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 INFLUENCE OF EMERGENCY MEDICAL STUDENTS TRAINING ON PREPAREDNESS TO PERFORM PAEDIATRIC LIFE SUPPORT

2021 ◽  
Vol 8 (4) ◽  
pp. 244-252
Author(s):  
Jerzy Kiszka ◽  
Dawid Filip ◽  
Piotr Wasylik
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Life Support ◽  
Advanced Life Support ◽  
Development Project ◽  
Competence Development ◽  
Emergency Medical ◽  
Before And After ◽  
Post Test ◽  
The Impact

Aim: Assessment of the increase in knowledge in specific categories among students of the last-year emergency medical students after 45-hour training in advanced paediatric life support. Comparison of the impact of participation in the project and the ILS course on the increase of knowledge in the field of advanced life support in children. Material and methods: 138 third-year emergency medical students of the University of Rzeszów were studied. A proprietary questionnaire on paediatric life support was conducted before and after completing a 45-hour training on emergency medical services in children (pretest/posttest). Results: The mean percentage of subjects’ correct answers in the post-test was slightly over 60 which was statistically significantly higher compared to the pre-test, t(276)=6.54; p<0.001. The highest percentage of correct answers concerned paediatric basic life support and AED (M=77.78; SD=12.47), while the lowest – cardiac arrest in children in special situations (M=60.54; SD=21.06). No statistically significant relationship was found between the percentage of correct answers in the pre-test/post-test and the respondents’ age, gender and participation in a competence development project (p>0.05). Conclusions: The knowledge of paediatric life support among the third year emergency medical students is good. The students of subsequent years and individuals reading the literature and participating in the competence development project are better prepared to perform life support procedures in newborns and infants. From year to year, students gain less knowledge from medical literature and have the least knowledge on cardiac arrest in children in special circumstances.

Impact of the San Diego County Firestorm on Emergency Medical Services

2006 ◽  
Vol 21 (5) ◽  
pp. 353-358 ◽  
Author(s):  
Gary M. Vilke ◽  
Alan M. Smith ◽  
Barbara M. Stepanski ◽  
Leslie Upledger Ray ◽  
Patricia A. Murrin ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
San Diego ◽  
Life Support ◽  
Advanced Life Support ◽  
San Diego County ◽  
Medical Services ◽  
Eye Injuries ◽  
Emergency Medical ◽  
The Impact ◽  
Respiratory Complaints

AbstractBackground:In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.Methods:A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.Results:During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.Conclusion:Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.

Patient Selection for Advanced Prehospital Care in a Two-Level Emergency Medical System

1989 ◽  
Vol 4 (1) ◽  
pp. 36-38 ◽  
Author(s):  
David Applebaum
Keyword(s):  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
First Aid ◽  
Emergency Medical Technicians ◽  
Emergency Medical ◽  
Dispatch System ◽  
The Impact ◽  
Selection Of Patients ◽  
Selection Of

In Jerusalem, the Emergency Medical Service is the sole prehospital provider for a population of 450,000 residents. Ambulances are dispatched from a centrally located first-aid center. Separate basic and advanced life support (MICU) ambulances are provided. Basic life support units are staffed by Emergency Medical Technicians (EMTs) trained to provide first aid and cardiopulmonary resuscitation (CPR). These units are dispatched to service persons in whom advanced life support (ALS) services are not likely to be required. The MICU is staffed by paramedical personnel plus a qualified physician. In order to maximize the efficiency of the service an attempt was made to use the MICU only for patients who may benefit from ALS interventions.Selection of patients for whom the ALS unit may be required is accomplished by switchboard operators. These personnel routinely dispatch the MICU for definite emergencies such as unconsciousness or absence of breathing. All other cases have been reported first to an on-call physician who ultimately decides whether or not to dispatch the MICU. This method of determining priority for dispatch is called the Consultation-Dispatch System (CDS). This method of determining priority seemed inefficient, so an alternative system was implemented that did not require prior physician consultation. This brief report details the impact of this change on system operation and MICU activity.

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.

scholarly journals Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

2020 ◽  
Vol 17 (6) ◽  
pp. 1930
Author(s):  
Pin-Hui Fang ◽  
Yu-Yuan Lin ◽  
Chien-Hsin Lu ◽  
Ching-Chi Lee ◽  
Chih-Hao Lin
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Emergency Medical Technician ◽  
Population Database ◽  
Emergency Medical ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Medical Technician

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

Job Stressors and Job Satisfaction in a Major Metropolitan Public EMS Service

1999 ◽  
Vol 14 (4) ◽  
pp. 32-35 ◽  
Author(s):  
J. Shelby Bowron ◽  
Knox H. Todd
Keyword(s):  
Job Satisfaction ◽  
Career Choice ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Medical Technicians ◽  
Medical Services ◽  
Job Stressors ◽  
Emergency Medical

AbstractIntroduction:Behavioral and social science research suggests that job satisfaction and job performance are positively correlated. It is important that Emergency Medical Services managers identify predictors of job satisfaction in order to maximize job performance among prehospital personnel.Purpose:Identify job stressors that predict the level of job satisfaction among prehospital personnel.Methods:The study was conducted with in a large, urban Emergency Medical Services (Emergency Medical Services) service performing approximately 60,000 Advanced Life Support (Advanced Life Support) responses annually. Using focus groups and informal interviews, potential predictors of global job satisfaction were identified. These factors included: interactions with hospital nurses and physicians; on-line communications; dispatching; training provided by the ambulance service; relationship with supervisors and; standing orders as presently employed by the ambulance service. These factors were incorporated into a 21 item questionnaire including one item measuring global job satisfaction, 14 items measuring potential predictors of satisfaction, and seven questions exploring demographic information such as age, gender, race, years of experience, and years with the company. The survey was administered to all paramedics and Emergency Medical Technicians (Emergency Medical Technicians s) Results of the survey were analyzed using univariate and multivariate techniques to identify predictors of global job satisfaction.Results:Ninety paramedics and Emergency Medical Technicians participated in the study, a response rate of 57.3%. Job satisfaction was cited as extremely satisfying by 11%, very satisfying by 29%, satisfying by 45%, and not satisfying by 15% of respondents. On univariate analysis, only the quality of training, quality of physician interaction, and career choice were associated with global job satisfaction. On multivariate analysis, only career choice (p = 0.005) and quality of physician interaction (p = 0.05) were predictive of global job satisfactionConclusion:Quality of career choice and interactions with physicians are predictive of global job satisfaction within this urban emergency medical service (Emergency Medical Technicians). Future studies should examine specific characteristics of the physician-paramedic interface that influence job satisfaction and attempt to generalize these results to other settings.

Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 681-690 ◽  
Author(s):  
James S. Seidel ◽  
Deborah Parkman Henderson ◽  
Patrick Ward ◽  
Barbara Wray Wayland ◽  
Beverly Ness
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P &lt; .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

scholarly journals Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Georgios Tziatzios ◽  
Dimitrios N. Samonakis ◽  
Theocharis Tsionis ◽  
Spyridon Goulas ◽  
Dimitrios Christodoulou ◽  
...  
Keyword(s):  
Airway Management ◽  
Public Hospital ◽  
Private Hospital ◽  
Life Support ◽  
Advanced Life Support ◽  
Nationwide Survey ◽  
Web Based ◽  
The Public ◽  
Management Techniques ◽  
The Impact

Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.

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