Abstract W P186: Usefulness of the New Prehospital Cerebrovascular Disease Triage Score for Patients With Impaired Consciousness by Emergency Medical Services

Background and Purpose: Early stroke recognition optimizes patients’ opportunities to benefit from therapeutic options; however, accurate stroke recognition by emergency medical services (EMS) is difficult in patients with impaired consciousness. Here we attempted to establish a new prehospital stroke triage score for such patients. Methods: In 2010, 713 patients (average age, 71 years; 421 men) presenting with impaired consciousness (score of <15 on the Glasgow coma scale) on EMS arrival, who were brought to our hospital, were included. We compared the relation between the symptoms and the vital signs on EMS arrival and the final diagnosis. Results: A final hospital diagnosis of stroke was made for 353 in 713 patients (49.5%). Systolic and diastolic blood pressure (SBP, DBP) on EMS arrival were significantly higher in the stroke group than in the non-stroke group (SBP: 172 mmHg vs 143 mmHg, p < 0.01, DBP: 93 mmHg vs 78 mmHg, p < 0.01). In contrast, the pulse rate (PR) was lower in the stroke group (84 bpm vs 88 bpm, p < 0.05). Receiver operating characteristic analysis showed that the optimum SBP, DBP, and PR cutoffs for stroke were 150 mmHg (sensitivity 76%, specificity 59%), 90 mmHg (63%, 70%), and 90 bpm (70%, 42%), respectively. Using univariate analysis, SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm and an arrhythmia case in addition to new-onset hemiparesis were significantly associated with stroke, whereas a case with cold sweat was not significantly associated. Using multivariable analysis, new onset hemiparesis (Odds ratio 11.0; 95% CI, 5.76-22.7), SBP of >150 mmHg (2.21, 1.26-3.87), DBP of >90 mmHg (2.88, 1.65-5.09), and PR of <90 bpm (2.25, 0.80-3.80) were significantly associated with stroke. The prehospital stroke triage score was calculated for each patient with 1 point assigned to patients with SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm, and 2 points for new onset hemiparesis. The triage score of >2points revealed stroke with relatively high sensitivity and specificity (sensitivity 63%, specificity 87%, AUC = 0.809). Conclusion: The new prehospital stroke triage score was calculated on the basis of vital signs in addition to new onset hemiparesis. This score is very useful for triage of stroke presenting with impaired consciousness.

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Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

BMC Emergency Medicine ◽

10.1186/s12873-020-00353-8 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Erik Höglund ◽

Magnus Andersson-Hagiwara ◽

Agneta Schröder ◽

Margareta Möller ◽

Emma Ohlsson-Nevo

Keyword(s):

Emergency Medical Services ◽

Vital Signs ◽

Signs And Symptoms ◽

Emergency Department Patient ◽

Medical Services ◽

Men And Women ◽

Safety Issues ◽

Levels Of Care ◽

Emergency Medical ◽

Number Of Patients

Abstract Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

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A drug-related Good Samaritan Law and calling emergency medical services for drug overdoses in a Canadian setting

Harm Reduction Journal ◽

10.1186/s12954-021-00537-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Soroush Moallef ◽

JinCheol Choi ◽

M.-J. Milloy ◽

Kora DeBeck ◽

Thomas Kerr ◽

...

Keyword(s):

Emergency Medical Services ◽

Multivariable Analysis ◽

Medical Services ◽

People Who Use Drugs ◽

Factors Associated ◽

Good Samaritan ◽

Emergency Medical ◽

Significant Difference ◽

Drug Overdoses ◽

The Impact

Abstract Background People who use drugs (PWUD) are known to fear calling emergency medical services (EMS) for drug overdoses. In response, drug-related Good Samaritan Laws (GSLs) have been widely adopted in the USA and Canada to encourage bystanders to call emergency medical services (EMS) in the event of a drug overdose. However, the effect of GSLs on EMS-calling behaviours has been understudied. We sought to identify factors associated with EMS-calling, including the enactment of the Canadian GSL in May 2017, among PWUD in Vancouver, Canada, a setting with an ongoing overdose crisis. Methods Data were derived from three prospective cohort studies of PWUD in Vancouver in 2014–2018. Multivariable logistic regression was used to determine factors associated with EMS-calling among PWUD who witnessed an overdose event. An interrupted time series (ITS) analysis was employed to assess the impact of GSL on monthly prevalence of EMS-calling. Results Among 540 eligible participants, 321 (59%) were males and 284 (53%) reported calling EMS. In multivariable analysis, ever having administered naloxone three or more times (adjusted odds ratio [AOR] 2.00; 95% confidence interval [CI] 1.08–3.74) and residence in the Downtown Eastside (DTES) neighbourhood of Vancouver (AOR 1.96; 95% CI 1.23–3.13) were positively associated with EMS-calling, while living in a single occupancy hotel (SRO) was negatively associated with EMS-calling (AOR 0.51; 95% CI 0.30–0.86). The post-GSL enactment period was not associated with EMS-calling (AOR 0.81; 95% CI 0.52–1.25). The ITS found no significant difference in the monthly prevalence of EMS-calling between pre- and post-GSL enactment periods. Conclusion We observed EMS being called about half the time and the GSL did not appear to encourage EMS-calling. We also found that individuals living in SROs were less likely to call EMS, which raises concern given that fatal overdose cases are concentrated in SROs in our setting. The link between many naloxone administrations and EMS-calling could indicate that those with prior experience in responding to overdose events were more willing to call EMS. Increased efforts are warranted to ensure effective emergency responses for drug overdoses among PWUD.

