911 and the area code from which you call: How to improve the disparity in California’s Emergency Medical Services

2020 ◽  
Vol 18 (3) ◽  
pp. 247-260
Author(s):  
Jeffrey A. Covitz, BS, MA, NRP ◽  
Anke Richter, PhD ◽  
Douglas J. MacKinnon, PhD
Keyword(s):  
Patient Care ◽  
Socioeconomic Factors ◽  
Emergency Medical Services ◽  
Patient Outcomes ◽  
The United States ◽  
Performance Measure ◽  
Medical Services ◽  
Measure Data ◽  
Geographical Differences ◽  
Emergency Medical

Introduction: Thirty-three separate local emergency medical services (EMS) authority agencies serve the 58 counties in California. Each local emergency medical services agency dictates widely different treatment and transport protocols for its paramedics. Although previous research has established the problem of geographic EMS disparities, nothing definitively explains their cause.Methods: We analyze California’s most recently available EMS performance-measure data to determine if there is still disparity in EMS patient care and patient outcomes in California. If there is a disparity, we determine whether the differences are accounted for by socioeconomic factors, geographical differences, or population size, by combining California EMS data with other state and county level data. If none of these factors are significantly correlated, this supports the hypothesis that something different, such as system structure, could be a potential cause of California’s EMS disparities. As a secondary analysis, we attempt to replicate these types of analyses at national and international levels, which could potentially permit a structural comparison as well.Results: There is still disparity in EMS patient care and patient outcomes in California. Regression analyses did not identify a single factor to explain the disparity in performance measures. Most notably, the regression found that basic socioeconomic factors and geographical differences frequently speculated as common drivers for disparity of services, including median income, population density, and availability of specialty care facilities, did not account for the disparity in services.Conclusions: Unfortunately, the striking lack of performance-measure data-a data desert-for EMS throughout the United States meant that the secondary analyses were inconclusive. Based on these results, we propose three recommendations:(1) most importantly, the lack of data must be addressed. Data collection should be standardized and mandatory for all EMS providers. (2) Treatment protocols for the state should be standardized and based on the latest evidence-based research. Providers should be required to offer the same level of care, to all geographic regions. (3) It may be beneficial to consider restructuring the California EMS system. While the research is limited due to imperfect information, consolidated systems seem to perform better. An existing framework for this already exists.

It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

2021 ◽  
pp. 1-9
Author(s):  
Sarayna S. McGuire ◽  
Anuradha Luke ◽  
Aaron B. Klassen ◽  
Lucas A. Myers ◽  
Aidan F. Mullan ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Performance Feedback ◽  
Life Support ◽  
Clinical Care ◽  
Medical Services ◽  
The Past ◽  
Emergency Medical ◽  
Overall Job Satisfaction

Abstract Objective: Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction. Methods: This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups. Conclusion: Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

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.

Abstract P138: Improving Emergency Medical Services Documentation of Time Last Known Well

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dot Bluma ◽  
Jessica Link Reeve ◽  
Susan M Godersky
Keyword(s):  
Emergency Medical Services ◽  
Symptom Onset ◽  
Systems Of Care ◽  
Onset Time ◽  
Reperfusion Therapy ◽  
Report Card ◽  
Medical Services ◽  
Emergency Department Physician ◽  
Measure Data ◽  
Emergency Medical

Background and Purpose: In a systems of care model, Emergency Medical Services (EMS) reporting a patient’s last known well (LKW) time to the receiving hospital is crucial for activation of the hospitals Acute Stroke Team. There is evidence that LKW is critical information for determining an acute ischemic stroke patient’s eligibility for advanced stroke therapy which includes intravenous Alteplase and/or mechanical endovascular reperfusion therapy. The 70 Wisconsin (WI) Coverdell Stroke Program (Coverdell) hospitals represent 80% of stroke admissions in WI. Coverdell developed a pre-arrival report card in Q3 2018 in which LKW was a tracked measure. Data entered into Get With The Guidelines®- Special Initiatives (SI) tab was collated to create the report card. After analysis of the data it was determined our performance improvement (PI) project would be to improve EMS’s documentation and reporting of time LKW. In Q3 2018, of those cases entered into the SI tab, EMS reporting a LKW time was 50%. Since LKW is not always obtainable, the project goal was set at 60%. Methods: We recognized implementation of this PI initiative would require a multi-prong approach. To assist EMS agencies in understanding the difference between LKW and symptom onset, we developed a document entitled, The Importance of an Accurate Last Known Well and Symptom Onset Time . A Coverdell team member attended WI’s EMS Physician Advisory Committee meetings where LKW data was discussed. In addition, an Emergency Department Physician hosted a webinar where the presentation highlighted the importance of documenting LKW. This webinar was recorded and sent to EMS agencies and hospitals. For loop closure and with the support of the WI’s EMS Director, LKW became a validated field for EMS in the WI Ambulance Run Data System. Findings: In Q2 2019 there was an improvement in documented LKW as evidenced by an increase to 59.2% The data has remained consistent even as more hospitals have begun to enter the data as demonstrated by the increasing N. Conclusion: The actions taken by the Coverdell program in educating EMS providers on the rationale and importance of LKW documentation was successful. However, additional efforts are required to reach and maintain the project goal of 60% with an additional stretch goal to 70%.

