The accuracy and reliability of an app-based audiometer using consumer headphones: pure tone audiometry in a normal hearing group.

OBJECTIVE: To undertake a preliminary evaluation of the test-retest reliability, and accuracy of an iPad audiometer app using commercial earphones as a low-cost alternative to a clinical audiometer in a restricted sample of normal hearing participants. DESIGN: Twenty participants self-reporting normal hearing undertook four pure-tone audiometry tests in a single session. Two tests were performed with a 2-channel Type 1 audiometer (GSI-61) using EAR insert earphones and two tests with an iPad based app (Audiogram Mobile) using Apple earbud headphones. STUDY SAMPLE: Twenty normal hearing participants (13 female and seven male participants, aged 21-26 years) were recruited for the test-retest and accuracy evaluations. RESULTS: The app resulted in different thresholds to the audiometer (F(1, 19) = 16.635, p < 0.001). However test-retest reliability was similar. The app froze or quit unexpectedly over 25% of times used. CONCLUSIONS: Audiometer apps have great potential for clinical settings, especially in resource scarce environments, but reliability should not be assumed. While a low cost-alternative to standard transducers, issues of accuracy and calibration of consumer headphones need to be addressed before such combinations can be used with confidence.

Paramedic Perspectives on Barriers to Prehospital Acute Stroke Recognition.

BACKGROUND: Emergency Medical Service (EMS) providers are tasked with rapid evaluation, stabilization, recognition, and transport of acute stroke patients. Although prehospital stroke scales were developed to assist with stroke recognition, unrecognized challenges exist in the prehospital setting that hinder accurate assessment of stroke. The goal of this qualitative study was to systematically understand the challenges and barriers faced by paramedics in recognizing stroke presentations in the field. METHODS: Paramedics from 12 EMS agencies serving a mix of rural, suburban, and urban communities in the State of California participated in five focus group discussions. Group size ranged from 3-8, with a total of 28 participants. Demographics of the participants were collected and focus group recordings were transcribed verbatim. Transcripts were subjected to deductive and inductive coding, which identified recurrent and divergent themes. RESULTS: Strong consensus existed around constraints to prehospital stroke recognition; participants cited the diversity of stroke presentations, linguistic diversity, and exam confounded by alcohol and or drug use as barriers to initial evaluation. Also, lack of educational feedback from hospital staff and physicians and continuing medical education on stroke were reported as major deterrents to enhancing their diagnostic acumen. Across groups, participants reported attempting to foster relationships with hospital personnel to augment their educational needs, but this was easier for rural than urban providers. CONCLUSIONS: While challenges to stroke recognition in the field were slightly different for rural and urban EMS, participants concurred that timely, systematic feedback on individual patients and case-based training would strengthen early stroke recognition skills.

Emergency Neurologic Life Support (ENLS): Evolution of Management in the First Hour of a Neurological Emergency.

Emergency neurological life support (ENLS) is an educational program designed to provide users advisory instruction regarding management for the first few hours of a neurological emergency. The content of the course is divided into 14 modules, each addressing a distinct category of neurological injury. The course is appropriate for practitioners and providers from various backgrounds who work in environments of variable medical complexity. The focus of ENLS is centered on a standardized treatment algorithm, checklists to guide early patient care, and a structured format for communication of findings and concerns to other healthcare professionals. Certification and training in ENLS is hosted by the Neurocritical Care Society. This document introduces the concept of ENLS and describes the revisions that constitute this second version.

Reviving Freedom House. How the storied ambulance company has been reborn.

Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.

Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study.

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016-6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS-hospital mNIHSS) was 2.4, 95% limits of agreement (-5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26-0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38-0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.