Increasing employee awareness of the signs and symptoms of heart attack and the need to use 911 in a State Health Department.

INTRODUCTION: Early recognition of the signs and symptoms of a heart attack can lead to reduced morbidity and mortality. METHODS: A workplace intervention was conducted among 523 Montana state health department employees in 2003 to increase awareness of the signs and symptoms of heart attack and the need to use 911. All employees received an Act in Time to Heart Attack Signs brochure and wallet card with their paychecks. Act in Time posters were placed in key workplace areas. A weekly e-mail message, including a contest entry opportunity addressing the signs and symptoms of heart attack, was sent to all employees. Baseline and follow-up telephone surveys were conducted to evaluate intervention effectiveness. RESULTS: Awareness of heart attack signs and symptoms and the need to call 911 increased significantly among employees from baseline to follow-up: pain or discomfort in the jaw, neck, or back (awareness increased from 69% to 91%); feeling weak, light-headed, or faint (awareness increased from 79% to 89%); call 911 if someone is having a heart attack or stroke (awareness increased from 84% to 90%). Awareness of chest pain, pain or discomfort in the arms or shoulders, and shortness of breath were more than 90% at baseline and did not increase significantly at follow-up. At baseline, 69% of respondents correctly reported five or more of the signs and symptoms of heart attack; 89% reported correctly at follow-up. CONCLUSION: This low-cost workplace intervention increased awareness of the signs and symptoms of heart attack and the need to call 911.

A randomized, prospective, multisite comparison of pediatric prehospital training methods.

OBJECTIVE: Results of prehospital pediatric continuing education using train-the-trainer and CD-ROM training methods were compared to each other and to a control group. The null hypothesis was that no differences would be found in pretraining and posttraining measurements of knowledge and performance by either training method. METHODS: This was a prospective trial involving 12 sites. Random selections were made from ambulance service lists provided by 3-state emergency medical services (EMS) agencies. Preintervention and postintervention (12-month) measurements included a written examination and 2 performance scenarios videotaped for independent panel evaluation. Training was either an interactive CD-ROM or standard classroom instruction using a train-the-trainer model. Mean differences in written, performance, and combined scores were analyzed. RESULTS: Differences were noted in the combined and performance scores for the CD-ROM intervention group. No differences were noted in written measurements between or among the groups. CONCLUSION: In this small sample, interactive CD-ROM training shows promise for improving performance. The research design, with additional guards against sample size attrition, may provide a model for multisite EMS education research.

A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care.

In 2007, the Institute of Medicine's (IOM's) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.

National Emergency Medical Services Information System (NEMSIS).

The absence of emergency medical services (EMS) patient care data has hindered development and evaluation of EMS systems. The National Highway Traffic Safety Administration (NHTSA), in cooperation with the Health Resources and Services Administration (HRSA), has provided funding to the National Association of State EMS Directors to develop a National EMS Information System (NEMSIS). NEMSIS is being designed to provide a uniform national EMS dataset, with standard terms, definitions, and values, as well as a national EMS database, with aggregated data from all states on a limited number of data elements. Forty-eight of the states, the District of Columbia, and three territories signed a memorandum of agreement documenting support for the NEMSIS project and expressing a desire for full implementation of the NEMSIS dataset. NHTSA has agreed to house the National EMS Database at its National Center for Statistics and Analysis. NHTSA, in cooperation with HRSA and the Centers for Disease Control and Prevention, recently entered into a cooperative agreement with the University of Utah School of Medicine to operate a NEMSIS Technical Assistance Center that will provide related assistance to official EMS agencies and to commercial software vendors. The Technical Assistance Center will also biannually assess state and territorial capabilities to provide data to the national EMS database. NEMSIS will provide a uniform national EMS dataset, with standard terms, definitions, and values, as well as a national EMS database, with aggregated data from all states on a limited number of data elements. Many of the potential benefits of implementation of NEMSIS are enumerated in this report.

Emergency medical services information systems and a future EMS national database.

Since the early 1970s, various publications and legislation have contributed to the development of emergency medical services (EMS) information systems and databases. Yet, even today, EMS systems vary in their ability to collect patient and systems data and to put these data to use. In addition, no means currently exists to easily link disparate EMS databases to allow analysis at local, state, and national levels. For this reason, the National Association of State EMS Directors is working with its federal partners at the National Highway Traffic Safety Administration (NHTSA) and the Trauma and EMS program of the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau to develop a national EMS database. Such a database would be useful in developing nationwide EMS training curricula, evaluating patient and EMS system outcomes, facilitating research efforts, determining national fee schedules and reimbursement rates, and providing valuable information on other issues related to EMS care.

Assessment of nationally registered emergency medical technician certification training in the United States: the LEADS Project. Longitudinal Emergency Medical Technician Attributes Demo-graphic Study.

OBJECTIVES: To describe the adequacy and characteristics of emergency medical services education as assessed by a population-based sample of emergency medical technician (EMT)-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians. METHODS: Stratified random samples of EMT-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians were mailed a 46-item demographic survey and a 16-question education survey in 1999. RESULTS: Overall, EMT-basics and EMT-paramedics reported that course cost and distance to the course were not barriers. The majority of EMT-basic and EMT-paramedic respondents rated their course instructors and course materials as excellent or very good. EMT-basic and EMT-paramedic respondents felt that they were very well prepared from their training in the areas of trauma assessment (63% and 72%), medical assessment (59% and 65%), cardiac arrest management (64% and 76%), and airway management (69% and 77%), respectively. However, EMT-basic and EMT-paramedic respondents were less likely to feel very well prepared regarding childbirth (29% and 44%) and pediatric patient management (36% and 38%). Overall, EMT-paramedics were more likely to report being very well prepared for clinical activities and tasks from their training compared with EMT-basics. CONCLUSIONS: These findings suggest that EMT-basics and EMT-paramedics were satisfied and felt well prepared by their certification courses. Opportunities to improve certification training exist, particularly related to childbirth and pediatric patient management.