Articles: emergency-medicine.
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J Pain Symptom Manage · Jan 2023
Communication training and code status conversation patterns reported by emergency clinicians.
During acute health decompensations for seriously ill patients, emergency clinicians often determine the intensity end-of-life care. Little is known about how emergency clinicians conduct these conversations, especially among those who have received serious illness communication training. ⋯ Most emergency clinicians reported asking about procedure-based questions, and some asked about patient's value-based questions. Clinicians with recent serious illness communication training may ask more about some values and priorities.
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The requirements for emergency medical services (EMS) medical directors are commonly defined by state rules and regulations without national standardization. The extent of variability in the requirements to be an EMS medical director in the US is unclear. The objective of this study is to describe the state requirements to function as an EMS medical director in the US. ⋯ Requirements for EMS medical direction across the US are not standardized. Many states require a medical license, but emergency medicine board certification is not a common requirement. Future work will need to focus on required competencies for EMS medical direction to set clear standards and educational requirements in the US.
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Over the past decade, Emergency Department (ED) patient volumes have increased more than available hospital ICU capacity. This has led to increased boarding and crowding in EDs, requiring new methods of providing intensive care. Many hospitals nationwide have developed ICU boarding mitigation strategies at the hospital and ED level or implemented ED-based resuscitative care units to improve patient care and disposition. However, these have been described in the setting of larger medical centers without broader application to rural, community ED environments. The authors herein have created an ED model utilizing a physician and nurse on-call team to provide improved care to critically ill patients requiring resuscitation when an ICU bed is not immediately available. ⋯ Over a twelve-month period, the authors describe a novel rural community-based mobile critical care team. This team demonstrated the ability to quickly arrive at bedside, continue resuscitation, acquire a disposition, and provide individualized critical are. This model serves as a roadmap for developing similar community based-resuscitation programs.
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The National Emergency Medical Services Information System (NEMSIS) is a federally funded program designed to standardize Emergency Medical Services (EMS) patient care reporting and facilitate state and national data repositories for the assessment and improvement of EMS systems of care. This manuscript characterizes the 2020 submissions to the National EMS Database, detailing the strengths and limitations associated with use of these data for public health surveillance, improving prehospital patient care, critical resource allocation, clinician safety, system quality assurance and research purposes. ⋯ The National EMS Database is a free and publicly available resource for evaluating EMS system utilization, response, and prehospital patient care. Understanding the characteristics of the underlying dataset and known data limitations will help ensure proper analysis and reporting of research and quality metrics based on nationally standardized NEMSIS data.
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We present the first report, to our knowledge, of an Out-of-hospital cardiac arrest (OHCA) witnessed during a remote international video meeting. We report an emergency system activation and OHCA resuscitation initiated after an OHCA in a 41-year-old otherwise healthy female in Houston, Texas witnessed by a co-worker in Australia during a 1-on-1 Zoom video call. Remotely witnessed emergencies such as OHCA present unique challenges to successful cardiac resuscitation and will likely become significantly more common in the future as remote video calls increase.