Epidemiology of Prehospital Care at the San Diego (USA) - Tijuana (Mexico) International Border Crossing.

Introduction: San Diego has one of the busiest international land border crossings in the world. The epidemiology of prehospital care at the San Diego (California, USA)-Tijuana (Baja California, Mexico) border crossings are previously unreported. Investigators sought to describe prehospital care provided at the San Diego border crossings. Methods: This was a cross-sectional, retrospective data collection from April 2014 to March 2017 evaluating prehospital provider (PHP) contacts at 2 international border crossing addresses in San Diego. The 9-1-1 dispatch center and first response were provided by a single municipal fire agency with ambulance transportation provided by a contracting private agency. Patient dispatch data and electronic patient care records were queried for patient demographics, PHP arrival time, incident complaint, assessment narrative, and treatments provided. Natural language processing techniques were applied to map the narrative to the National Library of Medicine's Unified Medical Language System. Descriptive analysis was performed in the R software program. Results: A total of 6,261 PHP patient contacts were made at the 2 border crossings during the study period. 87% of the calls were at the San Ysidro border crossing compared to 13% at Otay Mesa. The population, composed of 50.8% males, had ages ranging from 0 days-103 years old, with a median age of 45 years old. There were 606 (9.7%) pediatric patients (<18 years) and 1,416 (22.6%) geriatric patients (>65 years). The top 3 incident complaints were respiratory distress (830, 10.8%), blunt trauma (827, 10.7%), and abdominal pain (814, 10.6%); and, the top 3 medications provided were oxygen (481, 7.7%), normal saline (393, 6.3%), and ondansetron (352, 5.6%). Conclusion: This was the first study of PHP assessment and care at the San Diego-Tijuana border crossings. We found a large diversity in patient ages. Respiratory distress and blunt trauma were the most frequent complaints and oxygen was the most frequent medication. The busiest day of the week was Sunday, and the busiest month of the year was July. Our newly described findings may assist EMS agencies with optimizing staff, equipment, and training at international border crossings.

An Urban 9-1-1 System's Experience with Left Ventricular Assist Device Patients.

Background: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. Methods: This is a retrospective chart review of known LVAD patients that belong to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's 2 emergency departments between January 2012 and December 2015. Identifying demographics were used to query the electronic medical record of the responding city fire agency and contracted transporting ambulance service. Two reviewers abstracted prehospital chief complaint, vital signs, assessments, and interventions. Emergency department and hospital outcomes were retrieved separately. Results: From January 2012 to December 2015, 15 LVAD patients were transported 16 times. The most common prehospital chief complaint was weakness (7/16), followed by chest pain (3/16). Of the 7 patients presenting with weakness, one was diagnosed with a stroke in the emergency department. Another patient was diagnosed with subarachnoid hemorrhage and expired during hospital admission. This was the only death in the cohort. The most common hospital diagnosis was GI bleed (3/16). The overall admission rate was 87.5% (14/16). Conclusions: EMS interactions with LVAD patients are infrequent but have high rates of admission and incidence of life-threatening diagnoses. The most common prehospital presenting symptoms were weakness and chest pain, and most prehospital interactions did not require LVAD-specific interventions. In addition to acquiring technical knowledge regarding LVADs, EMS providers should be aware of non-device-related complications including intracranial and GI bleeding and take this into account during their assessment.