Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up

Abstract Background In Sweden, the majority of patients who are transported to hospital by the emergency medical services (EMS) are relatively old and the majority suffer from comorbidity. About half these patients are admitted to a hospital ward and will stay in hospital. However, the other half will only make a visit to the emergency department (ED). The burden on the ED is extensive and many elderly patients have to stay for many hours in the ED. Aim To describe the patients who are brought to hospital by the EMS, with particular emphasis on those that were discharged from the ED, and to assess the proportion of these patients who did not require hospital resources, which could mean that they were candidates for primary care (PC). Methods An observational analysis of a cohort of patients who were transported to hospital by the EMS in 2016 in the Municipality of Gothenburg. Results In all, 5,326 patients were transported to hospital by the EMS of which 52% were discharged directly from the ED. These patients included 37% assessed as not requiring hospital resources. The three most common causes of contact with the EMS in this subset were abdominal pain (15%), back pain (8%) and non-specified disease (7%). Of these patients, 77% had contact with a physician in the ED, whereas 6% had contact with a nurse and 17% left the ED without any contact. Twenty-six per cent were given advice on follow-up in PC. Conclusions Among patients who were brought to hospital by the EMS, more than half were discharged directly from the ED. Among these patients, 37% were assessed as not requiring hospital resources. These patients comprised 15% of the overall study cohort and may be candidates for primary care.

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The Effect of the Familiarity of a Survey Sender on Response Outcomes in a Large-Scale Survey of Emergency Medical Services Agencies

Evaluation & the Health Professions ◽

10.1177/01632787211030635 ◽

2021 ◽

Vol 44 (3) ◽

pp. 260-267

Author(s):

Morgan M. Millar ◽

Hilary A. Hewes ◽

Andrea L. Genovesi ◽

Michael Ely ◽

Braden Green ◽

...

Keyword(s):

Emergency Medical Services ◽

Large Scale ◽

Nationwide Survey ◽

Survey Response ◽

Medical Services ◽

Healthcare Organizations ◽

Emergency Medical ◽

Established Relationship ◽

To Receive

Survey response is higher when the request comes from a familiar entity compared to an unknown sender. Little is known about how sender influences response to surveys of organizations. We assessed whether familiarity of the sender influences response outcomes in a survey of emergency medical services agencies. Emergency medical services agencies in one U.S. state were randomly assigned to receive survey emails from either a familiar or unfamiliar sender. Both deployment approaches were subsequently used nationwide, with each state selecting one of the two contact methods. Experimental results showed that requests from the familiar sender achieved higher survey response (54.3%) compared to requests from the unfamiliar sender (36.9%; OR: 2.03; 95% CI: 1.23, 3.33). Similar results were observed in the subsequent nationwide survey; in states where the familiar sender deployed the survey, 62.0% of agencies responded, compared to 51.0% when the survey was sent by the unfamiliar sender (OR: 1.57; 95% CI: 1.47, 1.67). The response difference resulted in nearly 60 additional hours of staff time needed to perform telephone follow-up to nonrespondents. When surveying healthcare organizations, surveyors should recognize that it is more challenging to obtain responses without a pre-established relationship with the organizations.

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Characteristics of Prehospital Electrocardiogram Use in North Carolina Using a Novel Linkage of Emergency Medical Services and Emergency Department Data

Prehospital Emergency Care ◽

10.1080/10903127.2019.1597230 ◽

2019 ◽

Vol 23 (6) ◽

pp. 772-779 ◽

Cited By ~ 1

Author(s):

Jessica K. Zègre-Hemsey ◽

Josephine Asafu-Adjei ◽

Antonio Fernandez ◽

Jane Brice

Keyword(s):

Emergency Department ◽

North Carolina ◽

Emergency Medical Services ◽

Medical Services ◽

Emergency Department Data ◽

Emergency Medical

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Feedback to Emergency Medical Services Providers: The Good, the Bad, and the Ignored

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00037444 ◽

1997 ◽

Vol 12 (2) ◽

pp. 74-77 ◽

Cited By ~ 3

Author(s):

Elisabeth F. Mock ◽

Keith D. Wrenn ◽

Seth W. Wright ◽

T. Chadwick Eustis ◽

Corey M. Slovis

Keyword(s):

Emergency Department ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Service Providers ◽

Medical Services ◽

Emergency Medical Service System ◽

Constructive Feedback ◽

Emergency Medical ◽

Emergency Medical Service Provider

AbstractHypothesis:To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel.Methods:Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale.Results:In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (<1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill.Conclusion:The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.

