Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Objectives: Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond to an opioid poisoning and administer opioid reversal therapy. Currently, the epidemiology of prehospital naloxone use among children and adolescents is incompletely characterized. ⋯ Naloxone was rarely documented to worsen clinical status. Our findings highlight the safety of prehospital naloxone use, as well as the importance of a high index of suspicion for opioid poisoning in the pediatric population. Opportunities exist to leverage linked data sources to develop interventions to improve prehospital opioid poisoning recognition and management.
-
Survival from out-of-hospital cardiac arrests (OHCA) remains lower in rural areas. Longer Emergency Medical Services (EMS) response times suggests that rural OHCA survival may need to rely more on early bystander intervention. This study compares the rates of bystander Cardiopulmonary Resuscitation (CPR) between rural and urban areas and examines societal factors associated with bystander CPR. ⋯ We observed lower rates of bystander CPR in communities with lower education, higher rates of non-Caucasian populations, and older populations. Our findings emphasize the need for public interventions in bystander CPR training to meet the needs of diverse community characteristics, and particularly in areas where EMS response times may be longer.
-
Despite early evidence of effectiveness, cost-savings, and resource optimization, mobile integrated health (MIH) programs have not been widely implemented in the United States. System, community, and organizational-level barriers often hinder evidence-based public health interventions, such as MIH programs, from being broadly adopted into real-world clinical practice. The objective of this study is to identify solutions to the barriers impeding the implementation of MIH through interviews with multilevel stakeholders. ⋯ An investigation of solutions to barriers that impede the translation of MIH models into sustainable practice elicited several unifying themes including the establishment of a cohesive identity for MIH to improve engagement and dissemination, the use of a strategic approach to program design that aligns with existing healthcare delivery workflows and collaboration with payors to promote a robust reimbursement structure. These findings may help accelerate the implementation of MIH programs into real clinical practice.
-
Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). ⋯ There is an opportunity for improvement for both LRs and FRs to apply AEDs per manufacturer's recommendations. Further research is needed to improve instructions and follow-up training to ensure accurate AED pad placement.
-
Emergency medical services (EMS) clinicians are in a unique position to screen for child maltreatment as they are often the first point of contact with the health care system and they may encounter children in their home environment. However, EMS training regarding the signs of child maltreatment is lacking. Although several child maltreatment screening tools have been developed for the primary care and emergency department (ED) settings, there appears to be no published literature describing or evaluating a prehospital screening aid. The objective of this study was to develop, implement, and examine the effectiveness and acceptability of a prehospital child maltreatment screening tool. ⋯ Shield screens were initiated on nearly 90% of pediatric patients evaluated by EMS during the study period, suggesting that this tool has the potential to help standardize child maltreatment screening in the prehospital setting.