Abstract 203: Characteristics of Emergency Medical Service Responses for Adults With Cardiovascular Disease-related Chief Complaints in The United States, 2016

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Isaac A Nwaise ◽  
Erika C Odom
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Emergency Medical Services ◽  
Statistical Tests ◽  
The United States ◽  
Medical Services ◽  
National Database ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Chief Complaints

Background: Gaps exist in understanding the commonality of cardiovascular disease (CVD)-related responses by emergency medical services responders in the United States (US) community setting. Objective: We examined characteristics of CVD-related responses among US adults with 9-1-1 emergency medical services (EMS) responses in a national database. Methods: The 2016 National Emergency Medical Services Information System (NEMSIS) database (Version 2.2.1) from 49 states was used. CVD-related chief complaints were defined by data element E09_12 in the NEMSIS code book. Exclusions were EMS cancellations, persons not found, those with unknown sex, and patients aged <18 years. Rates (per 1,000 EMS responses) were calculated for total population and by patient demographics. Chi-square statistical tests were used to assess associations. Percentages of CVD-related chief complaints were calculated for EMS responses (incident patient disposition, type of destination, and reasons for destination), and clinical characteristics (provider’s primary impression, provider’s secondary impression, primary symptom, and EMS condition code). Results: We identified over 19.8 million EMS responses among adults aged ≥18 years old in 2016, including 1,336,684 (67.4 per 1,000 EMS responses) with CVD-related chief complaints. Rates of CVD-related chief complaints per 1,000 EMS responses for females (68.5), patients aged 65-74 years old (87.7), Hawaiian Pacific Islanders (83.6), whites (73.4), and those living in the South census region (72.8) were significantly higher than their respective counterparts. Among EMS responses, most CVD-related chief complaints were treated and transported by EMS (83.1%), and of those transported by EMS, 83.5% were transported to a hospital. Reasons for hospital destinations among adults with CVD-related chief complaints were patient’s preferred hospital (34%) and closest facility (32.9%). Most CVD-related chief complaints were chest pain or discomfort according to provider’s primary impression (48%) and provider’s secondary impressions (6.1%). Finally, pain (46.2%) was the most frequently reported condition as primary symptom among EMS patient with CVD-related chief complaints. Conclusion: Approximately 1-in-15 EMS (9-1-1) responses among adults involved a CVD-related chief complaint. Future research could focus on trends for CVD-related EMS responses overtime. Keyword: 9-1-1 emergency system, prehospital cardiovascular disease, CVD-related events.

Emergency Medical Services Liability Litigation in the United States: 1987 to 1992

1994 ◽  
Vol 9 (4) ◽  
pp. 214-220 ◽  
Author(s):  
David L. Morgan ◽  
Michael P. Wainscott ◽  
Heidi C. Knowles
Keyword(s):  
Emergency Medical Services ◽  
The United States ◽  
Medical Services ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Trial Court ◽  
Legal Cases ◽  
Patient Transport ◽  
Emergency Medical ◽  
The Common

AbstractIntroduction:Although emergency medical services (EMS) liability litigation is a concern of many prehospital health care providers, there have been no studies of these legal cases nationwide and no local case studies since 1987.Methods:A retrospective case series was obtained from a computerized database of trial court cases filed against EMS agencies nation-wide. All legal cases that met the inclusion criteria were included in the study sample. These cases must have involved either ambulance collisions (AC) or patient care (PC) incidents, and they must have been closed between 1987 and 1992.Results:There were 76 cases that met the inclusion criteria. Half of these cases involved an AC, and the other cases alleged negligence of a PC encounter. Thirty (78.9%) of the plaintiffs in the AC cases were other motorists, and 35 (92.1%) of the plaintiffs in the PC cases were EMS patients. Almost half of the cases named an individual (usually an emergency medical technician or paramedic) as a codefendant. Thirty-one (40.8%) of the cases were closed without any payment to the plaintiff. There were five cases with plaintiffs' awards or settlements greater than [US] $1 million. Most (71.0%) ofthe ACs occurred in an intersection or when one vehicle rear-ended another vehicle. The most common negligence allegations in the PC cases were arrival delay, inadequate assessment, inadequate treatment, patient transport delay, and no patient transport.Conclusion:Risk management for EMS requires specific knowledge of the common sources of EMS liability litigation. This sample of recent legal cases provides the common allegations of negligence. Recommendations to decrease the legal risk of EMS agencies and prehospital providers are suggested.

The Group Process: A Regional Disaster Planning Methodology for Multidisciplinary Consensus

1987 ◽  
Vol 3 (1) ◽  
pp. 68-73
Author(s):  
Frank L. Brown ◽  
Sharon L. Connelly
Keyword(s):  
Human Resources ◽  
Emergency Medical Services ◽  
Group Process ◽  
Disaster Planning ◽  
The United States ◽  
Medical Services ◽  
Design And Implementation ◽  
Emergency Medical ◽  
Physical Resources ◽  
Planning Methodology

In accordance with the 1973 Emergency Medical Services Systems Act in the United States, one of the 15 functions to be performed by every EMS (Emergency Medical Services) system is disaster planning. The predicate of success in remediating such a macrosystem challenge as regional disaster planning requires the consensus of multidisciplinary health care and public safety human resources prior to the effective cataloging of physical resources. As the emergency physician is the medical leader of EMS system design and implementation, it is important that he explore newly developing disaster planning methodologies to facilitate consensus disaster planning.

Trauma System Development and Future Directions

1993 ◽  
Vol 8 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Judith B. Braslow ◽  
Joan A. Snyder
Keyword(s):  
Public Health ◽  
Emergency Medical Services ◽  
Trauma Care ◽  
System Development ◽  
Trauma System ◽  
The United States ◽  
Advisory Council ◽  
Medical Services ◽  
Emergency Medical ◽  
Care Systems

AbstractTraumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems.

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