Mobile Integrated Health and Hospital Utilization for Congestive Heart Failure in a Rural Setting.

Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs.Objective: This study evaluated the effect of a rural MIH program on emergency department and inpatient utilization for patients with congestive heart failure.Methods: A retrospective propensity score matched case-control study patients was performed for patients who participated in the MIH program associated with a single rural Pennsylvania health system between April 2014 and June 2020. Cases and controls were matched based on demographics and comorbidities. Pre- and post-intervention utilization were examined at 30, 90, and 180 days from the index encounters within the treatment groups, and then compared to the change in utilization among controls.Results: 1237 patients were analyzed. The change in all-cause ED utilization among cases was significantly better than the change in ED utilization among controls at 30 (Δ = -3.6%; 95% CI: -6.1%, -1.1%) and 90 days (Δ = -3.5%; 95% CI: -6.7%, -0.2%). There was no significant change in all-cause inpatient utilization at 30, 90, or 180 days. Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals.Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.

Helicopter Emergency Medical Services Performed Extended Focused Assessment With Sonography: Training, Workflow, and Sustainable Quality.

The extended focused assessment of trauma (EFAST) examination is an invaluable tool for the initial evaluation of the trauma patient. Miniaturization of ultrasound has enabled helicopter emergency medical services (HEMS) to use point-of-care ultrasound to care for trauma patients on scene. Our study demonstrated that HEMS crews accurately performed EFAST examinations after the implementation of a novel HEMS EFAST workflow, multifaceted training, and ongoing quality assurance. The HEMS crews' overall sensitivity was 53%, and specificity was 98%. The obtained image quality was highest for the lung, cardiac, and right upper quadrant components of the EFAST. Our results suggest that with a structured multifaceted training program, user-friendly workflow, and ongoing quality assurance, HEMS crews can perform EFAST examinations safely and reliably in the field. This would allow HEMS crews to detect life-threatening, time-sensitive conditions such as a pneumothorax, pericardial effusion, and intraperitoneal hemorrhage. HEMS EFAST has the potential to triage certain trauma patients directly to the operating room or newly emerging hybrid suites, bypassing the emergency room and saving crucial time.

Development, Implementation, and Assessment of a New Competency and Outcomes-Based Orientation in an Air Medical Transport Program.

OBJECTIVE: The development and evaluation of new employees in air medical transport has historically lacked standardization and competency-based learning goals. Here we discuss the development, implementation, and assessment of a new competency-based education and evaluation method at Geisinger's Life Flight air medical transport service. METHODS: Using Bloom's taxonomy of learning, 14 competencies for flight employees were identified. An electronic database was created to track progress across competencies and serve as an information repository for the identification of goals and the development of individualized learning plans. Ten months after implementation of the new method, 11 preceptors and education team members were surveyed to understand their views on the new program. RESULTS: At the time of survey administration, 20 orientees had completed orientation under the new education and evaluation program in an average of 6.45 weeks, with a range of 3 to 10 weeks. Of the 11 surveyed instructors, 81.1% definitely agree that the new method adequately assesses performance compared with 45.5% with the previous unstandardized method; 81.8% of the instructors rated the overall change as very helpful. CONCLUSION: The adoption of a competency-based learning model for air medical transport employee education and evaluation improves the assessment of performance and allows for the development of customized learning plans.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.