scholarly journals ‘Is the patient completely alert?’ – accuracy of emergency medical dispatcher determination of patient conscious state

2021 ◽  
Vol 18 ◽  
Author(s):  
Jason Belcher ◽  
Judith Finn ◽  
Austin Whiteside ◽  
Stephen Ball
Keyword(s):  
Predictive Value ◽  
Conscious State ◽  
Emergency Medical ◽  
Level Of Consciousness ◽  
Dispatch System ◽  
Emergency Ambulance ◽  
Chief Complaints ◽  
Emergency Medical Dispatcher ◽  
Key Issues

Introduction During emergency ambulance calls, one of the key issues assessed is the patient’s level of consciousness. An altered conscious state can be indicative of a need for a high priority response; however, the reliability of the resulting triage depends on how accurately alertness can be ascertained over the phone. This study investigated the accuracy of emergency medical dispatcher (EMD) determination of conscious state in emergency ambulance calls in Perth, Western Australia. Methods The study compared EMD determination of patient alertness based on the Medical Priority Dispatch System (MPDS), with conscious state as recorded by paramedics on arrival, for all emergency ambulance calls in a 1-year period in metropolitan Perth. Diagnostic accuracy was reported across the whole system and stratified by MPDS chief complaint. Results There were 109,678 calls included for analysis. In terms of identifying patients as not alert, the overall positive predictive value was 6.62% and negative predictive value was 99.93%, with 10 times as many patients dispatched as not alert than found to be not alert at scene. Sensitivity was only 69.94%. There was significant variation in accuracy between chief complaints. Conclusion The study found high levels of inaccuracy between dispatch identification of not-alert patients, and what paramedics found on scene. While not-alert dispatch was 10 times more common than patients being determined not-alert on scene, only 70% of not-alert patients on scene were classified as such during dispatch. Further research is suggested into the factors that affect the accuracy of EMD determination of patient conscious state.

scholarly journals Accuracy of call-taker assessment of patient level of consciousness: a systematic review

2020 ◽  
Vol 17 ◽  
Author(s):  
Jason Belcher ◽  
Judith Finn ◽  
Austin Whiteside ◽  
Stephen Ball
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Conscious State ◽  
Phone Call ◽  
Sufficient Data ◽  
Inclusion Criteria ◽  
Patient Level ◽  
Level Of Consciousness ◽  
High Level

IntroductionWhen triaging an emergency phone call for ambulance assistance, one of the key areas of questions asked in internationally used triage decision support systems is around the patient’s level of consciousness. A patient with a reduced level of consciousness can be indicative of a requirement for a high level of urgency of ambulance response. However, the value of this as a triage criterion is dependent on how accurately it can be determined by the call-taker. We sought to identify and summarise the results from published studies which determine the accuracy of call-taker assessment of conscious state during an emergency phone call.MethodsWe searched MEDLINE, EMBASE, CINAHL and Scopus databases for studies relating to concepts of emergency medical services, conscious state, triage and/or accuracy. Studies were screened and included if they dealt with emergency calls in the community, reported call-taker determination and on-scene determination of conscious state, and included sufficient data for at least one measure of diagnostic accuracy to be calculated.ResultsOut of 5753 articles initially identified, only two were found that matched the inclusion criteria. Both reported accuracy of a binary determination of consciousness versus unconsciousness, and found that it is common for the reported consciousness to differ from actual findings at scene. There were no studies identified that measured accuracy of determination of altered conscious states among conscious patients.ConclusionThere is a notable gap in the literature regarding accuracy of determination of the patient’s conscious state in an emergency call, which needs to be addressed.

