Emergency Medical Services System Changes Reduce Pediatric Epinephrine Dosing Errors in the Out-of-hospital Setting

2006 ◽  
Vol 13 (5Supplement 1) ◽  
pp. S150-S150 ◽  
Author(s):  
A. H. Kaji
Keyword(s):  
Emergency Medical Services ◽  
Hospital Setting ◽  
Medical Services ◽  
Emergency Medical ◽  
System Changes

Emergency Medical Services System Changes Reduce Pediatric Epinephrine Dosing Errors in the Prehospital Setting

PEDIATRICS ◽  
2006 ◽  
Vol 118 (4) ◽  
pp. 1493-1500 ◽  
Author(s):  
A. H. Kaji ◽  
M. Gausche-Hill ◽  
H. Conrad ◽  
K. D. Young ◽  
W. J. Koenig ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Prehospital Setting ◽  
Medical Services ◽  
Emergency Medical ◽  
System Changes

Prehospital Research

1993 ◽  
Vol 8 (S1) ◽  
pp. S5-S10 ◽  
Author(s):  
Donald M. Yealy
Keyword(s):  
Emergency Medical Services ◽  
Knowledge Base ◽  
Research Design ◽  
Prehospital Care ◽  
Hospital Setting ◽  
Medical Services ◽  
Professional Advancement ◽  
Emergency Medical ◽  
Potential Benefits ◽  
Basic Features

Prehospital care experienced a “honeymoon” from the early 1970s until recently. Treatments usually were extrapolated directly from the hospital setting, even though the prehospital environment is markedly different. That honeymoon is over and emergency medical services (EMS) providers must prove what is beneficial. Additionally, academic prehospital care physicians interested in professional advancement, must show the same ability as do the more traditional medical academicians to expand the knowledge base of their chosen field.This manuscript will highlight the basic features and identify the potential benefits and pitfalls of prehospital research. This chapter is not a cookbook for EMS research, nor will it obviate the need for accessing other sources on research design. Other manuscripts within this series will focus on more specific topics; yet, it will be obvious that many of the points made here will be re-emphasized in the following papers. That simply is a reflection of the importance of these commonly overlooked perils and pitfalls.

Abstract NS11: Using a Template in the Electronic Medical Record to Improve Communication Between Emergency Medical Services and the Emergency Department for Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Melissa Richardson ◽  
Christopher Rankin
Keyword(s):  
Emergency Medical Services ◽  
Medical Record ◽  
Point Of Care ◽  
Hospital Setting ◽  
Medical Services ◽  
Emergency Medical ◽  
Stroke Team ◽  
Get With The Guidelines ◽  
To Receive ◽  
Early Stroke

Background: In the advent of electronic medical records (EMR), emergency departments (ED) are challenged to include communication with inbound Emergency Medical Services (EMS) within the medical record. Using standardized documentation to guide and capture this critical communication may impact early activation of the stroke team and improve ‘Door to CT’ times. Starting with the “Pre-Notification” measure in Get With the Guidelines (GWTG), our team set out to improve this measure, then evaluate its impact on early stroke team activation and imaging timelines. Purpose: To utilize a standardized template in the EMR to improve the GWTG Pre-Notification measure by 30% and evaluate its impact on early stroke team activation and imaging. Methods: Initially, the team agreed that clear criteria for stroke team activation were needed. Once established, a standardized template was designed within the EMR. This included point of care glucose, neurological symptoms, cardiac rhythm, time ‘last known well’, and establishment of IV access/labs drawn. The communication nurses, designated to receive incoming EMS calls, were instructed on the use of this standardized template to guide and record communication for incoming stroke patients. Education and feedback were also provided to EMS providers so that they could anticipate required information and ensure that appropriate care occurred in the pre-hospital setting. Results: The “Pre-Notification Measure” improved from 29%-77%, early stroke team activation improved from 45% - 73%, and median ‘Door to CT’ time improved from 25 minutes - 18 minutes. (Figure). Conclusions: Using a standardized template in the EMR improves expectations of care for the ED and EMS providers. This translates into better scores for the GWTG “Pre-Notification” measure, as well early stroke team activation and imaging timelines.

scholarly journals Chemical sedation of excited delirium in the pre-hospital setting

2020 ◽  
Vol 4 (4) ◽  
pp. 34-39
Author(s):  
Richard Armour
Keyword(s):  
Emergency Medical Services ◽  
Patient Population ◽  
Hospital Setting ◽  
Pharmacological Agent ◽  
Medical Services ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Preliminary Diagnosis ◽  
Excited Delirium ◽  
Emergency Medical

A 30-year-old male presents to emergency medical services profoundly combative with a Richmond Agitation‐Sedation Scale of +4 after reported use of intravenous methamphetamines. A preliminary diagnosis of excited delirium syndrome is made based on the history obtained and the decision is made to chemically sedate the patient. While preparing for sedation, you wonder which pharmacological agent will produce the fastest and safest sedation in this patient population.

scholarly journals Trauma Ultrasound in Civilian Tactical Medicine

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lori Whelan ◽  
William Justice ◽  
Jeffrey M. Goodloe ◽  
Jeff D. Dixon ◽  
Stephen H. Thomas
Keyword(s):  
Decision Making ◽  
Law Enforcement ◽  
Emergency Medical Services ◽  
Hospital Setting ◽  
Clinical Applications ◽  
Medical Services ◽  
Medical Support ◽  
Emergency Medical ◽  
Tactical Medicine ◽  
Potential Use

The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years’ literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.

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.

