scholarly journals Frequency and severity of prehospital obstetric events encountered by emergency medical services in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca E. Cash ◽  
Robert A. Swor ◽  
Margaret Samuels-Kalow ◽  
David Eisenbrey ◽  
Anjali J. Kaimal ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Prehospital Care ◽  
The United States ◽  
Medical Services ◽  
Patient Acuity ◽  
Cohen’S Kappa ◽  
Specific Patient ◽  
Cohen's Kappa ◽  
Emergency Medical ◽  
High Acuity

Abstract Background Prehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality. The frequency of prehospital obstetric events is unclear because existing descriptions have reported obstetric and gynecological conditions together, without delineating specific patient presentations. Our objective was to identify the types, frequency, and acuity of prehospital obstetric events treated by EMS personnel in the US. Methods We conducted a cross-sectional analysis of EMS patient care records in the 2018 National EMS Information System dataset (n=22,532,890). We focused on EMS activations (i.e., calls for service) for an emergency scene response for patients aged 12-50 years with evidence of an obstetric event. Type of obstetric event was determined by examining patient symptoms, the treating EMS provider’s impression (i.e., field diagnosis), and procedures performed. High patient acuity was ascertained by EMS documentation of patient status and application of the modified early obstetric warning system (MEOWS) criteria, with concordance assessed using Cohen’s kappa. Descriptive statistics were calculated to describe the primary symptoms, impressions, and frequency of each type of obstetric event among these activations. Results A total of 107,771 (0.6%) of EMS emergency activations were identified as involving an obstetric event. The most common presentation was early or threatened labor (15%). Abdominal complaints, including pain and other digestive/abdomen signs and symptoms, was the most common primary symptom (29%) and primary impression (18%). We identified 3,489 (3%) out-of-hospital deliveries, of which 1,504 were preterm. Overall, EMS providers documented 34% of patients as being high acuity, similar to the MEOWS criteria (35%); however, there were high rates of missing data for EMS documented acuity (19%), poor concordance between the two measures (Cohen’s kappa=0.12), and acuity differences for specific conditions (e.g., high acuity of non-cephalic presentations, 77% in EMS documentation versus 53% identified by MEOWS). Conclusion Prehospital obstetric events were infrequently encountered by EMS personnel, and about one-third were high acuity. Additional work to understand the epidemiology and clinical care of these patients by EMS would help to optimize prehospital care and outcomes.

Introduction to Emergency Medical Services (EMS) Organization

1985 ◽  
Vol 1 (S1) ◽  
pp. 109-110
Author(s):  
Ronald D. Stewart
Keyword(s):  
United States ◽  
Emergency Medical Services ◽  
New World ◽  
Prehospital Care ◽  
The United States ◽  
Medical Services ◽  
Concerted Effort ◽  
Good Samaritan ◽  
The Past ◽  
Emergency Medical

Experience and history have taught us that much can be done for the sick and injured before such patients reach the hospital. From the legacy of the Good Samaritan to the modern day organization of emergency medical services, the immediate care of those stricken has undergone significant change in both philosophy and practice. While many prehospital care organizations with roots established deeply in the past still flourish, modern emergency care, in the new world at least, has developed rapidly only over the past ten years.In the United States, a concerted effort to improve the care of the wounded during the Civil War led to the introduction of the “flying ambulances” used earlier by Napoleon's Chief Surgeon, Larrey. Americans made significant contributions to acute care with the work of such noted men as Crile, with his form of external pneumatic counterpressure; Kouwenhoven, Knickerbocker and Jude at lohns Hopkins; Beck and the first reported defibrillation in a patient; Safar and his co-workers with the rediscovery of mouth-to-mouth; and many others.

Police Involvement in Pediatric Prehospital Care

PEDIATRICS ◽  
1991 ◽  
Vol 87 (5) ◽  
pp. 636-641
Author(s):  
Lisa M. Sinclair ◽  
M. Douglas Baker
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Prehospital Care ◽  
The United States ◽  
First Aid ◽  
Medical Services ◽  
Police Chiefs ◽  
Emergency Medical ◽  
Police Personnel ◽  
Care System