Association between Patient Unconscious or Not Alert Conditions and Cardiac Arrest or High-Acuity Outcomes within the Medical Priority Dispatch System “Falls” Protocol

2010 ◽  
Vol 25 (4) ◽  
pp. 302-308 ◽  
Author(s):  
Jeff Clawson ◽  
Christopher Olola ◽  
Greg Scott ◽  
Bryon Schultz ◽  
Richard Pertgen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ground Level ◽  
Medical Problems ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
Call Processing ◽  
Dispatch System ◽  
High Acuity ◽  
Emergency Medical Dispatcher ◽  
Level 3

AbstractIntroduction:Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though not alert” falls patients with severe outcomes mostly are “hot” transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing.Objectives:The objective of this study was to characterize the risk of cardiac arrest and “hot-transport” outcomes in patients with “not alert” condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors.Methods:This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3–OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) “not alert” condition and cardiac arrest and hot-transport outcomes then followed.Results:Overall, patients within the D-3 and D-2 “long fall” conditions had the highest proportions (compared to the other determinants in the “falls” protocol) of cardiac arrest and hot-transport outcomes, respectively. “Not alert” condition was associated significantly with cardiac arrest and hot-transport outcomes (p < 0.001).Conclusions:The “not alert” determinant within the MPDS® “fall” protocol was associated significantly with severe outcomes for short falls (<6 feet; 2 meters) and ground-level falls. As reported to 9-1-1, the complaint of a “fall” may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

The Accuracy of Emergency Medical Dispatcher-Assisted Layperson-Caller Pulse Check Using the Medical Priority Dispatch System Protocol

2012 ◽  
Vol 27 (3) ◽  
pp. 252-259 ◽  
Author(s):  
Greg Scott ◽  
Jeff Clawson ◽  
Mark Rector ◽  
Dave Massengale ◽  
Mike Thompson ◽  
...  
Keyword(s):  
Pulse Rate ◽  
Healthy Person ◽  
Medical Emergency ◽  
Phone Call ◽  
Patient Acuity ◽  
Emergency Medical ◽  
Gender And Age ◽  
Dispatch System ◽  
Emergency Medical Dispatcher ◽  
Pulse Check

AbstractIntroductionKnowing the pulse rate of a patient in a medical emergency can help to determine patient acuity and the level of medical care required. Little evidence exists regarding the ability of a 911 layperson-caller to accurately determine a conscious patient's pulse rate.HypothesisThe hypothesis of this study was that, when instructed by a trained emergency medical dispatcher (EMD) using the scripted Medical Priority Dispatch System (MPDS) protocol Pulse Check Diagnostic Tool (PCDxT), a layperson-caller can detect a carotid pulse and accurately determine the pulse rate in a conscious person.MethodsThis non-randomized and non-controlled prospective study was conducted at three different public locations in the state of Utah (USA). A healthy, mock patient's pulse rate was obtained using an electrocardiogram (ECG) monitor. Layperson-callers, in turn, initiated a simulated 911 phone call to an EMD call-taker who provided instructions for determining the pulse rate of the patient. Layperson accuracy was assessed using correlations between the layperson-caller's finding and the ECG reading.ResultsTwo hundred sixty-eight layperson-callers participated; 248 (92.5%) found the pulse of the mock patient. There was a high correlation between pulse rates obtained using the ECG monitor and those found by the layperson-callers, overall (94.6%, P < .001), and by site, gender, and age.ConclusionsLayperson-callers, when provided with expert, scripted instructions by a trained 911 dispatcher over the phone, can accurately determine the pulse rate of a conscious and healthy person. Improvements to the 911 instructions may further increase layperson accuracy.Scott G, Clawson J, Rector M, Massengale D, Thompson M, Patterson B, Olola CHO. The accuracy of emergency medical dispatcher-assisted layperson-caller pulse check using the Medical Priority Dispatch System protocol. Prehosp Disaster Med. 2012;27(3):1-8.

scholarly journals The Importance of Diet in Predicting the Remission of Urticaria—Determination of Allergen-Specific IgE

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 679
Author(s):  
Monica Iuliana Ungureanu ◽  
Liliana Sachelarie ◽  
Radu Ciorap ◽  
Bogdan Aurelian Stana ◽  
Irina Croitoru ◽  
...  
Keyword(s):  
Predictive Value ◽  
Allergic Diseases ◽  
Specific Ige ◽  
Egg White ◽  
Food Allergens ◽  
Pediatric Hospital ◽  
Disease Remission ◽  
Specific Serum ◽  
Different Types

