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.

Issue link: https://emsworld.epubxp.com/i/1032353

Contents of this Issue


Page 68 of 87

68 OCTOBER 2018 | EMSWORLD.com S P O T L I G H T: glucose, or neither. Multivariable logistic regression was used to control for other covariates including response characteristics (time of day, day of week), agency characteristics (type, vol- unteer status), and patient characteristics (age, gender, race/ ethnicity). Adjusted odds ratios and 95% confidence intervals are reported. Results—There were 1,219 patients excluded because they received naloxone and glucose, leaving 2,778,921 records. Overall, 399,766 (14%) resulted in transport refusal; 2,838 (7%) of those given naloxone refused, 16,548 (39%) given glucose refused, and 380,380 (14%) given neither drug refused (p<0.001). Of patients given naloxone, 60% were male, compared to 53% for glucose and 46% for neither (p<0.001). More patients receiving nalox- one were white, non-Hispanic (80%) compared to those given glucose (67%) or neither (71%) (p<0.001). About half (47%) of those given naloxone were 18–39 years old, compared to 14% of those given glucose and 22% of those given neither. After con- trolling for patient, agency, and response characteristics, odds of nontransport for patients given glucose were more than fourfold higher (aOR 4.67; 95% CI, 4.57–4.77) and odds of nontransport for patients given naloxone were 54% lower (aOR 0.46; 95% CI, 0.44–0.48) compared to patients given neither. Conclusion—In this large multiagency sample of EMS patient contacts, transport refusal rates were higher for those given glu- cose and lower for those given naloxone compared with those given neither. Patients given naloxone tended to be younger, male, and white, non-Hispanic. Limitations include retrospec- tive analysis and use of data from a single ePCR vendor. First-Pass Success Rates of Out-Of-Hospital Advanced Airway Management in Adults and Children Author: Jeffrey Jarvis, MD, MS, EMT-P Associate authors: David Wampler, PhD, EMT-P, Henry Wang , MD, MS Introduction—Prehospital advanced airway management (AAM, including endotracheal intubation [ETI] and supraglot- tic airway insertion [SGA]) of children is difficult. Multiple AAM attempts are associated with increased adverse events. Objective—To compare advanced air way management first-pass success (FPS) rates between adults and children in a national cohort of EMS agencies. Methods—The study reviewed 2017 clinical data from the ESO Solutions national database encompassing more than 2,000 EMS agencies. Subjects were all patients receiving any AAM attempts. FPS was self-reported. Using multivariable logistic regression, we compared the odds of ETI FPS between adults (age 14 years or more) and children (age less than 14 years), adjusting for gender, ethnicity, primary impression, and drug facilitation. The analysis was repeated for SGA FPS. First-pass success rates between pediatric age subsets (less than 1 year, 1–5 years, 6–10 years, 11–14 years) were also compared. Results—During the one-year period, 731 EMS agencies attempted AAM on 29,369 patients (median=18 per agency, IQR 6, 43), including 28,846 (98.2%) adults and 523 (1.8%) chil- dren. Most AAM were ETI: adults 22,049 (76.4%) and children 471 (90.1%). Most patients were white (65%), male (60.5%), and underwent AAM for cardiac arrest (67.3%). ETI FPS was lower in children than adults (58.6% vs. 72.7%; OR 0.56; 95% CI, 0.46–0.68; p<0.001). SGA FPS was similar between children and adults (84.6% vs. 89.8%; OR 0.62; 95% CI, 0.30–1.43, p=0.31). Among children ETI FPS was higher with increasing age: less than 1 year 55.7% (42.4%–68.5%), 1 to less than 6 years 54.8% (48.9%–60.7%), 6 to less than 10 years 62.7% (48.1%–75.9%), 10 to less than 14 years 73.5% (61.4%–83.5%, p<0.001). Among children SGA FPS was not associated with increasing age group: less than 1 80.0% (28.4%–99.5%), 1 to less than 6 95.2% (76.2%–99.9%), 6 to less than 10 57.1% (18.4%–90.1%), and 10 to less than 14 84.2% (60.4%–96.6%, p=0.44). Conclusion—ETI FPS is lower in children than adults. SGA FPS does not differ between children and adults. Response, Agency, and Patient Characteristics Associated With EMS Transport Rates Author: Jeffrey Jarvis, MD, MS, EMT-P Associate authors: David Phillips, BS, EMT-P, Remle Crowe, MS, EMT Introduction—The EMS 9-1-1 transport rate has important implications for current reimbursement practices and risks of negative outcomes related to nontransport. Little research exists regarding factors linked to EMS transport rate for 9-1-1 response. Objective—To identify response, agency, and patient charac- teristics associated with EMS transport rates. Methods—A retrospective analysis used all 9-1-1 responses with patient contact in 2017 in the ESO Solutions national data- base. Agencies without transport capability were excluded. Independent variables of interest were identified a priori: agency type, agency volunteer status, time of day, day of week, patient sex, patient race/ethnicity, and patient age. Multivariable logis- tic regression modeling was used to assess for an association between the independent variables and EMS transport. Adjusted odds ratios and 95% confidence intervals are reported. Results—We analyzed 2,786,615 records; 85% resulted in EMS transports by more than 900 agencies. Compared to third- service agencies, private agencies demonstrated 80% greater odds of transporting (aOR 1.80; 95% CI, 1.78–1.84). Compared to nonvolunteer agencies, volunteer agencies had 31% increased odds of transport (aOR 1.31; 95% CI, 1.26–1.36). Hispanic patients

Articles in this issue

Links on this page

Archives of this issue

view archives of EMS World - OCT 2018