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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Page 73 of 87

EMSWORLD.com | OCTOBER 2018 73 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE Can a Community Paramedic Reduce Hospital 30- Day Readmissions for Patients Discharged With a Diagnosis of CHF? Author: Steve Rottman, MD Associate authors: Baxter Larmon, PhD, MICP Introduction—In some systems community paramedics con- duct home visits for recently hospitalized patients. The effec- tiveness of these visits in reducing readmissions in patients with heart failure was examined. Objective—To understand if a home visit by a community paramedic can reduce 30-day hospital readmissions for patients discharged with a diagnosis of congestive heart failure (CHF). Methods—A firefighter/CP assigned to an urban/suburban community hospital evaluated CHF patients in the hospital and again at home 48 hours following hospital discharge, along with a wellness telephone call after the visit. Thirty-day readmis- sion data were obtained. IRB approval was obtained for both the baseline data and postinterventional phases of this study. Results—During the study period, 154 patients were consent- ed, and 107 received a CP home visit and wellness phone call; readmission data were obtained for 103 (96%). There were 16 (16%) readmissions: 1 at more than 30 days, and 1 patient died in less than 30 days, resulting in a study population of 101. The overall less-than-30-day readmission rate for CHF patients with an intervention by a CP was 14/101 (14%). Of the 14 readmissions at less than 30 days, 5 (36%) were CHF-related and 9 (64%) were for other causes. During the year prior to this study, the CHF less-than-30-day readmission rate was 24%. Conclusion—In this study a CP was able to reduce overall less- than-30-day CHF patient readmission rates by more than 42%. EMT-Basic and Paramedics-Performed Simulated Pediatric Anaphylaxis—Standard Syringe / Color- Coded Syringe / Epi Auto-injector Author: David Wampler, PhD, LP, FAEMS Associate authors: Alan Lewis, RN, EMT-P, David Miramontes, MD, FACEM Introduction—Onset of anaphylaxis requires prompt treat- ment with an intramuscular injection of epinephrine. Much of the rural public is only served by EMTs. Autoinjectors are typically the only mechanism within the EMT scope of practice. Autoinjectors have recently become prohibitively expensive and only provide discrete doses. A color-coded syringe (CCS) that corresponds to a pediatric tape-based dosing system might provide a facile EMT "check and inject" mechanism. Objective—To determine if EMTs would perform equally to paramedics in the administration of epinephrine using three delivery devices: EpiPen, standard syringe (SS), or CCS. Methods—This was a randomized three-period, three- sequence, three-treatment repeated-measures full-consent crossover study of the EpiPen (standard and EpiPen Jr), SS, and CCS. Participants were educated on all three delivery mechanisms by a member of the study staff. The subjects were randomly assigned a training manikin to simulate either a 6-month-old or 8-year-old child. The administration order was randomized, and each participant delivered three doses of epi- nephrine to the assigned manikin. Study staff visualized each dose before administration. Dosing errors and critical dosing errors were documented. Results—The study recruited 12 EMTs and 12 paramedics. There was no difference in age or experience between the EMTs and paramedics: 39 vs. 41 years old, and 13 plus/minus 8 vs. 15 plus/minus 6 years of experience, respectively. In all cases sub- jects using the CCS administered the epinephrine dose closest to the expected dose of the SS or autoinjector. The autoinjec- tor uniformly overdosed the 6-month-old by a factor of more than 2, and the SS had the highest degree of deviation from expected. There was no difference between EMT and paramedic with respect to the dosage delivered by any device. Five autoin- jector administrations had to be excluded due to early removal. There was no difference between EMTs and paramedics on the number of dose errors. Conclusion—EMTs performed equally to paramedics in the delivery of epinephrine to a child, and both performed best using a color-coded syringe versus standard syringe or auto injector. Deployment of Low-Titer O-Positive Whole Blood in the Prehospital Environment Author: David Wampler, PhD, LP, FAEMS Associate authors: Tasia Long, MHS, Randall Schaefer, MSN, RN, CEN, Rena Summers, BA, Brian Eastridge, MD, FACS, Eric Epley, NREMT-P, CEM, Elizabeth Waltman, MBA, Donald Jenkins, MD, FACS Introduction—Trauma patients bleed whole blood. Over the last three decades trauma patients requiring resuscitation have typically received blood component therapy: red blood cells, pri- marily, although recently plasma and platelets have been added in a 1:1:1 ratio. Blood-based resuscitation is within the scope of very few prehospital providers. Providing transfusion at the point of injury has resulted in improved clinical outcomes. Objective—To examine the deployment of low-titer O-positive whole blood (LTOWB) to the prehospital environment. Methods—The Southwest Texas Regional Advisory Council for Trauma led a multidisciplinary, multi-institutional regional pre- hospital LTOWB program in Southwest Texas. The program capi- talized on existing rural air-medical capabilities and two adult Level I trauma centers (one county-based and one military). Pro- tocols developed by the Army Blood Program for LTOWB were adopted by the South Texas Blood and Tissue Center, which in turn established a donor recruitment program (Brothers in Arms)

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