organización & administración , Servicios Médicos de Urgencia/normas , Auxiliares de Urgencia/organización & administración , Auxiliares de Urgencia/normas , Humanos , Nueva Zelanda , Recursos HumanosRESUMEN
INTRODUCTION: For the past 50 years paramedic services and paramedic roles in high-income nations have evolved in response to changes in community needs and expectations. The aim of this article is to review paramedic models of service delivery, with an emphasis on models that have the potential to improve the health and wellbeing of frontier and remote populations. METHODS: Paramedic models of relevance to rural and frontier settings were identified from searches of CINHAL and Medline, while key paramedic-specific journals were individualy searched in the event that they were not indexed. Search terms were ambulance, paramedic and EMS. These were then combined with model* and rural, remote and frontier. These findings were then synthesised. RESULTS: During the 1950s and 1960s the volunteer transport model, based on the values of community informed self-determination, developed to meet local needs for transport to local hospitals and medical services. Somewhat later, the technological model, characterised by professionally staffed and managed paramedic systems providing prehospital using advanced technology and technically skilled staff, became the dominant model in metropolitan and regional settings. Paramedic practitioner models are now emerging that are part of integrated prehospital systems. These provide a range of services to prevent injury and illness, respond to emergencies and facilitate recovery, and contribute to efforts to produce a healthy community. CONCLUSIONS: Implementation of paramedic practitioner models in frontier and remote settings raises challenging policy and practice issues, including changes in scopes of practice, design of education programs, self-regulation of paramedics, and reimbursement.
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Auxiliares de Urgencia/organización & administración , Modelos Organizacionales , Servicios de Salud Rural/organización & administración , Servicios Médicos de Urgencia/organización & administración , HumanosRESUMEN
OBJECTIVE: The Collaborative Emergency Centre (CEC) model of care was implemented in Nova Scotia without an identifiable, directly comparable precedent. It features interprofessional teams working towards the goal of providing improved access to primary health care, and appropriate access to 24/7 emergency care. One important component of CEC functioning is overnight staffing by a paramedic and registered nurse (RN) team consulting with an off-site physician. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within Nova Scotia's CECs. METHODS: We conducted a qualitative study informed by the principles of grounded theory. Semi-structured telephone interviews were conducted with paramedics with experience working in a CEC. Analysis involved an inductive grounded approach using constant comparative analysis. Data collection and analysis continued until thematic saturation was reached. RESULTS: Fourteen paramedics participated in the study. The majority were male (n=10, 71%) with a mean age of 44 years and mean paramedic experience of 14 years. Four major themes were identified: 1) interprofessional relationships, 2) leadership support, 3) value to community and 4) paramedic identity. CONCLUSIONS: Paramedics report largely positive interprofessional relationships in Nova Scotia's CECs. They expressed enjoyment working in these centres and believe this work aligns with their professional identity. High levels of patient and community satisfaction were reported. Paramedics believe future expansion of the model would benefit from development of continuing education and improved communication between leadership and front-line workers.
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Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/organización & administración , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Evaluación de Resultado en la Atención de Salud , Adulto , Técnicos Medios en Salud/organización & administración , Femenino , Humanos , Relaciones Interprofesionales , Entrevistas como Asunto , Liderazgo , Masculino , Persona de Mediana Edad , Nueva Escocia , Grupo de Atención al Paciente/organización & administración , Investigación CualitativaRESUMEN
OBJECTIVES: There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest. METHODS: Hospital data on trial participants were requested from Hospital Episode Statistics (HES), the Intensive Care National Audit and Research Centre, and Myocardial Ischaemia National Audit Project and National Audit of Percutaneous Coronary Interventions, using unique patient identifiers. Linked data were received between June 2014 and June 2015. RESULTS: Of 4471 patients randomised in the pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial, 2398 (53.6%) were not known to be deceased at emergency department arrival and were eligible for linkage. We achieved an overall match rate of 86.7% in the combined HES accident and emergency, inpatient and critical care dataset, with variable match rates (4.2%-80.4%) in individual datasets. Patient demographics, cardiac arrest-related characteristics and major outcomes were predominantly similar between HES matched and unmatched groups, in the linkage apart from location, response time and return of spontaneous circulation (ROSC) at handover. CONCLUSIONS: This study shows that it is feasible to track patients from the prehospital setting through to hospital admission using routinely available administrative datasets with a moderate to high degree of success. This approach has the potential to complement the trial data with the demographic and clinical management information about the studied cohort, as well as to improve the efficiency and reduce the costs of follow-up in cardiac arrest trials. CLINICAL TRIAL REGISTRATION: ISRCTN08233942; Post-results.
