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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72 OCTOBER 2018 | EMSWORLD.com S P O T L I G H T: Eect of County Poverty Ratio on ROSC in OHCA: A Statewide Analysis Author: Ginny Renkiewicz, PhD(c), MHS, Paramedic Associate authors: Lee Van Vleet, MHS, NRP, Paul Benny, NREMT, Megan Foust, EMT, David Stallings, BS, NRP, Sara E. Houston, MHS, NRP, Michael W. Hubble, PhD, MBA, NRP Introduction—It is well established that factors such as age, race, gender, urbanicity, and socioeconomic status affect sur- vival in out-of-hospital cardiac arrest (OHCA). However, extant research has not studied the effect of a locale's poverty ratio on the return of spontaneous circulation (ROSC) in OHCA. Objective—To examine the effect of county poverty ratio on the likelihood of achieving ROSC in OHCA for a mixed urban, suburban, and rural state. Methods—A retrospective study of OHCA was conducted using a statewide EMS patient database. All adult, nontraumatic arrests in North Carolina between Jan. 1, 2012, and June 30, 2014, were included. Data from the U.S. Census Bureau's Small Area Income and Poverty Estimates (SAIPE) program were used to determine the 2012 poverty rate for each of North Carolina's 100 counties. A logistic regression model was then used to quantify the influence of poverty ratio on ROSC while controlling for other patient demographics and EMS response variables. Results—A total of 7,280 patients met inclusion criteria. Over- all ROSC was achieved in 2,810 (39%) patients. For every 1% increase in the poverty rate, patients were 4.1% less likely to achieve ROSC (OR 0.959, p<0.001). Male patients were 29% less likely to achieve ROSC (OR 0.71, p<0.01). Additionally, for every minute increase in EMS response time, ROSC was 2.9% less likely to be achieved (OR 0.971, p<0.01). ROSC was more likely achieved by receiving lay person or first responder CPR prior to EMS arrival (OR 1.29, p<0.001), in arrests witnessed by a bystander (OR 2.40, p<0.001) or healthcare provider (OR 2.70, p<0.001), and with an initial shockable rhythm (OR 1.29, p<0.001). Age (OR 1.001, p=0.702) and minority status (OR 0.894, p=0.053) were not significant predictors. Conclusion—In this retrospective analysis, patients were more likely to achieve ROSC based on their county's poverty ratio, gender, receipt of CPR prior to EMS arrival, witnessed arrest, and initial shockable rhythm. Further study of this relationship in a variety of geographical settings is needed to better understand potential inequities of ROSC achievement. Does Prehospital Treatment of Significantly Injured Trauma Patients Vary by Age? Author: Ginny Renkiewicz, PhD(c), MHS, Paramedic Associate authors: Emily Kocha, BS, Paramedic, James Dinsch, MS, NRP, James Green, BS, NRP, Angela Magill, BS, Paramedic, Kara Stewart, EMT, Melisa McNeil, EdD(c), Paramedic Introduction—Research has explored the frequency and suc- cess of attempted interventions within patient age groups. Yet available research fails to compare attempted interventions between patient age groups who have a similar acuity. Addi- tional research is needed to compare interventions used among patient age groups. Objectives—To determine the frequency with which prehospi- tal providers attempt interventions in significantly injured trauma patients across all age groups. Methods—A retrospective observational study of trauma patients was conducted using the North Carolina Prehospital Reporting System (PreMIS) data from July 1, 2012, to Dec. 31, 2012. Inclusion criteria consisted of patients with a Glasgow Coma Score of 10 or less. Trauma patients were divided into adult (17–65 years), pediatric (0–16 years), and geriatric (65 years or more). Logistic regressions were used to calculate the odds ratios for advanced airway and vascular access attempts controlling for specified age groups, gender, minority status, and patient acuity as determined by GCS and the revised trauma score. Additionally, a linear regression was used to determine the effects of age groups, gender, minority status, and acuity on total prehospital on-scene time. Results—A total of 1,192 patients met the inclusion criteria, of which 888 (74.6%) were adult, 53 (4.4%) pediatric, and 250 (21%) geriatric. Advanced airway attempts were not statisti- cally significant for pediatric or geriatric patients when com- pared to adults. Vascular access attempts were less likely in geriatric patients (OR 0.40, p=0.00). Males were more likely to receive an advanced airway (OR 2.12, p=0.00) or vascular access attempt (OR 1.34, p=0.04). Minorities were less likely to receive a vascular access attempt (OR 0.61, p=0.01). As GCS and RTS scores increased, the airway (OR 0.81, p=0.00; OR 0.71, p=0.00) attempts decreased. As GCS scores increased, the vascular access (OR 0.91, p=0.01) attempts decreased. Age, gender, and RTS were nonsignificant for total on-scene time. EMS person- nel spent less time on scene with minorities (β=-2.12, p=0.04). Conclusion—This study found disparities in procedure attempts in the geriatric population and on-scene times among minorities. Additional investigation is warranted to determine the rationale for these disparities.

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