A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs

1990 ◽  
Vol 5 (4) ◽  
pp. 325-333 ◽  
Author(s):  
Daniel W. Spaite ◽  
Elizabeth A. Criss ◽  
Terence D. Valenzuela ◽  
Harvey W. Meislin ◽  
Paul Hinsberg
Keyword(s):  
Blood Pressure ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Patient Assessment ◽  
Chi Square ◽  
Measure Blood Pressure ◽  
One Year ◽  
Chi Square Analysis ◽  
Careful Assessment

AbstractWe prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p <0.05 considered significant.Among 227 patient encounters, BP and/or P measurements were omitted in 84 cases (37.0%). BP and/or P were omitted in 50.0% of children (age <18 years) compared to 26.5% of adults (p=0.023). Among patients who were transported to a hospital, 19.4% had BP omitted compared to 49.1% of those not transported (p=0.00003). Seven of 58 patients in whom TVs were attempted (12.1 %) had BP omitted compared to 54 of 169 patients without IV attempts (32.0%, p=0.0055). Blood Pressure was omitted in 21.9% of patients transported Code 3 and in 24.2% of patients with Glasgow Coma Scale ≤13. Omission of BP occurred more frequently in non-urban agencies (33.9%) than in urban ones (20.0%, p=0.027).In a statewide evaluation of prehospital patient assessment, failure to measure vital signs (VS) occurred on a frequent basis. Our data indicate that a concerning lack of attention to the most basic details of patient assessment is common. It is possible that failure to measure VS might even happen more frequently during routine patient encounters without an observer present. Medical control physicians must emphasize to EMS personnel the paramount importance of careful assessment to ensure optimal patient care.

Vital Signs Records Omissions on Prehospital Patient Encounter Forms

1993 ◽  
Vol 8 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Robert L. Moss
Keyword(s):  
Blood Pressure ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
False Alarms ◽  
Patient Encounter ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Frequent Failure ◽  
The Impact

AbstractIntroduction:A reported in-field, prospective evaluation of 227 prehospital patient assessments by advanced life support (ALS) emergency medical technicians (EMTs) found a frequent failure to measure vital signs. The objective of this retrospective review was to report the omission frequency of vital signs found in a centralized emergency medical services (EMS) data collection system.Methods:The EMS database contained information from 90,480 optically scanned, prehospital patient encounter forms. Each record identified EMT skill levels, response times, dispatch type, vital signs, medical and trauma information, treatment, and patient disposition. Records for 1989 and 1990 were collected from 92 rural EMS providers who responded to emergency medical and trauma events.Results:Of 90,480 emergency responses, 14,129 (15.6%) were false alarms, deceased, or canceled without vital patient contact. Valid encounters were documented for 76,351 (84.4%) patient contacts. Systolic blood pressure measurements were not recorded for 13,262 (17.4%) patients. Diastolic blood pressure was not recorded for 14,272 (18.7%) patients. A pulse record was not recorded for 12,125 (15.9%) patients. A ventilatory rate was absent in 12,958 (17.0%) patient records.Conclusion:This study found a frequent failure by non-metropolitan basic life support (BLS) and advanced life support (ALS) EMTs to record vital signs on prehospital emergency patient encounter forms. It supports a previous report of direct in-field observations of ALS EMTs failing to measure vital signs during patient assessment. The impact of vital sign omissions upon individual patient care can be assessed only by receiving medical control physicians. In the absence of effective emergency physician networking, the statewide magnitude of the problem among BLS and ALS EMTs has not been recognized as a system issue.

scholarly journals Association between Dietary Habits and Prehypertension among Indonesian Young Adults at Prof. Dr. R. D. Kandou Hospital Manado

2019 ◽  
Vol 11 (2) ◽  
pp. 80
Author(s):  
Ribka Wowor
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Medical Students ◽  
Dietary Habits ◽  
Soft Drink ◽  
Warning Sign ◽  
Junk Food ◽  
Chi Square ◽  
Soft Drink Consumption ◽  
Chi Square Analysis

