scholarly journals Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology

2014 ◽  
Vol 21 (7) ◽  
pp. 818-830 ◽  
Author(s):  
Daniel W. Spaite ◽  
Bentley J. Bobrow ◽  
Uwe Stolz ◽  
Duane Sherrill ◽  
Vatsal Chikani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical ◽  
Study Methodology ◽  
The Impact

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

The impact of a mass gathering events with an on-site medical management team on municipal 911 emergency medical services

2013 ◽  
Vol 31 (1) ◽  
pp. 256-257 ◽  
Author(s):  
Michael J. Heiby ◽  
William Barnhardt ◽  
Thomas Berry ◽  
Melanie Welcher ◽  
William J. Brady
Keyword(s):  
Emergency Medical Services ◽  
Medical Management ◽  
Management Team ◽  
Medical Services ◽  
Mass Gathering ◽  
Emergency Medical ◽  
The Impact

scholarly journals Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study

2020 ◽  
pp. emermed-2019-208958 ◽  
Author(s):  
Nicola Wing Young Man ◽  
Roberto Forero ◽  
Hanh Ngo ◽  
David Mountain ◽  
Gerard FitzGerald ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
New South ◽  
New South Wales ◽  
Interrupted Time Series ◽  
Medical Services ◽  
Hospital Data ◽  
Emergency Medical ◽  
South Wales ◽  
Meta Regression Analysis ◽  
The Impact

IntroductionDelayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays.MethodsEMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series ‘Before-and-After’ trend analysis was used for assessing the Policy’s impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes.ResultsBefore the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia’s increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall.ConclusionThe Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.

scholarly journals The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia

Organizacija ◽  
2015 ◽  
Vol 48 (4) ◽  
pp. 247-258 ◽  
Author(s):  
Tatjana Kitić Jaklič ◽  
Jure Kovač
Keyword(s):  
Emergency Medical Services ◽  
Planning Process ◽  
National Level ◽  
Social Factor ◽  
Software Tool ◽  
Medical Services ◽  
Emergency Medical ◽  
Rate Of Increase ◽  
Starting Point ◽  
The Impact

Abstract Background and Purpose: The modern environment requires that organizations (profit and non-profit) continually harmonize their organizational models with changes in their respective environments and with their own visions and strategies for further development. The organizational structure of Emergency Medical Services (hereinafter EMS) is currently a very topical issue in Slovenia, given that a project to establish a new organization of EMS is currently underway at the national level. By examining the case of one region in Slovenia, this article presents an analysis of factors that impact on the number and types of EMS activities and depicts a forecast of future trends for the requirement of EMS. The analysis presents the initial phase of a strategic planning process for the mentioned activity and consequently, a starting point for the formation of an organizational EMS model. Methodology: This article presents an analysis of factors that impact on the formulation of an EMS model on the basis of research carried out for one geographical region of Slovenia. For the previous period, data was collected from 2002 to 2014. The software tool used for the analysis was STATA 13.0. For the purpose of forecasting a five-year period trend we used statistical package RStudio and Hyndman’s Forecast package given that this package contains algorithms for forecasting univariate time series including exponential smoothing using automated spatial models and ARIMA modelling. Results: The research has confirmed a correlation between social/environmental factors and the rate of increase in the demand for EMS. A population’s age structure has been identified as the key social factor that increases the need for EMS. On the basis of this finding, this article presents a model for forecasting growth trends in the scope of EMS activities. Conclusion: The research study has identified some important elements that are imperative to take into consideration when formulating an EMS network at the prehospital level. Population ageing has emerged as a key social factor. In the accordance with forecasted trends, an increase in the burden placed on EMS activities may also be anticipated in the future.

Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

2016 ◽  
Vol 31 (6) ◽  
pp. 608-613 ◽  
Author(s):  
Bruno Schnegg ◽  
Mathieu Pasquier ◽  
Pierre-Nicolas Carron ◽  
Bertrand Yersin ◽  
Fabrice Dami
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Time Of Day ◽  
Medical Services ◽  
Time Interval ◽  
Patient Age ◽  
Emergency Medical ◽  
Patient Âgé ◽  
Prehospital Emergency ◽  
The Impact

AbstractIntroductionThe concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).SchneggB, PasquierM, CarronPN, YersinB, DamiF. Prehospital Emergency Medical Services departure interval: does patient age matter?Prehosp Disaster Med. 2016;31(6):608–613.

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