Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Objective: Pediatric patients represent low frequency but potentially high-risk encounters for emergency medical services (EMS) providers. Scant information is available from EMS agencies on the frequency of pediatric skill evaluation and the presence of pediatric emergency care coordination, both which may help EMS systems optimize care for children. The objective of our study was to assess the frequency and type of methods used to assess psychomotor skills competency using pediatric-specific equipment and pediatric care coordination in EMS ground transport agencies. ⋯ Pediatric-specific psychomotor skills testing is more common in EMS agencies that respond to a higher pediatric call volume and have a PECC. For EMS agencies that infrequently treat children, the presence of a PECC may enhance the frequency of pediatric psychomotor skills evaluation. The presence of a PECC can potentially increase provider confidence and safety for all pediatric prehospital patients regardless of volume and location.
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Objective: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted to increase understanding about the difficulties of responding to pediatric calls and to obtain information about how organizations can better support EMS providers in managing potentially difficult calls. Methods: Paramedics and emergency medical technicians from a single U. ⋯ Suggestions for additional resources included: increased opportunities for external feedback; more frequent pediatric clinical training; institutionalization of recovery time after difficult calls; and improved storage and labeling of pediatric equipment. Conclusions: This study provides qualitative data about the difficulties of responding to pediatric calls and resources needed to support clinicians. Findings from this study can be used to guide EMS leaders in designing and implementing institutional initiatives to enhance training and support for prehospital clinicians providing care to children.
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Case Reports
Autistic Man Falling Through the Cracks: Advanced Patient Transport and the "Pop-up" Recovery Ward.
The Royal Flying Doctor Service was tasked to relocate a 19 year-old autistic patient with severe social anxiety, agoraphobia, and morbid obesity from one residential location to another. The retrieval team was confronted with two main challenges: 1) Continuous risk elevation in an elective patient transportation as distinct from other urgent prehospital transfers of mental health patients; and 2) prehospital ketamine/propofol sedation of an aggressive/combative patient with recovery from sedation in a private property. The transfer accomplished the successful relocation of the patient.
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Objectives: Pediatric specialty care is increasingly regionalized. It is unknown how regionalization affects emergency medical services (EMS) providers' destination decisions for non-trauma pediatric patients. We sought to characterize the rates of bypass of the closest facility, and destination facilities' levels of pediatric care in three diverse EMS agencies. ⋯ Conclusions: This study reveals a high rate of pediatric bypass for non-trauma patients in three diverse EMS agencies. Bypass results in increased EMS resource utilization through longer transport time and distance. For non-trauma pediatric patients for whom there is little destination guidance, further work is required to determine bypass' effects on patient outcomes.
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Introduction: There is a minimal amount of published data regarding to Emergency Medical Services (EMS) fellowship programs. The purpose of this study was to obtain program characteristics and diversity data regarding EMS fellowship programs. Methods: A survey was sent to program directors at all EMS fellowship programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). ⋯ EMS fellowships (12.0%, 33/274), OR = 1.8, 95% CI:1.2-2.6, p < 0.002. Conclusion: A significant number of EMS fellowship positions have remained unfilled since implementation of an accreditation process for EMS fellowships. The percentage of females and under-represented minority faculty in EMS programs was much lower than for EM residency programs.