Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan

2018 ◽  
Vol 33 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Rekar K. Taymour ◽  
Mahshid Abir ◽  
Margaret Chamberlin ◽  
Robert B. Dunne ◽  
Mark Lowell ◽  
...  
Keyword(s):  
New York ◽  
Emergency Medical Services ◽  
Research Agenda ◽  
Grey Literature ◽  
Quality Measurement ◽  
Medical Services ◽  
Washington Dc ◽  
Environmental Scan ◽  
Policy Practice ◽  
Emergency Medical

AbstractIntroductionIn a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care.ObjectiveThis systematic literature review and environmental scan addresses NAM’s recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight?MethodsTo answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved.ResultsA total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight.Conclusions:Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement.TaymourRK, AbirM, ChamberlinM, DunneRB, LowellM, WahlK, ScottJ. Policy, practice, and research agenda for Emergency Medical Services oversight: a systematic review and environmental scan. Prehosp Disaster Med. 2018;33(1):89–97.

scholarly journals Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030626 ◽  
Author(s):  
Helge Haugland ◽  
Anna Olkinuora ◽  
Leif Rognås ◽  
David Ohlen ◽  
Andreas Krüger
Keyword(s):  
Adverse Events ◽  
Emergency Medical Services ◽  
Quality Indicators ◽  
Emergency Services ◽  
Quality Measurement ◽  
Medical Services ◽  
Total Quality ◽  
Emergency Medical ◽  
Sentinel Events ◽  
Quality Measurements

ObjectivesA consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these QIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS.DesignIn this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four QI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset.SettingNordic physician-staffed helicopter emergency medical services.Participants16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway.ResultsThe dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All QIs were feasible to obtain. The variability of 14 out of 15 QIs was adequate. Rankability was adequate for all QIs. Actionability was assessed as being adequate for 10 QIs. Documentation was adequate for 14 QIs. Benchmarks for all QIs were proposed.ConclusionsAll 15 QIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI ‘Adverse Events’ with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs ‘Able to respond immediately when alarmed’, ‘Time to arrival of P-EMS’, ‘Time to preferred destination’, ‘Provision of advanced treatment’ and ‘Significant logistical contribution’ was assessed as being poor. Benchmarks for the QIs and a total quality score are proposed for future quality measurements.

scholarly journals Hangings attended by emergency medical services: a scoping review

2021 ◽  
Vol 5 (4) ◽  
pp. 40-48
Author(s):  
Gary Shaw ◽  
Lee Thompson ◽  
Graham McClelland
Keyword(s):  
Emergency Medical Services ◽  
Scoping Review ◽  
Grey Literature ◽  
Psychological Impact ◽  
Patient Characteristics ◽  
Medical Services ◽  
North East ◽  
Emergency Medical ◽  
Advanced Airway ◽  
The Uk

<sec id="s1"> Background: In the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice. </sec> <sec id="s2"> Methods: A five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England. Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised. </sec> <sec id="s3"> Results: Sixteen papers were included in the review. Australia was the most frequent source of studies (n = 5, 31%). Most studies (n = 11, 69%) were published in the past 10 years. The median sample size was 53 (IQR 41‐988, range 10‐3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes. </sec> <sec id="s4"> Conclusion: Hanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focused on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings. </sec>

scholarly journals Prehospital Indicators for Disaster Preparedness and Response: New York City Emergency Medical Services in Hurricane Sandy

2016 ◽  
Vol 10 (3) ◽  
pp. 333-343 ◽  
Author(s):  
Silas W. Smith ◽  
James Braun ◽  
Ian Portelli ◽  
Sidrah Malik ◽  
Glenn Asaeda ◽  
...  
Keyword(s):  
New York ◽  
Emergency Medical Services ◽  
Safety Net ◽  
Hurricane Sandy ◽  
Urgent Care ◽  
Medical Services ◽  
Computer Assisted ◽  
Emergency Medical ◽  
Regional Health Care ◽  
Ambulance Transports

AbstractObjectiveWe aimed to evaluate emergency medical services (EMS) data as disaster metrics and to assess stress in surrounding hospitals and a municipal network after the closure of Bellevue Hospital during Hurricane Sandy in 2012.MethodsWe retrospectively reviewed EMS activity and call types within New York City’s 911 computer-assisted dispatch database from January 1, 2011, to December 31, 2013. We evaluated EMS ambulance transports to individual hospitals during Bellevue’s closure and incremental recovery from urgent care capacity, to freestanding emergency department (ED) capability, freestanding ED with 911-receiving designation, and return of inpatient services.ResultsA total of 2,877,087 patient transports were available for analysis; a total of 707,593 involved Manhattan hospitals. The 911 ambulance transports disproportionately increased at the 3 closest hospitals by 63.6%, 60.7%, and 37.2%. When Bellevue closed, transports to specific hospitals increased by 45% or more for the following call types: blunt traumatic injury, drugs and alcohol, cardiac conditions, difficulty breathing, “pedestrian struck,” unconsciousness, altered mental status, and emotionally disturbed persons.ConclusionsEMS data identified hospitals with disproportionately increased patient loads after Hurricane Sandy. Loss of Bellevue, a public, safety net medical center, produced statistically significant increases in specific types of medical and trauma transports at surrounding hospitals. Focused redeployment of human, economic, and social capital across hospital systems may be required to expedite regional health care systems recovery. (Disaster Med Public Health Preparedness. 2016;10:333–343)

scholarly journals System impacts of the COVID‐19 pandemic on New York City's emergency medical services

2020 ◽  
Vol 1 (6) ◽  
pp. 1205-1213
Author(s):  
David J. Prezant ◽  
Elizabeth A. Lancet ◽  
Rachel Zeig‐Owens ◽  
Pamela H. Lai ◽  
David Appel ◽  
...  
Keyword(s):  
New York ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical
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