Patient Outcome Using Medical Protocol to Limit “Lights and Siren” Transport

1994 ◽  
Vol 9 (4) ◽  
pp. 226-229 ◽  
Author(s):  
Douglas F. Kupas ◽  
David J. Dula ◽  
Bruno J. Pino
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Emergency Medical Services ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Vehicle Collisions ◽  
Patient Transport ◽  
Emergency Medical ◽  
Warning Lights

AbstractIntroduction:Emergency medical services vehicle collisions (EMVCs) associated with the use of warning “lights and siren” (L&S) are responsible for injuries and death to emergency medical services (EMS) personnel and patients. This study examines patient outcome when medical protocol directs L&S transport.Design:During four months, all EMS calls initiated as an emergency request for service and culminating in transport to an emergency department (ED) were included. Medical criteria determined emergent (L&S) versus non-emergent transport. Patients with worsened conditions, as reported by EMS providers, were reviewed.Setting:Countywide suburban/rural EMS system.Results:Ninety-two percent (1,495 of 1,625) of patients were transported non-emergently. Thirteen (1%) of these were reported to have worsened during transport, and none of them suffered any worsened outcome related to the non-L&S transport.Conclusion:This medical protocol directing the use of warning L&S during patient transport results in infrequent L&S transport. In this study, no adverse outcomes were found related to non-L&S transports.

scholarly journals Prehospital time and mortality in polytrauma patients: a retrospective analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Berkeveld ◽  
Z. Popal ◽  
P. Schober ◽  
W. P. Zuidema ◽  
F. W. Bloemers ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Total Mortality ◽  
Medical Services ◽  
Severely Injured ◽  
Emergency Medical ◽  
Polytrauma Patients ◽  
Level I ◽  
Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

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

1997 ◽  
Vol 12 (2) ◽  
pp. 74-77 ◽  
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.

scholarly journals The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

CJEM ◽  
2015 ◽  
Vol 18 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Judah Goldstein ◽  
Jennifer McVey ◽  
Stacy Ackroyd-Stolarz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Emergency Medical Services ◽  
Acute Care ◽  
Functional Independence ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Care Needs ◽  
Frail Older Adults ◽  
Emergency Medical

AbstractCaring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

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

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.

Emergency Medical Services Liability Litigation in the United States: 1987 to 1992

1994 ◽  
Vol 9 (4) ◽  
pp. 214-220 ◽  
Author(s):  
David L. Morgan ◽  
Michael P. Wainscott ◽  
Heidi C. Knowles
Keyword(s):  
Emergency Medical Services ◽  
The United States ◽  
Medical Services ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Trial Court ◽  
Legal Cases ◽  
Patient Transport ◽  
Emergency Medical ◽  
The Common

AbstractIntroduction:Although emergency medical services (EMS) liability litigation is a concern of many prehospital health care providers, there have been no studies of these legal cases nationwide and no local case studies since 1987.Methods:A retrospective case series was obtained from a computerized database of trial court cases filed against EMS agencies nation-wide. All legal cases that met the inclusion criteria were included in the study sample. These cases must have involved either ambulance collisions (AC) or patient care (PC) incidents, and they must have been closed between 1987 and 1992.Results:There were 76 cases that met the inclusion criteria. Half of these cases involved an AC, and the other cases alleged negligence of a PC encounter. Thirty (78.9%) of the plaintiffs in the AC cases were other motorists, and 35 (92.1%) of the plaintiffs in the PC cases were EMS patients. Almost half of the cases named an individual (usually an emergency medical technician or paramedic) as a codefendant. Thirty-one (40.8%) of the cases were closed without any payment to the plaintiff. There were five cases with plaintiffs' awards or settlements greater than [US] $1 million. Most (71.0%) ofthe ACs occurred in an intersection or when one vehicle rear-ended another vehicle. The most common negligence allegations in the PC cases were arrival delay, inadequate assessment, inadequate treatment, patient transport delay, and no patient transport.Conclusion:Risk management for EMS requires specific knowledge of the common sources of EMS liability litigation. This sample of recent legal cases provides the common allegations of negligence. Recommendations to decrease the legal risk of EMS agencies and prehospital providers are suggested.

scholarly journals Are emergency medical services offload delay patients at increased risk of adverse outcomes?

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 505-512 ◽  
Author(s):  
Dana Stewart ◽  
Eddy Lang ◽  
Dongmei Wang ◽  
Grant Innes
Keyword(s):  
Emergency Medical Services ◽  
Care Delivery ◽  
Hospital Length ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Medical Services ◽  
Emergency Medical ◽  
Increased Risk ◽  
High Acuity ◽  
Offload Delay

ABSTRACTObjectiveEmergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied.MethodsWe used administrative data to study all high-acuity Canadian Triage Acuity Scale 2–3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered “delayed.” Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality.ResultsOf 162,002 high-acuity arrivals, 70,711 had offload delays <15 minutes and 41,032 had delays > 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates.ConclusionIn this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

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