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Reanimación Cardiopulmonar/métodos , Servicios Médicos de Urgencia , Auxiliares de Urgencia/organización & administración , Masaje Cardíaco , Paro Cardíaco Extrahospitalario/terapia , Análisis por Conglomerados , Estudios de Factibilidad , Humanos , Almacenamiento y Recuperación de la Información , Paro Cardíaco Extrahospitalario/mortalidad , Sistema de RegistrosRESUMEN
BACKGROUND: Low-income older adults who live in subsidized housing have higher mortality and morbidity. We aimed to determine if a community paramedicine program - in which paramedics provide health care services outside of the traditional emergency response - reduced the number of ambulance calls to subsidized housing for older adults. METHODS: We conducted an open-label pragmatic cluster-randomized controlled trial (RCT) with parallel intervention and control groups in subsidized apartment buildings for older adults. We selected 6 buildings using predefined criteria, which we then randomly assigned to intervention (Community Paramedicine at Clinic [CP@clinic] for 1 yr) or control (usual health care) using computer-generated paired randomization. CP@clinic is a paramedic-led, community-based health promotion program to prevent diabetes, cardiovascular disease and falls for residents 55 years of age and older. The primary outcome was building-level mean monthly ambulance calls. Secondary outcomes were individual-level changes in blood pressure, health behaviours and risk of diabetes assessed using the Canadian Diabetes Risk Questionnaire. We analyzed the data using generalized estimating equations and hierarchical linear modelling. RESULTS: The 3 intervention and 3 control buildings had 455 and 637 residents, respectively. Mean monthly ambulance calls in the intervention buildings (3.11 [standard deviation (SD) 1.30] calls per 100 units/mo) was significantly lower (-0.88, 95% confidence interval [CI] -0.45 to -1.30) than in control buildings (3.99 [SD 1.17] calls per 100 units/mo), when adjusted for baseline calls and building pairs. Survey participation was 28.4% (n = 129) and 20.3% (n = 129) in the intervention and control buildings, respectively. Residents living in the intervention buildings showed significant improvement compared with those living in control buildings in quality-adjusted life years (QALYs) (mean difference 0.09, 95% CI 0.01 to 0.17) and ability to perform usual activities (odds ratio 2.6, 95% CI 1.2 to 5.8). Those who received the intervention had a significant decrease in systolic (mean change 5.0, 95% CI 1.0 to 9.0) and diastolic (mean change 4.8, 95% CI 1.9 to 7.6) blood pressure. INTERPRETATION: A paramedic-led, community-based health promotion program (CP@clinic) significantly lowered the number of ambulance calls, improved QALYs and ability to perform usual activities, and lowered systolic blood pressure among older adults living in subsidized housing. Trial registration: Clinicaltrials.gov, no. NCT02152891.
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Servicios de Salud Comunitaria/normas , Prestación Integrada de Atención de Salud/normas , Servicios Médicos de Urgencia/estadística & datos numéricos , Auxiliares de Urgencia , Anciano , Técnicos Medios en Salud , Canadá , Análisis por Conglomerados , Servicios de Salud Comunitaria/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Auxiliares de Urgencia/organización & administración , Femenino , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Medición de RiesgoRESUMEN
BACKGROUND: Identification of stroke signs by emergency medical technicians (EMTs) is important for initiating the "stroke chain of survival." The aim of the present study was to clarify the effect of EMT-led lessons on stroke awareness for schoolchildren in the Akashi project on the transportation time to arrive at the hospital. METHODS: Stroke lessons were given by EMTs to 887 elementary school children in elementary schools between September 2014 and October 2015. Data on transportation times from prehospital records and final diagnoses at discharge were collected from both pre- (period 1; January-June 2014) and posteducation (period 2; January-June 2016) periods. Transportation time or onset-to-door time was divided into two parts: the onset-to-call time and the call-to-door time. RESULTS: One hundred forty-four patients in period 1 and 143 in period 2 were transported with potential strokes identified by EMTs. Among these, 119 (83%) in period 1 and 114 (80%) in period 2 had final diagnosis of stroke or transient ischemic attack. The mean age in period 2 was older than that in period 1 (75 years old versus 72 years old); however, there were no significant differences in gender and consciousness level between the 2 periods. The median call-to-door time of 28 minutes for period-2 patients was significantly shorter than that for period-1 patients (32 minutes, P = .0057). There were no differences in median onset-to-door times and onset-to-call times between the 2 periods. CONCLUSIONS: School-based education about stroke conducted by EMTs may be a promising strategy to cut the prehospital delay and to widely spread stroke awareness via school children and EMTs.