Background and Objectives: Different types of food introduced gradually in the diet will expose children to different food allergens, increasing the chance of developing allergic diseases. The aim of our study was to determine if allergen-specific IgE values can influence, depending on the diet, the prediction of remission of urticaria in children. Materials and Methods: This prospective study was conducted in 132 patients diagnosed over two years with urticaria, admitted to “Sf. Maria” Clinical Pediatric Hospital Iaşi. Total IgE assay was performed by ELISA, and determination of specific serum IgE by the CLA System Quanti Scan method (Innogenetics, Heiden, Germany). Data were gathered and statistical analysis was performed using statistical software SPSS, using descriptive and inferential statistics. Results: The determination of specific IgE to food allergens was performed on a total of 132 cases. The values of specific IgE were positive for one or more food allergens in 84 patients (63.64%). The most common allergens involved were: cow’s milk in 33.3% cases, egg white in 22.6% cases, and hazelnuts in 11.9% cases. The specific IgE values for the different types of food included in our study had a predictive value for disease remission. Conclusions: The determination of specific IgE confirms the presence of a particular food allergen and may have predictive value for the future development of an allergic manifestation.

scholarly journals Auditory localization should be considered as a sign of minimally conscious state based on multimodal findings

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Manon Carrière ◽  
Helena Cassol ◽  
Charlène Aubinet ◽  
Rajanikant Panda ◽  
Aurore Thibaut ◽  
...  
Keyword(s):  
Brain Function ◽  
Brain Metabolism ◽  
Survival Rates ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Auditory Localization ◽  
Positron Emission ◽  
Level Of Consciousness ◽  
Minimally Conscious

Abstract Auditory localization (i.e. turning the head and/or the eyes towards an auditory stimulus) is often part of the clinical evaluation of patients recovering from coma. The objective of this study is to determine whether auditory localization could be considered as a new sign of minimally conscious state, using a multimodal approach. The presence of auditory localization and the clinical outcome at 2 years of follow-up were evaluated in 186 patients with severe brain injury, including 64 with unresponsive wakefulness syndrome, 28 in minimally conscious state minus, 71 in minimally conscious state plus and 23 who emerged from the minimally conscious state. Brain metabolism, functional connectivity and graph theory measures were investigated by means of 18F-fluorodeoxyglucose positron emission tomography, functional MRI and high-density electroencephalography in two subgroups of unresponsive patients, with and without auditory localization. These two subgroups were also compared to a subgroup of patients in minimally conscious state minus. Auditory localization was observed in 13% of unresponsive patients, 46% of patients in minimally conscious state minus, 62% of patients in minimally conscious state plus and 78% of patients who emerged from the minimally conscious state. The probability to observe an auditory localization increased along with the level of consciousness, and the presence of auditory localization could predict the level of consciousness. Patients with auditory localization had higher survival rates (at 2-year follow-up) than those without localization. Differences in brain function were found between unresponsive patients with and without auditory localization. Higher connectivity in unresponsive patients with auditory localization was measured between the fronto-parietal network and secondary visual areas, and in the alpha band electroencephalography network. Moreover, patients in minimally conscious state minus significantly differed from unresponsive patients without auditory localization in terms of brain metabolism and alpha network centrality, whereas no difference was found with unresponsive patients who presented auditory localization. Our multimodal findings suggest differences in brain function between unresponsive patients with and without auditory localization, which support our hypothesis that auditory localization should be considered as a new sign of minimally conscious state. Unresponsive patients showing auditory localization should therefore no longer be considered unresponsive but minimally conscious. This would have crucial consequences on these patients’ lives as it would directly impact the therapeutic orientation or end-of-life decisions usually taken based on the diagnosis.

scholarly journals Integrating a Local Asset/Resource into Tourism and Leisure Offering: The Case of Tea Resources in Longwu Town, Zhejiang Province, China

2021 ◽  
Vol 13 (4) ◽  
pp. 1920
Author(s):  
Ziyi Yan ◽  
Marios Sotiriadis ◽  
Shiwei Shen
Keyword(s):  
Success Factors ◽  
Leisure Activities ◽  
Sustainable Tourism Development ◽  
Critical Success ◽  
Sustainable Operation ◽  
Marketing Planning ◽  
Key Issues ◽  
Sustainable Action ◽  
Effective Pairing

