Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The aim of this study was to describe the incidence of and modifiable risk factors for post intubation hemodynamic collapse in prehospital and interfacility critical care transport. ⋯ Hemodynamic collapse and life-threatening hemodynamic collapse after intubation occurred frequently in this critical care transport cohort. Shock index greater than one was associated with significantly higher risk of hemodynamic collapse and life-threatening hemodynamic collapse.
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Elder mistreatment (EM), encompassing abuse and neglect, is a significant public health issue, affecting up to 10% of community-dwelling older adults annually. Elder mistreatment is a growing concern with a higher prevalence in institutional settings and substantial associated healthcare costs. Prehospital clinicians (PHCs) such as emergency medical technicians and paramedics are uniquely positioned to detect and report EM during their interactions with older adults in their homes. The objective of the study is to describe the rate and characteristics of EM documented by PHCs using the National Emergency Medical Services Information System (NEMSIS) database. ⋯ Despite the high prevalence of EM, PHCs infrequently document EM in their encounters with older adults. Additional training and comprehensive protocols are needed to improve the identification and reporting of EM, mainly elder neglect. Empowering PHCs through education and protocol development can significantly impact the detection and intervention of EM.
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Shorter pauses in cardiopulmonary resuscitation (CPR) are associated with better health outcomes after out-of-hospital cardiac arrest (OHCA). Our primary objective was to examine the effect of a RapidShockTM defibrillator software upgrade compared with standard defibrillator software on the length of perishock pause during care for OHCA among adults. Secondary objectives were to assess the effects of RapidShockTM on other CPR pauses. ⋯ Overall, we observed that the use of "RapidShockTM" defibrillator software was associated with shorter CPR pauses compared with the "Standard" software. Additional studies are required to examine whether further reductions in CPR pauses may be achieved and to investigate associations between shorter CPR pauses and health outcomes.
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Emergency Medical Services patients who survive overdose are at high risk for subsequent overdose and death. Programs that seek to link overdose survivors to harm reduction and treatment services are increasingly common, though they vary in design and measured effect. Public Health - Seattle & King County (PHSKC) used a continuous quality improvement (CQI) process to assess and improve a phone-based model for post-overdose outreach in King County, Washington. ⋯ The PDSA process helped PHSKC's post-overdose outreach team identify adaptations to improve the efficiency of the post-overdose outreach program. The number of people referred to services was modest, reflecting the challenges of post-incident phone-based outreach. Our experience highlights the value of incorporating CQI processes in ongoing program operations and the need for a multi-pronged overdose prevention strategy.
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Disparities remain in survival after out-of-hospital cardiac arrest (OHCA) for women compared to men. Our objective was to evaluate differences in automated external defibrillator (AED) use before Emergency Medical Services (EMS) arrival and time from arrival to initial EMS defibrillation by EMS-assessed gender (women or men). ⋯ Women with OHCA received lower rates of pre-EMS AED application and delays in initial EMS defibrillation compared to men.