Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Opioid-associated fatal and non-fatal overdose rates continue to rise. Prehospital overdose education and naloxone distribution (OEND) programs are attractive harm-reduction strategies, as patients who are not transported by EMS after receiving naloxone have limited access to other interventions. This narrative summary describes our experiences with prehospital implementation of evidence-based OEND practices across Ohio as part of the HEALing Communities Study (HCS). ⋯ Our OEND implementation experiences across multiple Ohio EMS agencies identified several barriers, facilitators, and creative solutions that may inform future prehospital harm-reduction programs.
-
Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation. ⋯ Our prehospital buprenorphine induction program successfully inducted eligible patients and connected them with follow up. Almost half of inducted patients were able to follow up with our outpatient provider. One in ten patients who received buprenorphine from EMS remained in treatment. There exists an opportunity for EMS to screen more patients for buprenorphine induction as only one in four patients who received naloxone were screened for buprenorphine induction. Lessons learned include the need for recurrent EMS clinician education regarding buprenorphine screening, the need for a "buprenorphine champion" to follow up with inducted patients and addressing early administrative and technological barriers to ensure data exchange.
-
Paramedic services face increasing challenges due to delays in patient transfer of care (TOC) at emergency departments (EDs). Prolonged TOC times directly impact paramedic services' ability to provide emergency response, though the patient and clinical factors contributing to these delays remain unclear. We examined TOC times for all transports to the ED and analyzed factors associated with prolonged TOC. ⋯ Prolonged TOC times disproportionately affect older or clinically complex patients, regardless of their acuity or need for paramedic intervention. Our findings highlight the importance for paramedic services, hospitals, and stakeholders to develop targeted care models and collaborations to reduce prolonged TOC.
-
Abusive head trauma (AHT) is a leading cause of death in young children. Analyses of patient characteristics presenting to Emergency Medical Services (EMS) are often limited to structured data fields. Artificial Intelligence (AI) and Large Language Models (LLM) may identify rare presentations like AHT through factors not found in structured data. Our goal was to apply AI and LLM to EMS narrative documentation of young children to detect AHT. ⋯ AI and LLMs have high sensitivity and specificity to detect AHT-CAN in EMS free-text narratives. Words associated with physical signs of trauma are strongly associated with AHT-CAN. LLMs augmented with a list of n-grams may help EMS identify signs of trauma that aid in the detection of AHT in young children.
-
International Prehospital Emergency Care (PEC) standards have been primarily developed by and for high resource settings. Most PEC systems in Asia, which are still in the early stages of development, struggle to achieve these standards. There is a need for an evaluation tool which can define achievable basic building blocks for PEC systems in low resource settings to improve quality of PEC. We aimed to identify the core, basic elements (building blocks of a PEC system) for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for low resource settings in Asia. ⋯ Through a Delphi consensus process, stakeholders identified core elements for PEC systems in low resource settings. These findings will inform the development of a tool for quality assurance and monitoring in low resource settings in South and Southeast Asian countries.