The purpose of this article is to report on a research project in the field of tea tourism. The project’s aim was to identify the prerequisites and critical success factors for and to suggest the adequate strategies to achieve an effective pairing/partnership between the tea industry and tourism/leisure activities. Drawing on the blended theoretical foundations of sustainable tourism development, community-based tourism, and strategic marketing planning, this study first analyzed the tea offering as a tourism asset. It then suggested the appropriate pairing between tea offering and tourism/leisure activities. The suggested framework for managing the partnership was empirically tested and validated within the Chinese context. Findings allowed one to form a comprehensive and integrated set of key issues and elements to take into account. Clear and specific development aims along with the necessary conditions are leading to the determination of suitable strategies and adequate actions. The study also indicates the key elements for the successful integration, effective pairing, and sustainable operation of tea tourism offering. The study is completed by summarizing management implications and guidelines for involved stakeholders to attain expected outcomes from sustainable action plans.

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

2021 ◽  
Vol 70 (5) ◽  
pp. 23-36
Author(s):  
Ekaterina A. Kondratyeva ◽  
Alina O. Ivanova ◽  
Maria I. Yarmolinskaya ◽  
Elena G. Potyomkina ◽  
Natalya V. Dryagina ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Serum ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Unresponsive Wakefulness Syndrome ◽  
Level Of Consciousness ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

IMPORTANCE OF ANTIBODIES TO 21-HYDROXYLASE FOR THE DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND PROGNOSIS OF AUTOIMMUNE CHRONIC PRIMARY ADRENAL INSUFFICIENCY

2021 ◽  
Vol 100 (2) ◽  
pp. 78-86
Author(s):  
L.S. Sozaeva ◽  
◽  
N.V. Makazan ◽  
L.V. Nikankina ◽  
N.M. Malysheva ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Adrenal Insufficiency ◽  
Predictive Value ◽  
Primary Adrenal Insufficiency ◽  
Polyglandular Autoimmune Syndrome ◽  
Diagnosis And Prognosis ◽  
Specificity And Sensitivity ◽  
Enzymelinked Immunosorbent Assay

21-hydroxylase (21-OH) is the main antigen of the adrenal cortex, so the determination of antibodies (Ab) to 21-OH can help in the diagnosis and prognosis of chronic primary adrenal insufficiency (CPAI). Purpose of the study: evaluation of the relevance of Ab to 21-OH for the diagnosis and prediction of autoimmune CPAI. Materials and methods of research: the study consisted of three blocks: 1) assessment of the specificity and sensitivity, as well as the prognostic potential of Ab to 21-OH in patients with polyglandular autoimmune syndrome (APS) – individuals with APS type 1 with and without CPAI (n=106); 2) assessment of the dynamics of the level of Ab to 21-OH – patients with autoimmune CPAI were included (n=41); 3) assessment of the significance of Ab data for the differential diagnosis of various forms of CPAI, including patients with CPAI and APS type 1 exclusion (n=30). The study of Ab to 21-hydroxylase was performed using enzymelinked immunosorbent assay (BioVendor kits, Czech Republic). Results: statistically significant differences were obtained in the frequency of detection of Ab to 21-OH in patients with or without PCNI (p<0,001). The sensitivity of the method was 96%, specificity was 75%, a positive predictive value was 90%, and the negative predictive value was 89%. In 83% of patients, the level of Ab decreased with time (median size decreases – 20,4%/year). An inverse relationship was also found between the level of Ab and the duration of the course of CPAI (R=–0,460, p<0,001). In a group of 30 patients with CPAI and with exclusion of APS type 1, 21 were found to have Ab to 21-OH, only one of them had a monogenic non-autoimmune cause of CPAI (a mutation in the MC2R gene). Monogenic forms of CPAI were found in another 7 patients (mutations were found in the DAX1 and ABCD1 genes), among them an increase in Ab to 21-OH was not detected. Conclusion: determination of Ab to 21-OH is a specific and sensitive method for the diagnosis of autoimmune CPAI. An increase in Ab to 21-OH is a risk marker of autoimmune CPAI development.

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