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

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Page 74 of 87

74 OCTOBER 2018 | EMSWORLD.com S P O T L I G H T: to meet the needs for sustainability of a large regional LTOWB program. Healthcare providers were trained on administration of LTOWB. In an effort to minimize wastage and maximize use, a system for cycling product to the county-based Level I trauma center was established. Results—The LTOWB rollout to 14 rural and urban air-medical bases began in January 2018. There have been several docu- mented uses of LTOWB under this program; outcomes appear favorable initially. To date no complications have occurred, and zero LTOWB has been wasted due to cycling prehospital units into the Level I trauma center three weeks before expiration. Five additional air-medical bases outside of the original pro- gram participants have begun carrying LTOWB. A large urban ground EMS agency in the region anticipates deployment of LTOWB by special operations and supervisor vehicles as part of systemwide program expansion. Conclusion—A robust whole blood program required the integration and collaboration of an interdisciplinary stake- holder team to provide clinical and administrative education, cold chain management, and donor sustainability; and ensure product accessibility and prudent utilization. The LTOWB pro- gram identified necessary infrastructure to scale to additional prehospital platforms and other trauma systems in order to improve clinical outcomes for trauma. An Assessment of the Use of Spine Immobilization by EMS Professionals in South Carolina Author: Robert Wronski, MBA, NRP Associate authors: Courtney Harrison, MS, Arnold Alier, EdD, NRP, Sean Kaye, BA, EMT-P, Jennifer K. Wilson, BA, EMT-B, Vic- tor Grimes, MPH, Antonio R. Fernandez, PhD, NRP, FAHA Introduction—The National Association of EMS Physicians and American College of Surgeons Committee on Trauma state that use of backboards for prehospital spinal immobilization (SI) should be considered only when potential benefits out- weigh risks. Objective—To identify factors related to prehospital SI for trauma patients in South Carolina. Methods—This retrospective observational study examined all 2016 9-1-1 EMS trauma calls in South Carolina. Study data were obtained from the South Carolina EMS data system. Inde- pendent variables included whether the patient met the 2011 Centers for Disease Control and Prevention (CDC) criteria for transport to a trauma center, community size, and patient age, gender, and race. Patient age in years was categorized as 1 or below, greater than 1–7, 8–17, 18—54, and 55 or more. Race was categorized as white (referent group), black, or other. Univariate and multivariable logistic regression modeling was performed. Results—In 2016 there were 135,902 trauma calls in South Carolina. SI was performed on 24,699 (18.2%). There were 3,341 (2.5%) trauma patients who met CDC criteria; all had SI per- formed. Among patients who did not meet CDC criteria, 21,358 (16.1%) had SI performed. CDC criteria predicted SI perfectly; therefore, it was omitted from logistic regression analysis. Uni- variate analyses revealed significant (p<0.05) relationships between SI and all independent variables. These relation- ships remained significant after multivariable modeling. Urban patients had decreased odds of SI (OR 0.79; 95% CI, 0.77–0.82, p<0.001). African-Americans had decreased odds of SI (OR 0.97; 95% CI, 0.94–0.99, p=0.03). No difference was noted among other races (OR 1.05; 95% CI, 0.96–1.13, p=0.28). Males had increased odds of SI (OR 1.28; 95% CI, 1.24–1.31, p<0.001). All age groups had decreased odds of SI when compared to those 18–54 and 1 and below (OR 0.25; 95% CI, 0.19–0.33, p<0.001), 1–7 (OR 0.35; 95% CI, 0.31–0.40, p<0.001), 8–17 (OR 0.89; 95% CI, 0.84–0.95, p<0.001), and 55 or more (OR 0.54; 95% CI, 0.52– 0.55, p<0.001) The multivariate logistic model demonstrated good fit (p=0.43). Conclusion—EMS professionals in South Carolina appear to be considering risks and benefits of SI. All those who met the CDC criteria for transport to a trauma center had SI. Younger and senior patients were much less likely to have SI. Using Telehealth and Alternative Transportation for Nonurgent EMS Care Author: James Langabeer, PhD, EMT Associate authors: Michael Gonzalez, MD, FACEP, Tiffany Cham- pagne-Langabeer, PhD, Guy Gleisberg, MBA, EMT Introduction—The use of telehealth in prehospital emer- gency medical services has historically been limited to small pilot studies or specific emergent conditions, such as stroke and acute cardiovascular care. Objective—To analyze the impact of telehealth on agency operational efficiency. Methods—A prospective case-control study design was used to assess the effect of using telehealth technology on two dependent variables: percent of patients transported by ambulance and cost-effectiveness. The intervention pro- cedures consisted of telehealth technology with field-based videoconferencing between the patient and a board-certified emergency medicine physician, which guided disposition (i.e., ED or clinic) and transportation (i.e., ambulance or taxi) deci- sions. Inclusion criteria were adults with low-acuity, nonurgent complaints. Mean differences were calculated between the intervention cases and a control group consisting of all simi- lar complaint codes during a 36-month period (2015–2017). Resource utilization was measured from the agency perspec-

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