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 67 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE substantially limited and unreliable in rural regions compared to urban centers. Cellular telephones have largely replaced tra- ditional landlines, with fewer than 40% of households with a dedicated landline telephone. Given the time-sensitive nature of EMS calls, this puts residents of rural communities at a disad- vantage in regard to prehospital treatment and ultimate survival of cardiac arrest events. Patients in poor cellular coverage areas may be at an increased risk of death-on-arrival (DOA) status on arrival of EMS. Objective—To review the effects of cellular coverage on DOA status on arrival of EMS. Methods—A medium-size rural North Carolina county (located within a metropolitan statistical area) reported EMS call data from January 2015 through December 2017. Patients with a prima- ry dispatch disposition of "cardiac arrest" were included. Multi- variate logistic regression with time-fixed effects was conducted. Control variables included mean age, sex proportion, minority proportion, poverty rate, and median home price at the zip code level. To quantify cellular coverage, GIS (geographic information system) analyses were performed on publicly available cellular coverage maps and grouped into four categories: excellent, above average, below average, and poor. Results—There were 532 cardiac arrest patients who met inclusionary criteria, with a DOA of EMS rate of 37%. Overall 21% of patients were located in areas with excellent cellular cover- age and 29% in poor cellular coverage areas. Statistical analysis revealed a negative correlation between cellular coverage and DOA status. Patients in poor coverage areas were 64% more likely to be DOA (OR 1.6409; 95% CI, 0.3614–1.0276, p=0.063) than those in an excellent coverage area. This finding is statisti- cally significant at a 10% alpha level. Conclusion—Cardiac arrest is an incredibly time-sensitive con- dition, and patient survival is highly dependent on how quickly treatment arrives. Rural areas, such as the county in this study, disproportionately experience limited cellular coverage. The results of this study show that patients in rural areas are at an unnecessarily increased risk of cardiac arrest death prior to arrival of EMS. Further study is needed to expand the geographic area of analysis and drive policy change within the telecommunica- tions sector. Evaluation of Workplace Violence in the Prehospital Environment Author: Courtney Harrison, MS Associate authors: Joseph Zalkin, BSHS, EMT-P, Robert Nelson, MD, FACEP, Sean Kaye, BA, EMT-P, David Ezzell, MPA, EMT-P, James Winslow, MD, MPH, FACEP, Jennifer Wilson, BA, EMT-B, Antonio Fernandez, PhD, NRP, FAHA Introduction—The threat of physical or verbal assault while in the field is high for EMS and first responders. This study focused on EMS' and first responders' opinions on workplace violence. Objective—To understand EMS professionals' opinions about workplace violence. Methods—This retrospective observational study examined all responses obtained via a questionnaire that was built using Lime Survey, an online open-source survey software. The survey was distributed via multiple listservs for EMS and first responders operating in North Carolina in June 2018. The survey questions were structured to gauge both the frequency with which people experienced workplace violence and the likelihood they would document these experiences if a reporting portal were available. Answers were reported on a five-point Likert scale. Results—A total of 1,203 respondents completed this survey. Overall, 54.78% reported they had physical violence directed at them within the last 24 months, and further categorized the type of assault experienced as verbal (26.85%), physical (8.48%), or both (35.41%). When asked if they felt safe while working, 22.22% reported not feeling safe, 33.86% were neutral, and 34.20% reported feeling safe. Regarding the likelihood of being injured by a patient while working during the next six months, 25.29% did not think there was a chance, 24.96% were neutral, and 39.98% thought there was a chance. Conclusion—Workplace violence is a serious issue that should be addressed in order to ensure the safety of EMS and first responders in the field. The results of the survey show that many see the potential for violence as a valid threat to personal safety and, given the opportunity, would use a reporting portal to document these instances. Characteristics of EMS Transport Refusal Following Glucose or Naloxone Administration Author: Jeffrey Jarvis, MD, MS, EMT-P Associate authors: David Phillips, BS, EMT-P, Remle Crowe, MS, EMT Introduction—EMS responses resulting in transport refusal are of interest due to clinical outcome, liability, and financial risks. Treat-and-release protocols are being increasingly developed for hypoglycemia and opioid overdose. Scant literature exists comparing the characteristics of refusals between patients given naloxone, glucose, or neither medication. Objective—To describe the characteristics of transport refus- al among patients who received glucose, naloxone, or neither medication. Methods—Using 2017 data from the ESO Solutions national database, a retrospective analysis of all 9-1-1 responses with patient contact was conducted. The outcome was transport refusal. Patients were classified as having received naloxone,

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