Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Communication errors are a source of preventable medical errors. In high-risk health care settings, identifying the source and addressing root causes can reduce error and improve patient safety. While air medical transport is a high-risk setting, its sources and rates of error have been investigated only within the last several years. ⋯ Communication-based errors are common in the initial phases of call booking in air medical transport. Human and process-driven errors contribute equally to these errors.
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Comparative Study
Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest.
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. ⋯ This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.
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Prehospital personnel rely on timely and accurate pulse oximetry data when performing critical skills, such as rapid-sequence intubation (RSI). However, loss of signal may be a frequent occurrence in patients with poor peripheral perfusion. In addition, a delay or latency period in the timeliness of pulse oximetry data may exist with probes placed on the fingers. ⋯ A high incidence of pulse oximetry failure was observed with the use of a digital pulse oximetry probe during prehospital RSI. In addition, a latent period appears to exist in the majority of patients undergoing desaturation.
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In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. ⋯ Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.
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Comparative Study
Prevalence of depression and cognitive impairment in older adult emergency medical services patients.
To characterize the proportion of older adult emergency department (ED) patients with depression or cognitive impairment. To compare the prevalences of depression or cognitive impairment among ED patients arriving via emergency medical services (EMS) and those arriving via other modes. ⋯ Consent was obtained from 1,342 eligible older adults; 695 (52%) arrived via EMS. The median age for those arriving via EMS was 74 years (interquartile range 65, 82), 52% were female, and 81% were white. Fifteen percent of EMS patients had moderate or greater depression, as compared with 14% of patients arriving via other modes (p = 0.52). Thirteen percent of the EMS patients had cognitive impairment, as compared with 8% of those arriving via other modes (p < 0.01). The depressed EMS patients frequently reported a history of depression (47%) and taking antidepressants (51%). The cognitively impaired EMS patients infrequently reported a history of dementia (16%) and taking medications for dementia (14%). Conclusions. In this cohort of community-dwelling older adult ED patients, depression and cognitive impairment were common. As compared with ED patients arriving by other transport means, patients arriving via EMS had a similar prevalence of depression but an increased prevalence of cognitive impairment. Screening for depression and cognitive impairment by EMS providers may have value, but needs further investigation.