scholarly journals Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

2018 ◽  
Vol 26 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Thomas Karlsson ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Prospective Observational Study ◽  
Medical Services ◽  
Initial Assessment ◽  
Level Of Care ◽  
Emergency Medical

scholarly journals Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Medical History ◽  
Prospective Observational Study ◽  
Patient Characteristics ◽  
Critical Conditions ◽  
Initial Assessment ◽  
Level Of Care ◽  
Emergency Medical ◽  
Time Critical

Abstract Background Crowding in the emergency department (ED) is a safety concern, and pathways to bypass the ED have been introduced to reduce the time to definitive care. Conversely, a number of low-acuity patients in the ED could be assessed by the emergency medical services (EMS) as requiring a lower level of care. The limited access to primary care in Sweden leaves the EMS nurse to either assess the patient as requiring the ED or to stay at the scene. This study aimed to assess patient characteristics and evaluate the initial assessment by and utilisation of the ambulance triage system and the appropriateness of non-transport decisions. Methods A prospective observational study including 6712 patients aged ≥16 years was conducted. The patient records with 72 h of follow-up for non-transported patients were reviewed. Outcomes of death, time-critical conditions, complications within 48 h and final hospital assessment were evaluated. The Mann-Whitney U test, Fisher’s exact test, and Spearman’s rank correlation were used for statistical analysis. Results The median patient age was 66 years, and the most common medical history was a circulatory diagnosis. Males received a higher priority from dispatchers and were more frequently assessed at the scene as requiring hospital care. A total of 1312 patients (19.7%) were non-transported; a history of psychiatric disorders or no medical history was more commonly noted among these patients. Twelve (0.9%) of the 1312 patients not transported were later admitted with time-critical conditions. Full triage was applied in 77.4% of the cases, and older patients were triaged at the scene as an ‘unspecific condition’ more frequently than younger patients. Overall, the 30-day mortality was 4.1% (n = 274). Conclusions Age, sex, medical history, and presentation all appear to influence the initial assessment. A number of patients transported to ED could be managed at a lower level of care. A small proportion of the non-transported patients were later diagnosed with a time-critical condition, warranting improved assessment tools at the scene and education of the personnel focusing on the elderly population. These results may be useful in addressing resource allocation issues aiming at increasing patient safety.

scholarly journals Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Early Warning Score ◽  
Medical Services ◽  
Emergency Medical ◽  
Field Assessment ◽  
High Acuity ◽  
Sensitive Conditions

Abstract Background In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse’s field assessment with the physician’s final hospital diagnosis. Methods A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse’s field assessment compared to hospital physician’s diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann–Whitney U test and Fisher’s exact test, and several binary classification tests were determined. Results Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse’s field assessment was appropriate in 84% of these cases. Conclusions In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse’s field assessment of time-sensitive conditions was appropriate in the majority of cases.

scholarly journals Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens

2020 ◽  
Vol Volume 12 ◽  
pp. 393-401
Author(s):  
Morten Breinholt Søvsø ◽  
Bodil Hammer Bech ◽  
Helle Collatz Christensen ◽  
Linda Huibers ◽  
Erika Frischknecht Christensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Sociodemographic Characteristics ◽  
Out Of Hours ◽  
Emergency Medical

scholarly journals Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

2015 ◽  
Vol 9 (1_suppl) ◽  
pp. 59-81 ◽  
Author(s):  
Farzin Beygui ◽  
Maaret Castren ◽  
Natale Daniele Brunetti ◽  
Fernando Rosell-Ortiz ◽  
Michael Christ ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Hospital Management ◽  
Position Paper ◽  
Medical Services ◽  
Initial Assessment ◽  
Hospital Treatment ◽  
Emergency Medical ◽  
Acute Dyspnoea ◽  
Cardiovascular Care

Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts’ opinions, for all emergency medical services’ health providers involved in the pre-hospital management of acute cardiovascular care.

scholarly journals Utilisation of prehospital emergency medical services for hyperglycaemia: A community-based observational study

PLoS ONE ◽  
2017 ◽  
Vol 12 (8) ◽  
pp. e0182413 ◽  
Author(s):  
Melanie Villani ◽  
Natalie Nanayakkara ◽  
Sanjeeva Ranasinha ◽  
Arul Earnest ◽  
Karen Smith ◽  
...  
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Community Based ◽  
Emergency Medical ◽  
Prehospital Emergency
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