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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70 OCTOBER 2018 | EMSWORLD.com S P O T L I G H T: of 0.92, specificity of 0.52, and diagnostic accuracy of 0.61. When the VAN screening tool was expanded to predict either an LVO or significant ICH, it showed sensitivity of 0.95, specificity of 0.63, and diagnostic accuracy of 0.74. Conclusion—For the prehospital setting, the study sug- gests that by expanding the VAN screening tool's application to include both LVO or ICH, it offered a high degree of accuracy when deciding which patients would directly benefit with trans- port to a facility that includes endovascular thrombectomy or neurosurgical interventions. Community Paramedic Partnership: Impact on Healthcare Utilization of Partnership Between a Municipal Fire/EMS Agency and the Local Level I Trauma Center Author: Tia Radant, MS, NRP Associate authors: Joseph Pasquarella, MS, Ann Majerus, CMPA, Matthew Simpson, BA, NRP, Paula Miller, MPH, Adam Mayer, BS, Sandi Wewerka, MPH, Aaron Burnett, MD Introduction—A public-private partnership between a Level I trauma center and an urban, municipal fire/EMS department for patients discharged from the hospital with an acute exac- erbation of congestive heart failure (CHF) was launched in 2014. This program aimed to improve healthcare utilization and reduce readmissions through a unique community paramedic partnership. Objective—To quantify the impact of a postdischarge com- munity paramedic program on the rates of healthcare utilization during the 90 days and 180 days following hospitalization for patients admitted with an acute CHF exacerbation. Methods—Inpatients with CHF were offered visits by a com- munity paramedic for up to 30 days postdischarge. Inclusion criteria included local residency, no home-care services at discharge, diagnosis of CHF, English-speaking, and consent to home visits by a community paramedic. The community para- medic visited the patient in the home 1 to 2 times per week for four weeks following discharge. At each visit the paramedic conducted medication reconciliation, a physical exam, home safety evaluation, coordination of follow-up care and referral to additional resources as needed. Healthcare utilization was analyzed descriptively using means and standard deviations and was compared to a control population not receiving community paramedic visits using Wilcoxon rank sum tests. Results—During the study period of February 2015 through June 2018, 115 patients were enrolled. As of July 2018 50 had completed the program and had complete data. When com- pared to control patients, community paramedic patients had fewer hospital admissions during the 90 days (p=0.265) and 180 days (p=0.0311) following completion of paramedic visits. There was no difference in emergency department visits at 90 days; however, patients in the community paramedic program had significantly fewer visits in the 180 days following community paramedic visit completion (p=0.0486). Though in general clinic visits were lower in the community paramedic group, there was no statistically significant difference in clinic visits during the 90 and 180 days following completion of community paramedic visits between the two groups. Conclusion—Partnership between a fire/EMS department and a Level I trauma center for a community paramedic program can be successful. Community paramedics providing postdischarge care could result in reduced admissions/ED visits. Epinephrine vs. Defibrillation: Does Operational Order Matter in Out-of-Hospital Cardiac Arrest? Author: Ginny Renkiewicz, PhD(c), MHS, Paramedic Associate authors: Matthew V. Opinski, EMT, Steven J. Tanaka, BS, NRP, Joseph E. Kunkleman, EMT, Franklin L. Westbrook, BS, Para- medic, Michael W. Hubble, PhD, MBA, NRP Introduction—The administration of both vasopressors and defibrillation has been shown to increase the rate of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Objective—To determine the significance of operational order (the first chronological intervention of either a vasopressor or defibrillation) of vasopressors and defibrillation in OHCA. Methods—A retrospective study of OHCA patients was con- ducted using data from the Prehospital Medical Information System (PreMIS) from Jan. 1, 2012, to June 30, 2014. Included were adult patients with a witnessed arrest who presented in a shockable rhythm. Patients were excluded if the etiology of their arrest was drowning, electrocution, trauma, or unknown. A chi- square test was used to evaluate the direct relationship between operational order and ROSC. A logistic regression was used to identify predictors of ROSC after controlling for confounders. Results—A total of 736 patients were evaluated within the studied timeframe. Of those, 556 patients (75.5%) were male, 164 patients (22.3%) were minorities, and mean age was 62.79 (±14.29) years. ROSC occurred in 401 patients (54.5%), and 352 patients (47.8%) received lay person CPR. A total of 181 patients (24.9%) received a vasopressor first. A chi-square of the relation- ship between the operational order of first-line treatment and the influence on ROSC was not significant (p=0.239). A logistic regression model showed operational order was not significant (OR 0.836, p=0.31) when controlling for other OHCA-related factors.

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