Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Objectives: Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond to an opioid poisoning and administer opioid reversal therapy. Currently, the epidemiology of prehospital naloxone use among children and adolescents is incompletely characterized. ⋯ Naloxone was rarely documented to worsen clinical status. Our findings highlight the safety of prehospital naloxone use, as well as the importance of a high index of suspicion for opioid poisoning in the pediatric population. Opportunities exist to leverage linked data sources to develop interventions to improve prehospital opioid poisoning recognition and management.
-
International Prehospital Emergency Care (PEC) standards have been primarily developed by and for high resource settings. Most PEC systems in Asia, which are still in the early stages of development, struggle to achieve these standards. There is a need for an evaluation tool which can define achievable basic building blocks for PEC systems in low resource settings to improve quality of PEC. We aimed to identify the core, basic elements (building blocks of a PEC system) for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for low resource settings in Asia. ⋯ Through a Delphi consensus process, stakeholders identified core elements for PEC systems in low resource settings. These findings will inform the development of a tool for quality assurance and monitoring in low resource settings in South and Southeast Asian countries.
-
In 2021, the opioid overdose crisis led to 1441 fatalities in Chicago, the highest number ever recorded. Interdisciplinary post-overdose follow-up teams provide care at a critical window to mitigate opioid-related risk and associated fatalities. Our objective was to describe a pilot follow-up program in Chicago including eligible overdose incidents, provision of response team services, and program barriers and successes. ⋯ The CARE ORT model proved successful in engaging predominantly older, non-Hispanic Black men in post-overdose outreach who were stably housed. While the number of individuals reached compared to the total eligible individuals was low, the program successfully navigated multiple barriers of limited EMS referral information, limited accuracy of data management, and urban realities of public overdose locations to reach a marginalized patient population with a high risk of mortality.
-
Despite early evidence of effectiveness, cost-savings, and resource optimization, mobile integrated health (MIH) programs have not been widely implemented in the United States. System, community, and organizational-level barriers often hinder evidence-based public health interventions, such as MIH programs, from being broadly adopted into real-world clinical practice. The objective of this study is to identify solutions to the barriers impeding the implementation of MIH through interviews with multilevel stakeholders. ⋯ An investigation of solutions to barriers that impede the translation of MIH models into sustainable practice elicited several unifying themes including the establishment of a cohesive identity for MIH to improve engagement and dissemination, the use of a strategic approach to program design that aligns with existing healthcare delivery workflows and collaboration with payors to promote a robust reimbursement structure. These findings may help accelerate the implementation of MIH programs into real clinical practice.
-
Emergency medical services (EMS) clinicians are in a unique position to screen for child maltreatment as they are often the first point of contact with the health care system and they may encounter children in their home environment. However, EMS training regarding the signs of child maltreatment is lacking. Although several child maltreatment screening tools have been developed for the primary care and emergency department (ED) settings, there appears to be no published literature describing or evaluating a prehospital screening aid. The objective of this study was to develop, implement, and examine the effectiveness and acceptability of a prehospital child maltreatment screening tool. ⋯ Shield screens were initiated on nearly 90% of pediatric patients evaluated by EMS during the study period, suggesting that this tool has the potential to help standardize child maltreatment screening in the prehospital setting.