Abstract: Prehypertension is a warning sign, early in age which denotes the risk of hypertension later on in life. Clinical and academic challenges of medical students may have adverse effect on their lifestyle, predisposing vulnerable subjects to elevated blood pressure. This study was aimed to determine the association between dietary habits and prehypertension among Indonesian young adults in Manado. This was an analytical study with a cross-sectional study. Subjects were 111 medical students (undergraduate and postgraduate) aged between 20-30 years, of either sex. A pre-tested questionnaire was used to elicit the details on physical activity, family history of hypertension, tobacco use, and dietary habits. According to JNC-7 guidelines, a systolic blood pressure (SBP) of 120 to 139 mmHg and/or diastolic blood pressure (DBP) of 80 to 89 mmHg is considered as prehypertension. Of the 111 subjects, 22.5% showed blood pressure levels within the range of prehypertension. Chi-square analysis revealed that junk food consumption (OR=3,152; 95% CI=1,253-7,925; P=0,023), and soft drink consumption (OR=4,747; 95% CI=1,797-12,539; P=0,002) were the risk factors of prehypertension. Conclusion: Dietary habits were associated with the prehypertension among young adults in Manado.Keywords: dietary habits, prehypertension, young adultsAbstrak: Prehipertensi merupakan tanda peringatan dini akan resiko terjadinya hipertensi di kemudian hari. Mahasiswa kedokteran memiliki kesibukan studi terutama pada masa kepaniteraan klinik di Rumah Sakit. Tuntutan dalam pendidikan dan pelayanan sekaligus di RS berdampak terhadap pola aktivitas mereka sehari-hari sehingga dapat memengaruhi tekanan darah. Penelitian ini bertujuan untuk mengetahui hubungan antara diet (konsumsi makanan dan minuman) dengan kejadian prehipertensi pada mahasiswa kedokteran Univrsitas Sam Ratulangi. Jenis penelitian ialah analitik dengan desain potong lintang. Hasil penelitian mendapatkan 111 mahasiswa kedokteran peserta P3D dan PPDS (calon spesialis) berusia antara 20-30 tahun sebagai subyek penelitian. Dilakukan pemeriksaan tekanan darah dan berat badan. Penentuan kebiasaan makan ditetapkan berdasarkan hasil pengisian kuesioner. Definisi prehipertensi berdasarkan kriteria JNC 7 yaitu tekanan darah sistolik lebih dari 120 mmHg tapi kurang dari 140 mmHg, dan atau tekanan darah diastolik lebih dari 80 mmHg tapi kurang dari 90 mmHg. Uji Chi-square dilakukan untuk melihat hubungan antara konsumsi junk food dan soft drink dengan kejadian prehipertensi dan didapatkan adanya hubungan antara konsumsi junk food (OR=3,152; 95% CI=1,253-7,925; P=0,023), dan soft drink (OR=4,747; 95% CI=1,797-12,539; P=0,002) dengan kejadian prehipertensi pada subyek dewasa muda. Simpulan: Diet (konsumsi junk food dan soft drink) berhubungan dengan kejadian prehipertensi pada subyek dewasa muda di Manado.Kata kunci: diet, prehipertensi, dewasa muda

Patients Who Refuse Transportation by Ambulance: A Case Series

1997 ◽  
Vol 12 (4) ◽  
pp. 45-50 ◽  
Author(s):  
John E. Hipskind ◽  
JM Gren ◽  
DJ Barr
Keyword(s):  
Medical Information ◽  
Life Support ◽  
Motor Vehicle ◽  
Demographic Data ◽  
Vital Signs ◽  
Case Series ◽  
Advanced Life Support ◽  
Care Program ◽  
Motor Vehicle Crash ◽  
Discharge Instructions

AbstractIntroduction:Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.Methods:This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.Results:Overall, 30% (683 of2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11–40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.Conclusion:There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.

The Prevalence of Persistent Intradialytic Hypertension in a Hemodialysis Population with Extended Follow-Up

2012 ◽  
Vol 35 (12) ◽  
pp. 1031-1038 ◽  
Author(s):  
Peter N. Van Buren ◽  
Catherine Kim ◽  
Robert D. Toto ◽  
Jula K. Inrig
Keyword(s):  
Blood Pressure ◽  
Linear Models ◽  
Hemodialysis Patients ◽  
Weight Changes ◽  
Mixed Linear Models ◽  
Ultrafiltration Rate ◽  
Chi Square ◽  
Median Percentage ◽  
Chi Square Analysis

