Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. ⋯ Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.
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Observational Study
Accuracy of Prehospital Intravenous Fluid Volume Measurement by Emergency Medical Services.
Prehospital treatment protocols call for intravenous (IV) fluid for patients with shock, yet the measurement accuracy of administered fluid volume is unknown. The purpose of the current study was to assess the accuracy of documented and self-reported fluid volumes administered to medical patients by paramedics during prehospital care. We conducted a pilot, observational study nested within a parent cohort study of prehospital biomarkers in a single EMS agency transporting patients to a tertiary care hospital in Pittsburgh, Pennsylvania over 8 months. Among eligible nontrauma, noncardiac arrest patients, we studied the self-reported IV fluid volume on ED arrival by paramedics, documented fluid volume in the EMS record, and compared those to the mass-derived fluid volume. We quantified the absolute error between methods, and determined EMS transport times or initial prehospital systolic blood pressure had any effect on error. We enrolled 50 patients who received prehospital IV fluid and had mass-derived fluid volume measured at ED arrival. Of these, 21 (42%) patients had IV fluid volume subsequently documented in EMS records. The median mass-derived fluid volume was 393 mL [IQR: 264-618 mL]. Mass-derived volume was similar for subjects who did (386 mL, IQR: 271-642 mL) or did not (399 mL, IQR: 253-602) have documented fluid administration (p > 0.05). The median self-reported fluid volume was 250 mL [IQR: 150-500 mL] and did not differ by documentation (p > 0.05). The median absolute error comparing self-reported to mass-derived fluid volume was 109 mL [IQR: 41-205 mL], and less than 250 mL in more than 80% of subjects. The median absolute error comparing documented fluid to mass-derived fluid volume was 142 mL [IQR: 64-265 mL], and was less than 250 mL in 71% of subjects. No difference in absolute error for either self-reported or document fluid volumes were modified by transport time or prehospital systolic blood pressure. Prehospital IV fluid administration is variably documented by EMS, and when recorded is typically within 250 mL of mass-derived fluid volume. ⋯ emergency medical services; prehospital resuscitation; intravenous fluids; fluids.
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The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18-24 y and sustained an injury within the previous 24 h. ⋯ Controlling for sex, acute alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p < 0.001). Acute alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients.
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Prehospital dosing errors affect approximately 56,000 US children yearly. To decrease these errors, barriers, enablers and solutions from the paramedic (EMT-P) and medical director (MD) standpoint need to be understood. We conducted a mixed-methods study of EMT-P and MDs in Michigan utilizing focus groups (FG). ⋯ Simplification of dose delivery, an improved length based tape for EMS, pediatric checklists, and dose cards in mL were given as solutions. This mixed-methods study identified barriers and potential solutions to reducing prehospital pediatric drug dosing errors. Solutions should be thoroughly tested prior to implementation.
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Research on field triage of injured patients is limited by the lack of a widely used criterion standard for defining trauma center need. Injury Severity Score (ISS) >15 has been a commonly used outcome measure in research for determining trauma center need that has never been validated. A multidisciplinary team recently published a consensus-based criterion standard definition of trauma center need, but this measure has not yet been validated. ⋯ The kappa coefficient of agreement for ISS and the consensus-based criterion standard was 0.43. We determined that the consensus-based criterion standard could be identified through a medical record review. Use of the consensus-based criterion standard for field triage research will more accurately identify injured patients who need the resources of a trauma center when compared to ISS.