Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

1999 ◽  
Vol 14 (3) ◽  
pp. 67-72 ◽  
Author(s):  
John R. Richards ◽  
Stephen J. Ferrall
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Patient Characteristics ◽  
University Hospital ◽  
Medical Services ◽  
Shortness Of Breath ◽  
Study Objective ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

scholarly journals Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

2021 ◽  
Vol 29 (4) ◽  
pp. 224-229 ◽  
Author(s):  
E. R. de Koning ◽  
M. J. Boogers ◽  
J. Bosch ◽  
M. de Visser ◽  
M. J. Schalij ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
Time Period ◽  
Number Of Patients ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

Abstract 203: Characteristics of Emergency Medical Service Responses for Adults With Cardiovascular Disease-related Chief Complaints in The United States, 2016

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Isaac A Nwaise ◽  
Erika C Odom
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Emergency Medical Services ◽  
Statistical Tests ◽  
The United States ◽  
Medical Services ◽  
National Database ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Chief Complaints

Background: Gaps exist in understanding the commonality of cardiovascular disease (CVD)-related responses by emergency medical services responders in the United States (US) community setting. Objective: We examined characteristics of CVD-related responses among US adults with 9-1-1 emergency medical services (EMS) responses in a national database. Methods: The 2016 National Emergency Medical Services Information System (NEMSIS) database (Version 2.2.1) from 49 states was used. CVD-related chief complaints were defined by data element E09_12 in the NEMSIS code book. Exclusions were EMS cancellations, persons not found, those with unknown sex, and patients aged <18 years. Rates (per 1,000 EMS responses) were calculated for total population and by patient demographics. Chi-square statistical tests were used to assess associations. Percentages of CVD-related chief complaints were calculated for EMS responses (incident patient disposition, type of destination, and reasons for destination), and clinical characteristics (provider’s primary impression, provider’s secondary impression, primary symptom, and EMS condition code). Results: We identified over 19.8 million EMS responses among adults aged ≥18 years old in 2016, including 1,336,684 (67.4 per 1,000 EMS responses) with CVD-related chief complaints. Rates of CVD-related chief complaints per 1,000 EMS responses for females (68.5), patients aged 65-74 years old (87.7), Hawaiian Pacific Islanders (83.6), whites (73.4), and those living in the South census region (72.8) were significantly higher than their respective counterparts. Among EMS responses, most CVD-related chief complaints were treated and transported by EMS (83.1%), and of those transported by EMS, 83.5% were transported to a hospital. Reasons for hospital destinations among adults with CVD-related chief complaints were patient’s preferred hospital (34%) and closest facility (32.9%). Most CVD-related chief complaints were chest pain or discomfort according to provider’s primary impression (48%) and provider’s secondary impressions (6.1%). Finally, pain (46.2%) was the most frequently reported condition as primary symptom among EMS patient with CVD-related chief complaints. Conclusion: Approximately 1-in-15 EMS (9-1-1) responses among adults involved a CVD-related chief complaint. Future research could focus on trends for CVD-related EMS responses overtime. Keyword: 9-1-1 emergency system, prehospital cardiovascular disease, CVD-related events.

scholarly journals Managing CBRN Mass Casualty Incidents at Hospitals - Find a Simple Solution for a Complex Problem: a Pilot Study

2021 ◽  
Author(s):  
Maximilian Kippnich ◽  
Nora Schorscher ◽  
Helmut Sattler ◽  
Uwe Kippnich ◽  
Patrick Meybohm ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Full Scale ◽  
The Body ◽  
University Hospital ◽  
Medical Services ◽  
Temperature Management ◽  
Simulated Patients ◽  
Special Forces ◽  
Technical Requirements ◽  
Emergency Medical

Abstract Background Chemical, Biological or Radio-nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals. The challenge becomes even greater, if decontamination needs to be performed nearby or even within the hospital campus. To be prepared for such scenarios, the University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. Bullet points of the strategy are decontamination by Special Forces of the fire brigade and CBRN-experts of the Emergency Medical Services and the adaption to the hospitals spatial conditions. The focus of the presented study was to proof the practicability of the concept, the duration of the decontamination process and the temperature management during a full-scale exercise.Methods On demand the decontamination unit can be put into operation within the roofed basement access zone in front of the emergency department. The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services in adequate personal protective equipment are responsible for the decontamination process itself. The study was designed as full-scale exercise, which was documented by a camera team. The body temperature of the decontaminated Persons and the environment temerature was measured.Results The entire process proofed to be successful. The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5,5 ± 0,6 minutes (mean ± SD) including handovers and undressing. 30 people have participated in the full-scale exercise. At the end of the decontamination process the temperature of the undressed upper body of the training patients was 27,25 ± 1 °C (81,05 ± 2 °F) (mean ± SD), the water in the shower was about 35°C (95°F).Conclusion The presented concept is comprehensive and simple for a best possible c care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

scholarly journals Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

2019 ◽  
Author(s):  
Linda Huibers ◽  
Anders H Carlsen ◽  
Grete Moth ◽  
Helle C Christensen ◽  
Ingunn S Riddervold ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Medical Services ◽  
Healthcare Service ◽  
Service Providers ◽  
Patient Characteristics ◽  
Medical Services ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Medical ◽  
Acute Healthcare

Abstract Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

scholarly journals Determining Potentially Avoidable Emergency Medical Services (EMS) Transports: A Population Level Study Using Linked Administrative Data in Alberta Health Services (AHS)

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Ping Cai ◽  
Gregory Vogelaar ◽  
Kim Liss ◽  
Hude Quan
Keyword(s):  
Emergency Medical Services ◽  
Quality Care ◽  
Population Level ◽  
Patient Characteristics ◽  
Medical Services ◽  
Community Based ◽  
Rural Residents ◽  
Term Care ◽  
Emergency Medical ◽  
Alternative Settings

IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model. Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta. We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission. ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals<18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%). Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.

Emergency Medical Services Time Intervals for Acute Chest Pain in the United States, 2015–2016

2019 ◽  
Vol 24 (4) ◽  
pp. 557-565 ◽  
Author(s):  
Eric R. Cui ◽  
Alexandra Beja-Glasser ◽  
Antonio R. Fernandez ◽  
Joseph M. Grover ◽  
N. Clay Mann ◽  
...  
Keyword(s):  
United States ◽  
Chest Pain ◽  
Emergency Medical Services ◽  
Acute Chest Pain ◽  
The United States ◽  
Medical Services ◽  
Time Intervals ◽  
Emergency Medical

scholarly journals Emergency medical service, nursing, and physician providers’ perspectives on delirium identification and management

Dementia ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. 329-343 ◽  
Author(s):  
Michael A LaMantia ◽  
Frank C Messina ◽  
Shola Jhanji ◽  
Arif Nazir ◽  
Mungai Maina ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Emergency Medical Services ◽  
Mental Status ◽  
Medical Services ◽  
Diagnostic Strategy ◽  
Emergency Physicians ◽  
Emergency Nurses ◽  
Study Objective ◽  
Emergency Medical

Purpose of the study The study objective was to understand providers’ perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient’s home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients’ baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.

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