One hundred fourteen emergency medical services agencies and 76 police chiefs throughout the United States were prospectively surveyed to ascertain the current utilization of police personnel within the prehospital care system. More than three fourths (77%) of the surveys mailed were completed. Respondents indicated the following: (1) a majority (92%) of police personnel were trained in cardiopulmonary resuscitation and basic first aid, (2) only half (57%) of police were trained in moving or transporting patients, and (3) few (36%) police were provided ongoing training in emergency pediatric medical skills. In spite of this, police were reportedly present at calls activating emergency medical services systems between 24% and 69% of the time, and the majority of these were trauma related. Police chiefs surveyed indicated that their officers played a large role in medical management prior to arrival of emergency medical services personnel; 87% would initiate cardiopulmonary resuscitation and 93% would begin basic first aid. Sixty-one percent of police chiefs indicated that officers would occasionally "scoop and run" with a critically ill child rather than await emergency medical services arrival. The data indicate that, right or wrong, police personnel are actively involved in their prehospital care system at present. In many instances, their help may be needed. Further thought should be given toward defining an exact emergency medical services role for police personnel and toward providing adequate initial and ongoing basic medical training for these individuals.

Joint Position Statement on Emergency Medical Services and Emergency Medical Services Systems

1993 ◽  
Vol 8 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Keyword(s):  
Primary Prevention ◽  
Emergency Medical Services ◽  
Traffic Safety ◽  
Prehospital Care ◽  
National Research Council ◽  
The United States ◽  
Medical Services ◽  
Highway Traffic ◽  
National Highway Traffic Safety ◽  
Emergency Medical

In 1966, a National Academy of Science's National Research Council white paper described inadequacies in the emergency health care available in the United States. Entitled “Accidental Death and Disability: The Neglected Disease of Modern Society,” this paper cited a diversity or lack of standards for many aspects of emergency medical services (EMS) and a general absence of a systemized approach.Federal response in the early 1970s, through the National Highway Traffic Safety Administration and the EMS System Act of 1973, addressed the fragmented delivery of EMS, and set standards for planning and developing such services within the context of an EMS system. The System Act addressed the primary prevention of injury and acute, critical illness as well as methods for comprehensive intervention, from system access and prehospital care through stabilization and rehabilitation, in those cases where primary prevention fails.

Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met? II. Training and Equipping Emergency Medical Services Providers for Pediatric Emergencies

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 808-812 ◽  
Author(s):  
James S. Seidel
Keyword(s):  
Emergency Medical Services ◽  
Prehospital Care ◽  
The United States ◽  
Pediatric Emergency ◽  
Emergency Medical Technicians ◽  
Medical Services ◽  
Didactic Training ◽  
Pediatric Emergencies ◽  
Emergency Medical ◽  
Intravenous Catheters

Emergency medical services have been organized to meet the needs of adult patients. A study was undertaken to determine the training in pediatrics offered to paramedics and emergency medical technicians throughout the United States and the equipment carried by prehospital care provider agencies. Most training (50%) takes place at colleges and universities and the remainder at hospitals and emergency medical services agencies. Many programs (40%) have less than ten hours of didactic training in pediatrics and 41% offer ten hours or less of clinical experience. Some programs offer no training in pediatric emergency medicine. The most common deficiencies in pediatric equipment included back-boards, pediatric drugs, resuscitation masks, and small intravenous catheters. More attention to training and equipping prehospital personnel for pediatric emergencies may help to improve outcomes of out-of-hospital resuscitations of infants and children.

scholarly journals Emergency Medical Service Use Among Latinos Aged 50 and Older in California Counties, Except Los Angeles, During the Early COVID-19 Pandemic Period

2021 ◽  
Vol 9 ◽  
Author(s):  
Esmeralda Melgoza ◽  
Hiram Beltrán-Sánchez ◽  
Arturo Vargas Bustamante
Keyword(s):  
Health Disparities ◽  
Los Angeles ◽  
Respiratory Distress ◽  
Emergency Medical Services ◽  
Service Use ◽  
Prehospital Care ◽  
The United States ◽  
Medical Services ◽  
Lower Odds ◽  
Emergency Medical

