Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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In Denmark, calls to the Danish emergency number 1-1-2 concerning medical emergencies are received by an emergency medical communication center (EMCC). At the EMCC, health care professionals (nurses, paramedics, and physicians) decide the necessary response, depending on the level of emergency as indicated by the Danish Index for Emergency Care. The index states 37 main criteria (symptoms) and five levels of emergency, descending from A (life threatening) to E (not serious). An ambulance is not sent to emergency level-E patients (level-E patients), but they are given other kinds of help/advice. No prior studies focusing on Danish level-E patients exist, hence the sparse knowledge about them. This study aimed to characterize level-E patients in the Central Denmark Region and to investigate their progress in the health care system after the 1-1-2 call, regarding contacting 1-1-2 again, general practitioner and Emergency Department (ED) visits, hospital admission, and death. ⋯ Level-E patients who contacted the EMCC of the Central Denmark Region were most frequently young adults. Almost 60% of level E-patients, who could be tracked, had no further contact with the health care system within a day after their 1-1-2 call. Of those who did, a quarter contacted an ED, indicating that level-E patients needed medical attention. The low fatality rates suggest limited undertriage, that is, level-E patients do not seem to need emergency medical service transportation. Further studies on undertriage among other things are needed.
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Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED). ⋯ Hypoglycemia in the pediatric seizure patient is extremely rare, thus universal field BGT has low utility and potential downstream effects. We propose a novel algorithm for the initial evaluation and management of prehospital pediatric seizures. Although limited to a retrospective analysis of a single medical center, our findings suggest the importance of reassessing prehospital seizure protocols. A larger patient sample should be studied to validate these findings and identify unique cases where glucose testing might be useful.
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Multicenter Study Comparative Study
Comparison of Emergency Medical Services and Trauma Care Systems Among Pan-Asian Countries: An International, Multicenter, Population-Based Survey.
Knowledge on the current trauma systems in Asian countries is limited. The objective of this study was to describe the emergency medical services (EMS) and trauma care systems among countries participating in the Pan-Asian Trauma Outcomes Study (PATOS) Clinical Research Network. ⋯ Substantial variability exists in EMS systems in Asia, especially for injured patients. Futures studies are required to assess the impact of this variability on patient outcomes.
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The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care. ⋯ The system of care approach on which this rural EMS measures set is based can support the FORHP's goal of better focusing State Flex Program activity to improve program impact on the performance of rural EMS services in the areas of financial viability, quality improvement, and local/regional health system performance.
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Blunt injuries to the cervical trachea remain rare but present unique and challenging clinical scenarios for prehospital providers. These injuries depend on prehospital providers either definitively securing the injured airway or bridging the patient to a treatment facility that can mobilize the necessary resources. ⋯ Ultimately, a systematic approach to all airways will ensure that prehospital providers are best prepared for even the most challenging scenarios.