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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EMSWORLD.com | OCTOBER 2018 75 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE tive, and cost-effectiveness ratios were calculated for all fixed and variable costs. T-tests were used to analyze univariate dif- ferences between groups. Results—There were 15,065 patients in the intervention group. The subjects were majority female (53%), 44.1 years old (+/-19), and black/African-American (56.3%). There was a statistically significant 76% difference in the frequency of ambulance trans- ports between the case and control groups (11% intervention, 47% control, p<0.001). Use of lower-cost taxi transportation was offered instead of ambulance transport. After all technology, operational, personnel, vehicle, and indirect costs were mea- sured, cost-effectiveness analyses showed a $103 mean differ- ence per encounter ($270 intervention vs. $167 control, p<0.001). Total agency cost savings for this sample was $1.55 million USD. Conclusion—In this single-site study, we found a telehealth intervention significantly reduced the number of ambulance transports and resulted in cost-effectiveness. A randomized clinical trial is needed to further explore if telehealth is superior to traditional care. Are All Children Created Alike? Dierences in MTP Across Three Age Groupings (0–5, 6–12, & 13–17) Author: Caroline Zhu Associate authors: Ashley C. McGinity, MD, Tracy Cotner-Pouncy, RN, Brian J. Eastridge, MD, Sondra Epley, RN, Leslie Greebon, MD, Rachelle B. Jonas, RN, Lillian F. Liao, MD, Susannah E. Nicholson, MD, Ronald M. Stewart, MD, Donald H. Jenkins, MD Introduction—Hemorrhage due to trauma is a leading cause of death in pediatric patients. Massive transfusion protocols (MTPs) potentially reduce mortality in pediatric trauma patients, but triggers for MTP activation are ill-defined. Objective—To characterize pediatric trauma patients requiring transfusion in the first 24 hours to evaluate potential triggers for MTP and transfusion in the prehospital setting. Methods—Using a Level I trauma center's registry, all pedi- atric trauma patients (0–17) from January 2015 to August 2017 who required transfusion in the first 24 hours of their stay were selected. Patients were categorized by age: 0–5, 6–12, and 13–17 years old. Several variables were studied using the independent samples t-test and chi-square test to assess for differences between survivors and nonsurvivors. Results—The all-cause mortality was 26% (18/70), with 22% (4/18) of deaths due to bleeding. The odds of death were high- er for blunt trauma compared to penetrating (OR 1.19; 95% CI, 0.79–1.81). Eighteen patients received massive transfusion, 78% (14/18) of whom were of adolescent age (13–17 years old). The mortality rate in the adolescent group was 21% (7/33) despite a higher pulse pressure in the adolescent patients who died. Of note, prehospital times were routinely longer than 60 minutes. Conclusion—Despite not finding any valid transfusion triggers, the prolonged prehospital time, high mortality rate, and need for massive transfusion in this study support the inclusion of adoles- cent patients in prehospital whole blood transfusion programs. A Retrospective Analysis of the Impact of EMD on Cardiac Arrest in North Carolina in 2017 Author: Paul Allen, EMT-P Associate authors: Randall Likens, AAS, EMT-P, Courtney Harrison, MS, Sean Patrick Kaye, BA, EMT-P, Antonio R. Fernandez, PhD, NRP, FAHA Introduction—Emergency medical dispatch (EMD) is a critical part of the American Heart Association cardiac arrest "chain of survival." EMD must quickly identify cardiac arrest, dispatch the proper response, and compel lay persons to initiate CPR through prearrival instructions. Frequent evaluations should be made to assess if EMD impacts patient disposition. Objective—To determine if EMD prearrival instructions signifi- cantly impacted cardiac arrest patients' prehospital disposition in North Carolina. Methods—This retrospective observational study examined all 2017 9-1-1 EMS cardiac arrest patients in North Carolina. Study data were obtained from the North Carolina EMS Data System. During the study period protocols allowed termination of resus- citation efforts on scene for cardiac arrest patients who had no signs of reversal. If efforts were terminated, the patient was not transported. Transported patients were either successfully resuscitated or showed signs of reversal. Descriptive statistics and univariate odds ratios were calculated to determine if EMD prearrival instructions were associated with the decision to transport or not transport a cardiac arrest patient. Results—There were 10,247 9-1-1 calls dispatched as cardiac arrests by EMD. Data were available for prearrival instructions delivery on 7,099 (69.3%) calls. Of these, prearrival instruc- tions were provided on 5,570 (78.5%) and not provided on 1,529 (21.5%). Patient disposition was available on 4,184 calls. Of these, 728 (17.4%) patients were not transported, and 3,456 (82.6%) were. Of the 399 calls that were not transported, prear- rival instructions were provided on 310 (77.7%), and no instruc- tions for 89 (22.3%). Among 2,364 calls that were transported, 1,865 (78.9%) received prearrival instructions, and 499 (21.1%) did not. This difference was not statistically significant (OR 1.01; 95% CI, 0.97–1.06, p=0.589). Conclusion—EMD is a critical part of the system of care and essential to the cardiac arrest chain of survival. However, this study did not identify an association between the delivery of EMD prearrival instructions and patient disposition for those in cardiac arrest. Further study should be conducted to determine the impact of EMD on patient outcomes.

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