The COVID-19 pandemic has disproportionately affected Latino adults aged 50 and older in California. Among adults aged 50–64, Latinos constitute approximately one-third (32%) of the population, but over half (52%) of COVID-19 cases, and more than two-thirds (64%) of COVID-related deaths as of June 2, 2021. These health disparities are also prevalent among Latinos 65 years and older who constitute 22% of the population, but 40% of confirmed COVID-19 cases and 50% of COVID-related deaths. Emergency medical services (EMS) are an essential component of the United States healthcare system and a vital sector in COVID-19 response efforts. Using data from the California Emergency Medical Services Information System (CEMSIS), this study examines racial and ethnic differences in respiratory distress related EMS calls among adults aged 50 and older in all counties except Los Angeles. This study compares the early pandemic period, January to June 2020, to the same time period in 2019. Between January and June 2019, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks, Asians, and Whites. During the early pandemic period, January to June 2020, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks but slightly higher odds compared to Whites. Differences by race/ethnicity and region were statistically significant. Understanding EMS health disparities is crucial to inform policies that create a more equitable prehospital care system for the heterogeneous population of middle aged and older adults.

Abstract WP276: Simplification of a Prehospital Short NIHSS Scale Does not Increase Interrater Agreement Between Emergency Medical Services and Stroke Specialists

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jelle Demeestere ◽  
Carlos Garcia-Esperon ◽  
Longting Lin ◽  
Allan Loudfoot ◽  
Andrew Bivard ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Weighted Kappa ◽  
Interrater Agreement ◽  
Medical Services ◽  
Kappa Statistics ◽  
Single Centre ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Emergency Medical ◽  
Patient Arrival

Objective: To assess if simplifying a prehospital 8-item NIHSS scale (NIHSS-8, fig 1) to a 0 (symptom absent) – 1 (symptom present) scoring system increases interrater agreement between emergency medical services (EMS) and stroke specialists. Methods: We analysed interrater agreement between EMS and stroke specialists of a single centre on a prospectively collected cohort of 64 suspected acute ischemic stroke patients. EMS performed NIHSS-8 score upon patient arrival at the emergency department. The stroke specialist scored the full 15-item NIHSS blind to the EMS scores and within 5 minutes of patient arrival. Linear-weighted Cohen’s kappa statistics was used to assess agreement between EMS and stroke specialist on the total NIHSS-8 score and each NIHSS-8 scale item. We then simplified each item to a 0-1 score and reassessed interrater agreement for the overall NIHSS-8 scale using linear-weighted Cohen’s kappa statistics and for each NIHSS-8 item using Cohen’s kappa statistics. We used Cohen’s kappa statistics to assess agreement for original and simplified NIHSS-8 cut-off scores. Results: EMS and stroke specialist reached substantial agreement on overall NIHSS-8 scoring (linear-weighted kappa 0.69). Optimum agreement was reached for right arm weakness (linear-weighted kappa 0.79; Table 1) and a cut-off score of 2 and 5 (Cohen’s kappa 0.78; Table 2). When the score was simplified to a 0-1, overall agreement between EMS and stroke specialists was substantial (linear-weighted kappa 0.65). Optimum agreement was seen for LOC questions (Cohen’s kappa 0.78; Table 1) and a cut-off score of 2 (Cohen’s kappa 0.77; Table 2). Conclusion: Simplifying an 8-item prehospital NIHSS stroke scale does not increase interrater agreement between emergency medical services and stroke specialists.

scholarly journals (A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children

2011 ◽  
Vol 26 (S1) ◽  
pp. s63-s63
Author(s):  
M. Reilly
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Medical Services ◽  
A Priori ◽  
The United States ◽  
Medical Services ◽  
Special Populations ◽  
Provider Education ◽  
Emergency Medical ◽  
Nationally Representative

IntroductionRecent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.MethodsA nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.ResultsVery few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.ConclusionsOut study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.

Prehospital Care for Victims of Submersion

PEDIATRICS ◽  
1990 ◽  
Vol 86 (4) ◽  
pp. 625-626
Author(s):  
MARTHA BUSHORE
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Growth And Development ◽  
Prehospital Care ◽  
Rapid Response ◽  
Urban Setting ◽  
Medical Services ◽  
Emergency Medical ◽  
Study Results

In this issue of Pediatrics is a study1 that represents a milestone in the growth and development of Emergency Medical Services for Children systems. Linda Quan and co-workers provide us with a study of victims of submersion who were less than 20 years of age and who received care during a 10-years interval in an Emergency Medical Services unit and required hospitalization or died. Because the majority of these submersions occurred in the urban setting of King Country with the rapid response of Emergency Medical Services units and reliable recording of cardiopulmonary resuscitation (CPR) data, the study results are impressively complete.

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 < .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.

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