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Elderly and Nonelderly Use of a Dedicated Ambulance Corps’ Emergency Medical Services in Taiwan

BioMed Research International ◽

10.1155/2016/1506436 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Chien-Chia Huang ◽

Wei-Lung Chen ◽

Chien-Chin Hsu ◽

Hung-Jung Lin ◽

Shih-Bin Su ◽

...

Keyword(s):

Emergency Medical Services ◽

Vital Signs ◽

The Elderly ◽

Medical Services ◽

Transport Time ◽

Emergency Medical ◽

Respiratory Management ◽

Total Transport ◽

Stage Renal Disease ◽

End Stage

Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

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Public awareness of the need to call emergency medical services following the onset of acute myocardial infarction and associated factors in Japan

Journal of International Medical Research ◽

10.1177/0300060518757639 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1747-1755 ◽

Cited By ~ 3

Author(s):

Naohiro Yonemoto ◽

Akiko Kada ◽

Hiroyuki Yokoyama ◽

Hiroshi Nonogi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Medical Services ◽

Associated Factors ◽

Public Awareness ◽

Multivariable Analysis ◽

Significant Risk ◽

Medical Services ◽

Emergency Medical ◽

Off Time

Objectives Early recognition of acute myocardial infarction (AMI) and early activation of emergency medical services (EMS) are essential to reduce delays in patient care. We investigated public awareness of the need to call EMS at onset of AMI and evaluated associated factors. Methods In January 2008, a nationwide population-based survey using quota sampling was conducted in Japan. The primary outcome measure was responsiveness to promptly calling EMS at AMI onset, subdivided by on-time (daytime) and off-time (nights and holidays) hours. Results In total, 1200 participants were surveyed. Their mean age was 46.3 years (standard deviation, 17.4), and 50.3% (n=604) were women. A total of 11.6% (n=139) answered that they would call EMS during on-time hours, and 27.5% (n=330) stated that they would call during off-time hours. Multivariable analysis showed that the participants’ age, female sex, education level, and self-confidence regarding their understanding of AMI were significant associated factors. The associated factors were almost identical during the off-time hours; only sex was no longer significant. Conclusions Public awareness of the need to call EMS at AMI onset in Japan was low. Previous intervention studies that were not effective may not have targeted groups with significant risk factors.

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Keywords reflecting sepsis presentation based on mode of emergency department arrival: a retrospective cross-sectional study

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00396-z ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ulrika Margareta Wallgren ◽

Eric Larsson ◽

Anna Su ◽

Jennifer Short ◽

Hans Järnbert-Pettersson ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medical Services ◽

Vital Signs ◽

Cross Sectional Study ◽

Screening Tools ◽

Medical Services ◽

Cross Sectional ◽

Emergency Department Arrival ◽

Emergency Medical ◽

Sepsis Screening

Abstract Background Current sepsis screening tools are predominantly based on vital signs. However, patients with serious infections frequently present with normal vital signs and there has been an increased interest to include other variables such as symptoms in screening tools to detect sepsis. The majority of patients with sepsis arrive to the emergency department by emergency medical services. Our hypothesis was that the presentation of sepsis, including symptoms, may differ between patients arriving to the emergency department by emergency medical services and patients arriving by other means. This information is of interest to adapt future sepsis screening tools to the population in which they will be implemented. The aim of the current study was to compare the prevalence of keywords reflecting the clinical presentation of sepsis based on mode of arrival among septic patients presenting to the emergency department. Methods Retrospective cross-sectional study of 479 adult septic patients. Keywords reflecting sepsis presentation upon emergency department arrival were quantified and analyzed based on mode of arrival, i.e., by emergency medical services or by other means. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons. Adjustments for age, gender, and sepsis severity were performed by stratification. All patients were admitted to the emergency department of Södersjukhuset, Stockholm, and discharged with an ICD-10 code compatible with sepsis between January 1, and December 31, 2013. Results “Abnormal breathing” (51.8% vs 20.5%, p value < 0.001), “abnormal circulation” (38.4% vs 21.3%, p value < 0.001), “acute altered mental status” (31.1% vs 13.1%, p value < 0.001), and “decreased mobility” (26.1% vs 10.7%, p value < 0.001) were more common among patients arriving by emergency medical services, while “pain” (71.3% vs 40.1%, p value < 0.001) and “risk factors for sepsis” (50.8% vs 30.8%, p value < 0.001) were more common among patients arriving by other means. Conclusions The distribution of most keywords related to sepsis presentation was similar irrespective of mode of arrival; however, some differences were present. This information may be useful in clinical decision tools or sepsis screening tools.

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