Suspected Labour as a Reason for Emergency Medical Services Team Interventions in Poland—A Retrospective Analysis

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 49
Author(s):  
Ewa Rzońca ◽  
Agnieszka Bień ◽  
Arkadiusz Wejnarski ◽  
Joanna Gotlib ◽  
Grażyna Bączek ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Retrospective Analysis ◽  
Urban Areas ◽  
Hospital Setting ◽  
Medical Services ◽  
Medical Procedures ◽  
Emergency Medical ◽  
History Of ◽  
Time Of Year ◽  
Team Interventions

The purpose of this study was to present the characteristics of Emergency Medical Services (EMS) team responses to calls regarding suspected labour in out-of-hospital settings in Poland. We performed a retrospective analysis of EMS team interventions in cases of suspected onset of labour outside a hospital setting. The analysis included 12,816 EMS team responses to calls regarding women in suspected labour in the period between January 2018 and December 2019. The mean age of the patients studied was 28.24 years (SD = 6.47). The majority of patients were at term (76.36%) and in their second pregnancy (29.96%). EMS teams were most often dispatched in the summer (25.95%) and in urban areas (63.26%). Most EMS teams were basic (68.99%) and interventions most often took place between 19:00 and 06:59 (63.14%). Significant differences were observed between preterm and term pregnant women attended by EMS teams in terms of variables such as the age of the patient, number of previous labours, history of miscarriage, presence of vaginal bleeding, time of year, location of call, type and composition of EMS team dispatched, urgency code and time of call, duration of intervention, selected emergency medical procedures performed and test results.

Incidence and management of agitation in emergency medical services in Spain – “SOSEGA” Study

2016 ◽  
Vol 33 (S1) ◽  
pp. S171-S172
Author(s):  
R. Rodriguez Calzada ◽  
M.A. Suarez Fuentes ◽  
P. Roset Arisso ◽  
Keyword(s):  
Emergency Medical Services ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Medical Services ◽  
Adequate Treatment ◽  
Psychiatric Emergencies ◽  
Emergency Medical ◽  
Specific Protocol ◽  
Competing Interest ◽  
Treatment Procedures

IntroductionAgitation is a frequent and complex emergency. Its early detection and adequate treatment are crucial to ensure the best outcomes. Pre-hospital management of agitation requires appropriate measures to preserve patients’ safety, stabilize the patient and alleviate suffering, and transfer to the hospital psychiatric services, including involuntary admission if needed.ObjectivesTo describe the management of agitation by the Emergency Medical Services (EMS) in Spain.MethodsObservational retrospective survey on the protocols and procedures used, the number of in-calls received and the resources dedicated to attend emergencies in 2013.ResultsSeven out of the seventeen EMS in Spain provided information. All of them registered in a database in-calls and actions taken. Four of them had a specific protocol to attend psychiatric emergencies and agitation in-calls, and five coded the initial diagnostic with ICD-9. Paramedics attending emergencies register the diagnostic in 3/7 EMS. Nursing and Medical staff code the final diagnostic with ICD-9 in all. Emergency Coordination Centres received 4,437,388 in-calls (209/1000 inhabitants); 2.6% classified as psychiatric (6.2/1000 inhab.). Healthcare teams attended 2,028,467 emergencies, 84,933 (4.2%) were psychiatric (4.0/1000 inhab.) and 37,951 (1.9%) were patients with agitation (2.0/1000 inhab.). General practitioners attended 17% of all psychiatric emergencies, while ambulances attended 61%.ConclusionsThe incidence of acute agitation accounts for almost half of the total psychiatric emergencies in the pre-hospital setting. Since there are different healthcare providers in charge, specific protocols as well as treatment procedures are needed to provide the most adequate management, in order to ensure the best Psychiatric Emergency Chain.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Medication Related Adverse Events in the Emergency Medical Services: Analysis of a Patient Safety Register

2021 ◽  
Author(s):  
Ian Howard ◽  
Ian Howland ◽  
Nicholas Castle ◽  
Loua Al Shaikh ◽  
Robert Owen
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Emergency Medical Services ◽  
Adverse Drug Events ◽  
Descriptive Analysis ◽  
Hospital Setting ◽  
Medical Services ◽  
Common Error ◽  
Emergency Medical ◽  
Wide Range

Abstract BackgroundAdverse drug events encompass a wide range of potential unintended and harmful events, from adverse drug reactions to medication errors, many of which in retrospect, are considered preventable. However, the primary challenge towards reducing their burden lies in consistently identifying and monitoring these occurrences, a challenge faced across the spectrum of healthcare, including the emergency medical services. The aim of this study was to identify and describe medication related adverse events (AEs) in the out-of-hospital setting.MethodsThe medication components of a dedicated patient safety register were analysed and described for the period Jan 2017 – Sept 2020. Univariate descriptive analysis was used to summarize and report on basic case and patient demographics, intervention related AEs, medication related AEs, and AE severity. Multivariable logistic regression was used to assess the odds of AE severity, by AE type.FindingsA total of 3475 patient records were assessed where 161 individual medication AEs were found in 150 (4.32%), 12 of which were categorised as harmful. Failure to provide a required medication was found to be the most common error (1.67%), followed by the administration of medications outside of prescribed practice guidelines (1.18%). There was evidence to suggest a 63% increase in crude odds of any AE severity [OR 1.63 (95% CI: 1.03 – 2.6), p = 0.035] with the medication only AEs when compared to the intervention only AEs. ConclusionPrehospital medication related adverse events remain a significant threat to patient safety in this setting and warrant greater widespread attention and future identification of strategies aimed at their reduction.

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