Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Multicenter Study Observational Study
Association between Scene Time Interval and Survival in EMS-Treated Major Trauma Admitted to the Intensive Care Unit: A Multinational, Multicenter Observational Study.
Objective: Major trauma is a major concern in public health and a leading cause of mortality worldwide. This study aimed to evaluate the association between the prehospital scene time interval (STI) and survival in emergency medical service (EMS)-assessed major trauma patients admitted to the intensive care unit (ICU). Methods: A retrospective observational study using the Pan-Asian Trauma Outcomes Study (PATOS) database was conducted. ⋯ Conclusion: In EMS-assessed adult major trauma patients admitted to the ICU, we found significant associations between STIs longer than 8 minutes and outcomes. EMS intervention has a positive interaction effect with an intermediate STI on survival. More research is needed to understand the implications of practice for major trauma in the field.
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Observational Study
Cerebral oximetry during out-of-hospital resuscitation: Pilot Study of First Responder Implementation.
Background: Anoxic brain injury is a common mode of death following out-of-hospital cardiac arrest (OHCA). We assessed the course of regional cerebral oxygen saturation (rSO2) at the outset and during first responder resuscitation to understand its relationship with return of spontaneous circulation (ROSC) and functional survival. Methods: We undertook a prospective observational investigation of adult OHCA patients treated by a first-responder EMS agency in King County, WA. ⋯ Among patients who achieved ROSC, those who would survive with CPC 1-2 had a higher rSO2 cerebral oximetry following ROSC than nonsurvivors (74% vs. 60%, p = 0.04 at 5 minutes post ROSC), a difference that was not evident in the minutes prior to ROSC (55% vs. 51% at 3 minutes prior to ROSC, p = 0.5). Conclusion: In this observational study, where first responders applied cerebral oximetry, higher rSO2 during the course of care predicted ROSC among all patients and predicted favorable survival among those who achieved ROSC. Future investigation should evaluate whether and how treatments might modify rSO2 and in turn may influence prognosis.
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Study Objective: Most 911 calls result in ambulance transport to an emergency department. In some cases, transport is refused or deemed unnecessary. The frequency of pediatric non-transport is unknown. ⋯ Conclusion: Almost one-third of pediatric 911 activations result in non-transport. Although very few children have been included in pilots of alternate transport processes to date, non-transport is actually more common in children than adults. More work is needed to understand better the patient safety and economic implications of this practice.
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Introduction: Emergency response to a road traffic injury (RTI) plays a crucial role in patient survival, and the quality of the emergency response should be consistent regardless of the time of day. The aim of this study was to investigate prehospital care and survival outcomes compared between emergency response to RTI during the day and emergency response to RTI at night in Asia. Method: This cross-sectional study used data from the Pan-Asian Trauma Outcome Study (PATOS) that was conducted during 2015-2018. ⋯ The nighttime group had decreased survival in the ED (aOR: 0.80, 95%CI: 0.65-0.98); however, nighttime on-scene arrival did not impact survival to discharge (aOR: 1.10, 95%CI: 0.91-1.33). Conclusion: In the PATOS community, RTI patients that sustained their injuries at night received significantly more prehospital immobilization and IV access, and they had significantly decreased survival in the ED. The results of this study can be used to develop and enhance strategies to improve the care and outcomes of nighttime RTI in Asia.
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Background: Prehospital pediatric drug dosing errors occur at a high rate. Multiple factors contribute to these errors. The contribution of weight estimation errors to drug dosing errors is unknown. ⋯ Conclusions: BLT is the most frequently used method to obtain a patient weight. Drug dosing errors were most frequent with patient age, followed by BLT and asking the parent. System-based solutions-weight determination hierarchy, not using the BLT on seated patients, and more frequent training and practice with the BLT-are needed to improve drug-dosing accuracy.