Background Intradialytic hypertension, a phenomenon where blood pressure increases during hemodialysis, is associated with increased mortality in hemodialysis patients. The proportion of patients in which intradialytic hypertension persists over time is unknown. Methods In a retrospective cohort study, we studied all patients from our outpatient hemodialysis units that received ≥1 month of treatments during the period from January to August 2010. We reviewed all pre- and post-hemodialysis blood pressure and weight measurements from 22,955 treatments during this study period. We defined intradialytic hypertension as an increase in systolic blood pressure ≥10 mmHg from pre- to post-hemodialysis. Individual patients were defined as having persistent intradialytic hypertension if the change in blood pressure from pre- to post-hemodialysis, when averaged throughout the study period, was ≥+10 mmHg. We calculated weight changes between and during hemodialysis and defined ultrafiltration rate per treatment as ultrafiltration volume divided by minutes on hemodialysis. We compared patients with and without persistent intradialytic hypertension using chi-square analysis and mixed linear models. Results The prevalence of intradialytic hypertension was 21.3 per 100 treatments. The median percentage of intradialytic hypertension treatments per patient was 17.8% (9–31.3%, interquartile range). The prevalence of persistent intradialytic hypertension was 8 per 100 patients. Patients with persistent intradialytic hypertension had lower ultrafiltration rate compared to other patients (10.4 vs. 12.2 ml/min, p = 0.02). Conclusions Intradialytic hypertension is a persistent phenomenon in a subset of hemodialysis patients. Ultrafiltration rate was the only volume-related variable that differed between patients with and without persistent intradialytic hypertension.

Effectiveness of Interactive Videodisc Instruction for the Continuing Education of Paramedics

1994 ◽  
Vol 9 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Michael Heller ◽  
Walt A. Stoy ◽  
Larry J. Shuman ◽  
Harvey Wolfe ◽  
Chalice A. Zavada
Keyword(s):  
Computer Analysis ◽  
Life Support ◽  
Advanced Life Support ◽  
Interactive Videodisc ◽  
Chi Square ◽  
Group Score ◽  
Subject Areas ◽  
Student’S T ◽  
Mean Compliance ◽  
Student’S T Test

AbstractObjectives:To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets.Design/Setting:Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS).Interventions:All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using “Student's“ t-test and Chi-square with alpha set at 0.05.Exclusions:Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15).Results:Overall the mean compliance score of the pre-IVD group was 0.65 ±0.19 (±SD). The post-IVD group score was 0.65 ±0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030.Conclusion:Eight hours of IVD instruction did not result in improved paramedic performance as judged by computer analysis of trip sheets.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Abstract 326: Practice Variation in the Transition from Weight-based to Flat Dosing of Epinephrine During Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Martha Kienzle ◽  
Ryan W Morgan ◽  
Maya Dewan ◽  
Ken Tegtmeyer ◽  
Vijay Srinivasan ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Ideal Body Weight ◽  
Practice Variation ◽  
Free Standing ◽  
Chi Square ◽  
Actual Weight ◽  
Significant Difference ◽  
Fellowship Programs

Introduction: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations (0.01 mg/kg with a maximum dose of 1mg), but do not specify the age or weight at which adult (flat) dosing should be provided. Hypothesis: We hypothesized that there would be considerable practice variation in the transition from weight-based to flat dosing of epinephrine in pediatric ICUs (PICUs) and that more providers would prioritize weight than age in making this decision. Methods: We performed an IRB-exempt, multi-institution, internet-based survey. Recipients were U.S. PICU attending physicians (one per institution) involved in resuscitation system oversight. Proportions across categories were compared using Chi-square testing. Results: Of 137 institutions surveyed, 68 (50%) responded. Most responding institutions are children’s hospitals (free-standing or dedicated pediatric hospitals within combined hospitals) (67; 99%) and academic (55; 81%); 41 (60%) have PICU fellowship programs. Thirteen (19%) respondents are PICU medical directors, 16 (24%) are resuscitation committee members and 21 (31%) are PICU attendings with an interest in resuscitation. When choosing between weight-based and flat dosing, a significantly higher proportion of providers consider weight (64/68; 94%) vs. age (23/68; 34%) (p <0.01). Among those using age, there were no significant differences in the proportion of providers transitioning at 12 to <14 years of age (0, 0%), 14 to <16 (4, 17%), 16 to <18 (5, 22%) or ≥18 (6, 26%; p=0.82). Among those prioritizing weight, there was a significant difference between the proportion of providers transitioning at 50 to <60kg (28, 44%), 60 to <80kg (17, 27%), 80 to <100kg (5, 8%) or ≥100kg (8, 13%; p< 0.01). Twenty-nine (43%) institutions use an ideal body weight that is less than the patient’s actual weight when dosing epinephrine in obese patients. Conclusions: There is considerable practice variation in the transition from weight-based to flat epinephrine dosing during CPR in PICUs with most institutions using patient weight. Given the potential for large variation in amount of epinephrine delivered to these patients, prospective study is warranted to inform PALS guidelines.

scholarly journals Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale

CJEM ◽  
2002 ◽  
Vol 4 (01) ◽  
pp. 16-22 ◽  
Author(s):  
Daria Manos ◽  
David A. Petrie ◽  
Robert C. Beveridge ◽  
Stephen Walter ◽  
James Ducharme
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Emergency Department Patient ◽  
Observer Agreement ◽  
Care Providers ◽  
Emergency Department Triage ◽  
Triage Level

