Advanced Practice Providers in the Field: Implementation of the Los Angeles Fire Department Advanced Provider Response Unit.

Background: To address the growing number of low-acuity patients in the 911-EMS system, the Los Angeles Fire Department (LAFD) launched a pilot program placing an Advanced Provider Response Unit (APRU) in the field so that a prehospital nurse practitioner (NP) could offer patients treatment/release on scene, alternative destination transport, and linkage with social services. Objective: To describe the initial 18-month experience implementing this new APRU. Methods: This is a retrospective, descriptive review of all APRU-attended patients from January 2016 to June 2017. The APRU was an ambulance staffed by an NP and a firefighter/paramedic, equipped with basic point-of-care testing capability, and linked to incidents by either being summoned by on-scene first responders or by monitoring EMS radio traffic. Descriptive statistics were used and outcome measures included counts of clients attended, treat/release rates, impact on total time in service for other LAFD resources, patient need for subsequent re-use of 911 and self-reported experience of care. Results: During its first 18 months in service, the APRU attended 812 patients, including 792 911-patient incidents. 400 of these 911-patients (50.5%) were treated and released on scene or medically cleared and transported to an alternative site for specialty care. This included 76 patients with primary psychiatric complaints who were medically-cleared and transported directly to a mental health urgent care center. An additional 18 high utilizers of 911 were attended by the APRU and connected with a social work organization, and 12 of 18 (66.7%) decreased their use of EMS in the 90-days following APRU evaluation and referral. Of the 400 911-patients that did not go to the emergency department (ED), 26 (6.5%) re-contacted 911 within 3 days: all were transported to the ED with normal vital signs and without prehospital intervention, and all were ultimately discharged home from the ED. As a result of APRU intervention, 458 other LAFD field resources were quickly placed back in service and made available for the next time-critical call. Conclusions: Advanced practice providers such as nurse practitioners can be incorporated into the prehospital setting to address a growing subset of 911-patients whose needs can be met outside of the ED.

Analysis of Domestic Violence Related Homicides in Los Angeles County: Media Portrayals, Demographics, and Precipitating Circumstances.

Intimate partner violence (IPV) remains a pressing public health issue. Nationally, 1 in 5 women and 1 in 10 men have sustained severe physical violence from an intimate partner. Intimate partner homicides (IPH) are the most serious IPV outcome. This study examined documented IPH in Los Angeles County during 2017, analyzing if precipitating circumstances, victim demographics, victim/suspect relationship, and weapon type were related to how often a homicide was reported in online media stories. Cases were identified from the National Violent Death Reporting System (NVDRS), and standardized internet searches identified media articles associated with each case. Victim demographics from NVDRS and media articles were compared using Chi Square tests. Media report frequency, within different categorical predictor values, were examined using ANOVA models. 44 incidents were identified; averaging 5.2 articles per decedent. Univariate analyses showed significant difference in media reporting by poverty level (low versus high socioeconomic status) and presence of preceding argument. Multivariate analyses found significantly more media reports (p = 0.002) for incidents in which a preceding argument is reported, the victim was 30-39 years old and from a low socioeconomic status zip code. From our results certain characteristics of IPH are associated with greater media reporting. Promotion of consistent and responsible IPH media reporting guidelines is an opportunity to reinforce public health messaging and dispel myths. In turn, this will encourage the development of future policies and funding streams across the spectrum of preventing and stopping IPV.

The Use of Telemedicine for Home-Based Palliative Care for Children With Serious Illness: A Scoping Review.

CONTEXT: There is potential value to home-based palliative care for children with serious illness delivered via telemedicine (TM HBPC). Evidence to guide optimal design and delivery of TM HBPC is urgently needed. OBJECTIVES: To explore the existing literature to identify research on pediatric TM HBPC. METHODS: Systematic scoping review conducted following preferred reporting items for systematic reviews and meta-analysis for scoping reviews guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Web of Science, PsycINFO, and ERIC were searched (January-April 2020) using keywords and controlled vocabulary. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework was used to identify components in the literature that facilitate or limit dissemination of TM HBPC interventions. RESULTS: Seventeen articles were included. Most of the literature comprised small descriptive studies, such as case reports, and feasibility trials. Many studies focused on acceptability, and the TM HBPC model was generally acceptable to both clinicians and families. Few studies measured patient access to care, patient, and family centered health or quality of life outcomes. While included studies addressed multiple criteria for each of the Reach, Effectiveness, Adoption, Implementation, Maintenance dimensions, much of the information was qualitative and subjective. CONCLUSION: TM HBPC is a promising strategy to increase access to palliative care for children with serious illness. However, the current review found a need for more robust information describing implementation and effectiveness of TM HBPC models, adaptation across care settings, and maintenance over time to guide and facilitate broader dissemination.