Variation in the Use of 12‐Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

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Characteristics of Prehospital Electrocardiogram Use in North Carolina Using a Novel Linkage of Emergency Medical Services and Emergency Department Data

Prehospital Emergency Care ◽

10.1080/10903127.2019.1597230 ◽

2019 ◽

Vol 23 (6) ◽

pp. 772-779 ◽

Cited By ~ 1

Author(s):

Jessica K. Zègre-Hemsey ◽

Josephine Asafu-Adjei ◽

Antonio Fernandez ◽

Jane Brice

Keyword(s):

Emergency Department ◽

North Carolina ◽

Emergency Medical Services ◽

Medical Services ◽

Emergency Department Data ◽

Emergency Medical

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Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00027552 ◽

1999 ◽

Vol 14 (3) ◽

pp. 67-72 ◽

Cited By ~ 17

Author(s):

John R. Richards ◽

Stephen J. Ferrall

Keyword(s):

Chest Pain ◽

Emergency Medical Services ◽

Patient Characteristics ◽

University Hospital ◽

Medical Services ◽

Shortness Of Breath ◽

Study Objective ◽

Patient Disposition ◽

Emergency Medical ◽

Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

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EMS Knowledge and Skills in Rural North Carolina: A Comparison with the National EMS Education and Practice Blueprint

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00043089 ◽

1996 ◽

Vol 11 (4) ◽

pp. 254-260 ◽

Cited By ~ 1

Author(s):

Lawrence H. Brown ◽

Terry W. Copeland ◽

John E. Gough ◽

Herbert G. Garrison ◽

Kathleen A. Dunn

Keyword(s):

North Carolina ◽

Emergency Medical Services ◽

Medical Services ◽

Similar Action ◽

Knowledge And Skills ◽

Emergency Medical ◽

State And Local ◽

Ems Education ◽

National Emergency ◽

Eastern North Carolina

AbstractIntroduction:Many state and local emergency medical services (EMS) systems may wish to modify provider levels and their scope of practice to align their systems with the recommendations of the National Emergency Medical Services Education and Practice Blueprint. To determine any changes that may be needed in a typical EMS system, the knowledge and skills of EMS providers in one rural area of North Carolina were compared with the knowledge and skills recommended in the National Emergency Medical Services Education and Practice Blueprint.Methods:A survey listing 175 items of patient care-oriented knowledge and skills described in the National Emergency Medical Services Education and Practice Blueprint was developed. EMS providers from five rural eastern North Carolina counties were asked to identify on the survey those items of knowledge and skills they believed they possessed. The skills and knowledge selected by the respondents at the five different North Carolina levels of certification were compared with the knowledge and skills listed for comparable provider levels delineated by the National Emergency Medical Services Education and Practice Blueprint. The proportions of the recommended skills reported to be possessed by the respondents were compared to determine which North Carolina certification levels best correlate with the Blueprint.Results:One hundred forty-five EMS providers completed the survey. The proportion of recommended skills and knowledge reported to be possessed by Emergency Medical Technicians (EMTs) ranked significantly lower than did the skills and knowledge reported to be possessed by respondents at other levels in five of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Defibrillator-level personnel ranked lower than did those reported to be possessed by respondents at other levels in seven of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Intermediates ranked lower than did those reported to be possessed by respondents at other levels in nine of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Advanced Intermediates ranked lower than were the skills and knowledge reported to be possessed by respondents at other levels in two of the 10 Blueprint elements. Finally, the proportion of recommended skills and knowledge reported to be possessed by EMT-Paramedics ranked lower than were those reported to be possessed by respondents at other levels in one of the 10 Blueprint elements.Conclusion:In North Carolina, combining the EMT and EMT-Defibrillator levels and eliminating the EMT-Intermediate level would create three levels of certification, which would be more consistent with levels recommended by the Blueprint. The results of this study should be considered in any effort to revise the levels of EMS certification in North Carolina and in planning the training curricula for bridging those levels. Other states may require similar action to align with the National Emergency Medical Services Education and Practice Blueprint.

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

Public Health Reports ◽

10.1177/00333549211012400 ◽

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.

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Characterizing Opioid Overdoses Using Emergency Medical Services Data

Public Health Reports ◽

10.1177/00333549211026802 ◽

2021 ◽

Vol 136 (1_suppl) ◽

pp. 62S-71S

Author(s):

Josie J. Sivaraman ◽

Scott K. Proescholdbell ◽

David Ezzell ◽

Meghan E. Shanahan

Keyword(s):

Machine Learning ◽

North Carolina ◽

Emergency Medical Services ◽

Expert Knowledge ◽

Case Definition ◽

Medical Services ◽

Opioid Overdose ◽

Machine Learning Classification ◽

Emergency Medical ◽

Definition Of

Objectives Tracking nonfatal overdoses in the escalating opioid overdose epidemic is important but challenging. The objective of this study was to create an innovative case definition of opioid overdose in North Carolina emergency medical services (EMS) data, with flexible methodology for application to other states’ data. Methods This study used de-identified North Carolina EMS encounter data from 2010-2015 for patients aged >12 years to develop a case definition of opioid overdose using an expert knowledge, rule-based algorithm reflecting whether key variables identified drug use/poisoning or overdose or whether the patient received naloxone. We text mined EMS narratives and applied a machine-learning classification tree model to the text to predict cases of opioid overdose. We trained models on the basis of whether the chief concern identified opioid overdose. Results Using a random sample from the data, we found the positive predictive value of this case definition to be 90.0%, as compared with 82.7% using a previously published case definition. Using our case definition, the number of unresponsive opioid overdoses increased from 3412 in 2010 to 7194 in 2015. The corresponding monthly rate increased by a factor of 1.7 from January 2010 (3.0 per 1000 encounters; n = 261 encounters) to December 2015 (5.1 per 1000 encounters; n = 622 encounters). Among EMS responses for unresponsive opioid overdose, the prevalence of naloxone use was 83%. Conclusions This study demonstrates the potential for using machine learning in combination with a more traditional substantive knowledge algorithm-based approach to create a case definition for opioid overdose in EMS data.

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