Annals of emergency medicine
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We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. ⋯ Admitted patients in the ED are important determinants of ambulance diversion, whereas nurse hours and most emergency physicians are not. Reducing the volume of walk-in patients is unlikely to lessen the use of diversion.
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We determine the reproducibility of increased blood pressure measurements among adults in the emergency department or minor injury clinic. ⋯ Increased blood pressure is common among emergency or urgent care patients without a history of current hypertension, and most of these will have mixed or consistently abnormal results on repeat measures. Patients should be referred for repeat measures after a single abnormal measure in the ED.
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The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. ⋯ High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and advanced care paramedic crew type, with calls from the highest socioeconomic status neighborhoods being most likely to receive advanced care paramedic crews.
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Little is known regarding the potential effects of emergency medical services (EMS) on total heart disease mortality. Although EMS may provide health benefits in less acute cardiac conditions, its immediate, measurable, and direct effect on heart disease mortality is through resuscitation of persons suffering out-of-hospital cardiac arrest. The purpose of this study was to examine the involvement and potential mortality benefit of out-of-hospital EMS care of cardiac arrest on community heart disease mortality. ⋯ EMS was involved in the majority of out-of-hospital heart disease death events, resulting in a measurable reduction in heart disease mortality.