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Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/organización & administración , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Ataque Isquémico Transitorio/terapia , Accidente Cerebrovascular/terapia , Estudiantes/psicología , Tiempo de Tratamiento/organización & administración , Transporte de Pacientes/organización & administración , Anciano , Anciano de 80 o más Años , Niño , Conducta Infantil , Vías Clínicas , Femenino , Humanos , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Japón , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Teléfono , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: We examined whether teleconsultation from ambulances to a physician at an emergency medical communication center (EMCC) would increase the proportion of patients with nonurgent conditions being treated and released on site. METHODS: This research was a before-after pilot study. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation from the ambulance with the physician. The primary outcome was the proportion of patients treated and released on site. Secondary outcomes were the number of hospital admissions, mortality, and patient satisfaction. The intervention period was compared with a corresponding control period from the previous year. RESULTS: We observed an increase in the proportion of patients treated and released in the intervention period in 2014 compared with the control period in 2013, up from 21% (n=137) to 29% (n=221) (odds ratio=1.46; 95% confidence interval=1.14-1.89, P=0.002). The follow-up rate was 100%. There was no observable increase in hospital admissions or mortality among patients treated and released from 2013 to 2014. A telephone survey of patients treated and released showed that 98.4% (95% confidence interval=91.3-99.9) were very satisfied or satisfied with their treatment. CONCLUSION: Teleconsultation between a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety.
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Atención Ambulatoria/estadística & datos numéricos , Sistemas de Comunicación entre Servicios de Urgencia/estadística & datos numéricos , Auxiliares de Urgencia/organización & administración , Consulta Remota/organización & administración , Accesibilidad a los Servicios de Salud/normas , Humanos , Admisión del Paciente/estadística & datos numéricos , Proyectos PilotoRESUMEN
BACKGROUND AND PURPOSE: Although prehospital stroke notification has improved stroke treatment, incorporation of these systems into existing infrastructure has resulted in new challenges. The goal of our study was to design an effective prehospital notification system that allows for early and accurate identification of patients presenting with acute stroke. METHODS: We conducted a retrospective single-center cohort study of patients presenting with suspicion of acute stroke from 2014 to 2015. Data recorded included patient demographics, time of symptom onset, Cincinnati Prehospital Stroke Scale (CPSS) score, Glasgow Coma Scale score, National Institutes of Health Stroke Scale (NIHSS) score, emergency medical services (EMS) impression, acute stroke pager activation, acute intervention, and discharge diagnosis. Univariate logistic regression was performed with discharge diagnosis of stroke as the end point. RESULTS: A total of 130 patients were included in the analysis; 96 patients were discharged with a diagnosis of stroke or transient ischemic attack. Both NIHSS and the presence of face, arm and speech abnormalities on CPSS were significantly higher in patients with stroke (P < .05). EMS correctly recognized stroke in 77.1% of cases but falsely identified stroke in 85.3% of negative cases. CPSS identified 75% of acute stroke cases, but specificity was poor at only 20.6%. All patients receiving intervention had acute stroke pager activation in Emergency Department. CONCLUSIONS: Prehospital stroke notification systems utilizing EMS impressions and stroke screening tools are sensitive but lack appropriate specificity required for modern acute stroke systems of care. Better solutions must be explored so that prehospital notification can keep pace with advances in acute stroke treatment.
Asunto(s)
Técnicas de Apoyo para la Decisión , Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/organización & administración , Sistemas de Información en Hospital/organización & administración , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Prestación Integrada de Atención de Salud/organización & administración , Errores Diagnósticos , Evaluación de la Discapacidad , Diagnóstico Precoz , Servicio de Urgencia en Hospital/organización & administración , Femenino , Escala de Coma de Glasgow , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Minnesota , Grupo de Atención al Paciente/organización & administración , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Factores de Tiempo , Tiempo de TratamientoRESUMEN
OBJECTIVE: We evaluated the use of the Simple Triage and Rapid Treatment (START) method by Emergency Medical Services (EMS) and hypothesized that EMS can categorize patients using the START algorithm accurately. DESIGN: Retrospective Chart Review. SETTING: Inner-city Tertiary-Care Institutional Emergency Department (ED). PARTICIPANTS: Patients ≥ 18 years transported by EMS with a START color of Red, Yellow, or Green during the state triage tag exercise, October 9-15, 2011. INTERVENTIONS: EMS assigned each patient a START triage tag. Chart review of the electronic EMS run sheets was performed by investigators to determine a START color. MAIN OUTCOME MEASURES: START triage colors were re-categorized as Red = 1, Yellow = 2, and Green = 3. The difference between the investigators' color and EMS color were coded as: 0 for agreement in triage, -1 for undertriage by one category, -2 for undertriage by two categories, 1 for overtriage by one category, 2 for overtriage by two categories. RESULTS: Of 224 participants, START triage colors were: Red = 7.1 percent, Yellow = 19.2 percent, Green = 73.7 percent. The mean difference in triage categories was 0.228 (95% CI: 0.114-0.311, p<.001). 71.0 percent of patients were triaged to the same category, 5.8 percent undertriaged by one category, 0 percent undertriaged by two categories, 17.9 percent overtriaged by one category, and 5.4 percent overtriaged by two categories. CONCLUSION: EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.