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 Refusal to travel in the National Ambulance Service: A retrospective examination of calls from 2017.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Emergency Department ◽  
Life Support ◽  
Advanced Life Support ◽  
Light Response ◽  
Respiratory Arrest ◽  
Ambulance Service ◽  
Quality Improvement Initiative ◽  
Southern Area ◽  
Course Of Action ◽  
Rate Of Increase

<p><strong>Introduction </strong></p><p>When a member of the public calls for an ambulance through the 999/112 system, the only permitted course of action for the responding National Ambulance Service (NAS) staff is to convey the patient to an emergency department. Regardless of the clinical level, NAS staff do not have the authority or scope of practice to discharge the patient from the scene or make any other arrangements for the treatment of that person(1). The patient, meeting certain criteria, can refuse treatment or transport (RTT) of their own volition(1). Mortality rates for non-conveyed patients vary from 0.2%-3.5% within 24hours and are twice those of patients discharged from an emergency department(2, 3). In 2017, the refusal to travel rate in Ireland jumped from 7-8% of calls (2012-2014) to a national average of 11.3% (24,735) of total AS1 calls(4). Although this level of non-conveyance would still be below international norms the rate of increase was concerning(3).</p><p><strong>Aim.</strong></p><p>A quality improvement initiative necessitated identification of baseline RTT information.</p><p><strong>Methods</strong></p><p>Retrospective data collection was conducted on all calls closed with a ‘refusal to travel’ or ‘refusal of treatment’ occurring between 1st Jan 2017 and 9<sup>th</sup> Nov 2017 and was gathered from the National Emergency Operations Centre (NEOC).</p><p><strong>Results</strong></p><p>The top three dispatch classification that resulted in RTT were falls, unconsciousness or near fainting, and generally unwell patients. This was followed by chest pain, seizures, traffic incidents and breathing problems. It was noted that the time at which RTT calls occurred peaked nationally between 2000 and 2059. In the Southern area, peak RTT occurred between 2000-2059h and 0000-0100. 33.6% of RTT calls in the Southern Area were designated as Delta calls. This designation requires an advanced life support and a blue light response and is the call level with the second highest acuity below an Echo call, the designation for Cardiac or Respiratory arrest.</p><p><strong>Conclusions</strong></p><p>The NAS specifically utilises a risk adverse triage system. Examination of dispatch priorities may be warranted. The peak close of RTT calls between 2000-2059 may align with a shift changeover at 2000. Further study is required.</p>

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 Distribution of Pediatric Vital Signs in the Emergency Department: A Nationwide Study

Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 89
Author(s):  
Woori Bae ◽  
Kyunghoon Kim ◽  
Bongjin Lee
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Body Temperature ◽  
Respiratory Rate ◽  
Life Support ◽  
Vital Signs ◽  
Reference Ranges ◽  
Normal Body Temperature ◽  
Heart Rates ◽  
Normal Body

To effectively use vital signs as indicators in children, the magnitude of deviation from expected vital sign distribution should be determined. The purpose of this study is to derive age-specific centile charts for the heart rate and respiratory rate of the children who visited the emergency department. This study used the Korea’s National Emergency Department Information System dataset. Patients aged <16 years visiting the emergency department between 1 January 2016 and 31 December 2017 were included. Heart rate and respiratory rate centile charts were derived from the population with normal body temperature (36 to <38 °C). Of 1,901,816 data points retrieved from the database, 1,454,372 sets of heart rates and 1,458,791 sets of respiratory rates were used to derive centile charts. Age-specific centile charts and curves of heart rates and respiratory rates showed a decline in heart rate and respiratory rate from birth to early adolescence. There were substantial discrepancies in the reference ranges of Advanced Paediatric Life Support and Pediatric Advanced Life Support guidelines. Age-based heart rate and respiratory rate centile charts at normal body temperature, derived from children visiting emergency departments, serve as new evidence-based data and can be used in follow-up studies to improve clinical care for children.

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.

Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 45-49 ◽  
Author(s):  
Clémence Dallaire ◽  
Julien Poitras ◽  
Karine Aubin ◽  
André Lavoie ◽  
Lynne Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Communication ◽  
Vital Signs ◽  
Prehospital Setting ◽  
Interrater Agreement ◽  
Base Hospital ◽  
Emergency Department Nurses ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Κ Statistic

ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.

Emergency Care of the Child

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 572-576
Author(s):  
MARTHA BUSHORE
Keyword(s):  
Health Care Providers ◽  
Emergency Care ◽  
Life Support ◽  
Prehospital Care ◽  
Pediatric Emergency ◽  
Care Providers ◽  
Transport Services ◽  
Emergency Medical ◽  
Field Triage ◽  
Pediatric Emergency Care

Optimal emergency care of the child requires a well-developed EMS-C system. The components are easy to identify. We need macroregions with institutions acknowledging their institutional capabilities for pediatric emergency care and supporting field triage and transfer agreements. We need highly educated and skilled prehospital care providers, from emergency medical technicians in the field to air and ground transport services with specialized pediatric transport teams. In addition to having an appropriate hospital emergency department attending physician staff, hospitals must develop networks of cooperation between emergency departments appropriate for pediatrics and childern's emergency care centers. These centers strive for quality care through systematic record keeping, chart reviews, and audits identifying care deficiencies and appropriate remedies. Subsequent reviews document improved care. There are meetings of prehospital and hospital-based providers to discuss the management of challenging cases. Comprehensive pediatric emergency care involves integration of emergency stabilization patient care with community and hospital social services, patient education programs (such as Child Life), and comprehensive rehabilitation programs, as well as community accident prevention and basic life support programs. As we strive to develop optimal emergency medical services for our country to best serve our people, comprehensive emergency care of children must have separate consideration from comprehensive emergency care of adults. If we are to assure optimal outcome for the life-threatened child, we need to continuously assess regional needs and capabilities and encourage optimal involvement of health care providers and institutions.

scholarly journals A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa

2018 ◽  
Vol 33 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Annet Ngabirano Alenyo ◽  
Wayne P. Smith ◽  
Michael McCaul ◽  
Daniel J. Van Hoving
Keyword(s):  
South Africa ◽  
Emergency Care ◽  
Life Support ◽  
Major Incident ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Publication Type ◽  
Cross Sectional ◽  
Prehospital Emergency ◽  
Level Of Training

AbstractIntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.MethodsThis was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.ResultsA total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).ConclusionAccuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.

Life-threatening emergencies

2020 ◽  
pp. 43-65
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Life Support ◽  
Central Venous Access ◽  
Advanced Life Support ◽  
Venous Access ◽  
Central Venous ◽  
Sick Patient ◽  
Life Threatening

This chapter in the Oxford Handbook of Emergency Medicine examines all aspects of life-threatening emergencies encountered in the emergency department (ED). It examines anaphylaxis and its treatment, as well as choking. It discusses cardiac arrest and its management, as well as in-hospital resuscitation and adult Basic and Advanced Life Support algorithm use, post-resuscitation care, and central venous access. It explores recognition of the sick patient, sepsis, and shock.

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