EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | OCTOBER 2018 65 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE The Eects of Drug-Assisted Airway Management on Mean Arterial Pressure and Shock Index in the Presence of Trauma Author: Justin Brines, BS, NRP Associate authors: Bradley Baggett, BS, NRP, Bradley Dean, MA, NRP, Jacob O'Neal, EMT, Candance Van Vleet, DHA, NRP, RN, Jack- son Déziel, PhD, MPA, NRP, Michael Hubble, PhD, NRP Introduction—Airway management is a key component of prehospital care for seriously injured patients. Drug-assisted airway management is not a common intervention in the pre- hospital setting. Pharmacological and airway interventions can lead to adverse hemodynamic changes. Measuring mean arterial pressure (MAP) and shock index (SI) before and after a drug-assisted airway attempt could provide insight into the physiologic consequences of drug-assisted prehospital airway management in the trauma patient. Objective—To measure changes in MAP or SI associated with drug-assisted advanced airway management. Methods—A retrospective study was conducted using North Carolina Prehospital Medical Information System (PREMIS) data from July 1, 2012, to Dec. 31, 2012. Inclusion criteria consisted of prehospital trauma patients 12 years of age or more who received advanced airway management. Airway management was clas- sified as drug-assisted if the patient received a paralytic, dis- sociative, benzodiazepine, or opiate medication. Generalized linear regression models were estimated. The semi-elasticity of drug-assisted airway management's effects on MAP and SI were estimated. Results—A total of 577 patients met inclusion criteria. Of those, 257 (44.5%) received drug-assisted airway management, with 36.9% receiving a dissociative, 40.6% a paralytic, 31.5% a benzodiazepine, and 17% an opiate drug. Analysis revealed a 72% decrease in MAP associated with attempted drug-assisted airway intervention (-0.72, p=0.002). No statistically significant difference was noted in SI with drug-assisted airway attempts (-0.15, p=0.597). A statistically significant decrease in MAP was associated with paralytics (-0.48, p=0.029), dissociatives (-0.58, p=0.007), and opiates (-0.69, p=0.004). However, benzodiaz- epines had no statistically significant effect on MAP (-0.38, p=0.068). Conclusion—Mean arterial pressure decreased with the use of paralytics, dissociatives, and opiates. Administration of ben- zodiazepines did not significantly decrease MAP. The impact of drug-assisted airway management on shock index was not statistically significant. The Influence of Prior Ambulance Transport on Reported Perceptions of Patient Satisfaction During Subsequent Ambulance Transports in a High-Volume EMS System Author: Elliot Carhart, EdD, FAEMS Associate authors: Angus Jameson, Debbie Vass Introduction—Tracking patient satisfaction data can help an EMS system pursue targeted improvements by adapting to meet the predisposed patient expectations. Objective—To explore and describe any extraneous influence of prior ambulance transport on perceived patient satisfaction during subsequent ambulance transport. Methods—This quality improvement study involved the planned secondary analysis of prospectively collected data from a systemwide patient satisfaction initiative. A third-party vendor conducted telephone surveys aimed at obtaining 500 complete responses per month using a random sample from 130,000 local 9-1-1-initiated incidents resulting in ambulance transport. Incomplete responses and nonemergency calls were excluded. The instrument contained six questions intended to measure various aspects of patient satisfaction using a four- point ordinal scale (strongly disagree to strongly agree) along with a net promoter item. A single additional question was temporarily added to determine if a respondent had previously been transported by an ambulance before the current incident. This distinction was then used as a basis of comparison against reported patient satisfaction in each category. Results—Over the three-month study period, 1,508 complete patient responses were obtained. Most patients (74%) indicat- ed they had been transported in an ambulance on at least one occasion before the incident for which they were being surveyed. Patients who had been transported previously reported higher levels of satisfaction in all categories measured. However, the categorical differences were minimal, with only patient percep- tion of 9-1-1 call-taker professionalism demonstrating a statis- tically significant difference c2 (3, n=1,508)=8.930, p=.03. The top box score (very satisfied) of those having prior transport experience was 45%, compared to 37% for those who had never been transported via ambulance. Conclusion—Despite potential limitations of homogene- ity within our sample, these results still provide a meaningful context for the interpretation of our patient satisfaction data. These results also contribute to a void in the literature specific to patient satisfaction in the context of value-related charac- teristics of EMS. CLINICAL ABSTRACTS

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