ABSTRACTObjective:To determine the inter-observer agreement on triage assignment by first-time users with diverse training and background using the Canadian Emergency Department Triage and Acuity Scale (CTAS).Methods:Twenty emergency care providers (5 physicians, 5 nurses, 5 Basic Life Support paramedics and 5 Advanced Life Support paramedics) at a large urban teaching hospital participated in the study. Observers used the 5-level CTAS to independently assign triage levels for 42 case scenarios abstracted from actual emergency department patient presentations. Case scenarios consisted of vital signs, mode of arrival, presenting complaint and verbatim triage nursing notes. Participants were not given any specific training on the scale, although a detailed one-page summary was included with each questionnaire. Kappa values with quadratic weights were used to measure agreement for the study group as a whole and for each profession.Results:For the 41 case scenarios analyzed, the overall agreement was significant (quadratic-weighted κ = 0.77, 95% confidence interval, 0.76–0.78). For all observers, modal agreement within one triage level was 94.9%. Exact modal agreement was 63.4%. Agreement varied by triage level and was highest for Level I (most urgent). A reasonably high level of intra- and inter-professional agreement was also seen.Conclusions:Despite minimal experience with the CTAS, inter-observer agreement among emergency care providers with different backgrounds was significant.

scholarly journals Does History of Prematurity Prompt Blood Pressure Evaluations at Primary Care Visits?

2019 ◽  
Vol 6 ◽  
pp. 2333794X1982831
Author(s):  
Benjamin D. Kornfeld ◽  
Gal Finer ◽  
Laura E. Banks ◽  
Liliana Bolanos ◽  
Adolfo J. Ariza
Keyword(s):  
Blood Pressure ◽  
Mixed Methods Study ◽  
Elevated Blood ◽  
Chi Square ◽  
Screening Guidelines ◽  
Measurement Protocol ◽  
Care Patterns ◽  
History Of ◽  
Chi Square Analysis ◽  
Routine Assessment

Prematurity is a risk factor for elevated blood pressure (BP). We performed a mixed-methods study of care patterns and awareness of early BP screening recommendations for infants born prematurely (IBP) by interviewing/surveying providers on practice- and provider-level BP screening. IBP’s records were reviewed for BP screening documentation, demographics, and gestational age (GA). Visits <33 months were reviewed for anthropometrics, BP, and comorbidities. Chi-square analysis evaluated BP screening by GA and comorbidities. Twenty-six of 49 practices completed interviews; 81% had infant BP equipment available; 4% had BP measurement protocol for IBP. Twenty-eight of 86 providers were aware of screening guidelines; none reported routine assessment. Twenty-eight of 118 IBP had ≥1 BP documented; 43% had BP ≥90th percentile. Screening did not differ by GA group. Kidney-related diagnosis was associated with more frequent BP screening ( P = .0454). BP is not routinely measured though often elevated before age 3 in IBP.

scholarly journals Preparedness of Western Cape advanced life support providers to provide clinical stabilisation and intensive care for neonatal interfacility transfers

2020 ◽  
Vol 17 ◽  
Author(s):  
Erefaan Ismail ◽  
Raveen Naidoo ◽  
Dorcas Rosaley Prakaschandra
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Critically Ill ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Practical Training ◽  
Western Cape ◽  
Chi Square ◽  
Critically Ill Neonates

Introduction The Western Cape is a province in South Africa – known for the port city of Cape Town – surrounded by the Indian and Atlantic oceans. The transport of high-risk neonates between neonatal intensive care units in the Western Cape of South Africa is performed by advanced life support (ALS) providers.The implications of this practice have not been documented. This study will evaluate the preparedness of ALS providers to undertake intensive care of critically ill neonates during interfacility transfers.MethodsData collection was performed using a questionnaire with a response rate of 81% (n=145). The data analysis encompassed descriptive statistics using tables and figures. Inferential statistics was done using the chi-square test with a significance reported for p<0.05. Reliability was determined using Cronbach’s alpha.ResultsThe respondents highlighted that their initial ALS training was not adequate to prepare them for managing critically ill neonates. This view was expressed by the greater majority (n=63, 43.4%) when asked about their combined neonatal theory and practical training notional hours of their curriculum which focussed on managing critically ill neonates. ConclusionThere is an urgent need to improve the training programs of ALS providers with regards to neonatology. Numerous factors affecting the preparedness of ALS providers to manage critically ill neonates have been highlighted.

Sign in / Sign up

Export Citation Format

Share Document