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Linking Emergency Medical Services and Emergency Department Data to Improve Overdose Surveillance in North Carolina

Public Health Reports ◽

10.1177/00333549211012400 ◽

2021 ◽

Vol 136 (1_suppl) ◽

pp. 54S-61S

Author(s):

Jonathan Fix ◽

Amy I. Ising ◽

Scott K. Proescholdbell ◽

Dennis M. Falls ◽

Catherine S. Wolff ◽

...

Keyword(s):

Emergency Department ◽

North Carolina ◽

Emergency Medical Services ◽

Data Linkage ◽

Medical Services ◽

Opioid Overdose ◽

Naloxone Administration ◽

Emergency Medical ◽

Diagnosis Codes ◽

Linkage Methods

Introduction Linking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina. Methods We identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED. Results We identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records. Practice Implications Through an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses.

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Sobistat Emergency Response System for Severe Asthma: An Inexpensive, Very Rapid, Efficient, Simultaneous, Independant O2 and Bronchodilator Administration Device Optimized for Emergency Department, Emergency Medical Services and First Aid

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a3018 ◽

2020 ◽

Author(s):

M.T. Newhouse ◽

P. Goldman

Keyword(s):

Emergency Department ◽

Emergency Medical Services ◽

Severe Asthma ◽

Emergency Response ◽

First Aid ◽

Medical Services ◽

Emergency Response System ◽

Response System ◽

Emergency Medical

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Appropriate Use of Emergency Medical Services and a Solution for Emergency Department Overcrowding in Large Hospitals in Korea

Journal of Korean Medical Association ◽

10.5124/jkma.2009.52.11.1044 ◽

2009 ◽

Vol 52 (11) ◽

pp. 1044 ◽

Cited By ~ 2

Author(s):

Byung-Soo Do

Keyword(s):

Emergency Department ◽

Emergency Medical Services ◽

Medical Services ◽

Appropriate Use ◽

Emergency Department Overcrowding ◽

Emergency Medical

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Survey of Iowa Emergency Medical Services on the Effects of the 1993 Floods

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00037626 ◽

1997 ◽

Vol 12 (3) ◽

pp. 37-41 ◽

Cited By ~ 6

Author(s):

Stanley E. Chartoff ◽

Joann M. Gren

Keyword(s):

Emergency Medical Services ◽

Missouri River ◽

Medical Services ◽

Cross Sectional ◽

Emergency Medical ◽

First Response ◽

Service Areas ◽

The Government ◽

Survey Questionnaires

AbstractIntroduction:From June through August 1993, extensive flooding in the Mississippi and Missouri River basins resulted in 50 deaths and 12 billion dollars [U.S.] in damages in nine Midwestern states. In Iowa (1990 population 2,777,000), the government declared all 99 counties Federal Disaster Areas. This study examines how this event impacted local emergency medical services (EMS).Methods:All 797 registered prehospital ambulance, rescue, and first-response companies in Iowa received survey questionnaires. Two follow-up mailings were provided for non-responders.Results:A total of 468 EMS companies (59%) returned completed questionnaires. The geographic distribution ofresponders and non-responders was similar. Of the companies responding, 132 (28%) reported an impact on their operations from the flood disaster. The most frequently reported operational changes included the use of non-traditional vehicles, providing aid to regions outside usual service areas, and involvement in non-medical rescue operations.Conclusion:A major flood provides unique challenges for emergency medical services. Cross-sectional surveys can identify areas of improvement for prehospital systems located in flood-prone areas. Results from this study provide a basis for constructing a more refined instrument to study future flood disasters.

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