Paramedic Initiated Non-transport Of Pediatric Patients
children; emergency medical-services; Emergency Medicine; EMS; Environmental & Occupational Health; life; non-transport; Pediatrics; physician; pramedic triage; prehospital evaluation; Public; system
Introduction. In a time of emergency department overcrowding and increased utilization of emergency medical services, a highly functional prehospital system will balance the needs of the individual patient with the global needs of the community. Our community addressed these issues through the development of a multitiered prehospital care system that incorporated EMS initiated non-transport of pediatric patients. Objective. To describe the outcome of pediatric patients accessing a progressive prehospital system that employed EMS initiated non-transport. Methods. A prospective observational case series was performed on pediatric patients (< 21 years old) designated EMS initiated non-transport. Patients were designated non-transport after an initial EMS protocol driven, complaint-specific clinical assessment in conjunction with medical oversight affirmation. Telephone follow-up was completed on all consecutively enrolled non-transport patients to collect information about outcome ( safety) as well as overall satisfaction with the system. A five-point Likert scale was utilized to rate satisfaction. Results. There were 5,336 EMS requests during the study period. Seven hundred and four were designated non-transport, of which 74.8% completed phone follow-up. Categories of EMS request included minor; medical illness 43.4%, trauma 55.9%, and other 1.1%. There were 13 admissions (2.4%) to the hospital after EMS initiated non-transport designation. Admissions after non-transport had trends toward younger age ( p = 0.002) and medical etiology ( p = 0.006). There were no PICU admissions or deaths. Conclusion. Our EMS system provides an alternative to traditional protocols, allowing EMS initiated non-transport of pediatric patients, resulting in effective resource utilization with a high level of patient safety and family satisfaction.
Haines C J; Lutes R E; Blaser M; Christopher N C
Prehospital Emergency Care
2006
2006-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1080/10903120500541308" target="_blank" rel="noreferrer noopener">10.1080/10903120500541308</a>
Iatrogenic Spinal Cord Injury In A Trauma Patient With Ankylosing Spondylitis
ankylosing spondylitis; board; cervical spine; Emergency Medicine; EMS; Environmental & Occupational Health; fracture; healthy; iatrogenic injury; immobilization; immobilization devices; motion; Public; pulmonary-function; spinal; trauma
Maarouf A; McQuown C M; Frey J A; Ahmed R A; Derrick L
Prehospital Emergency Care
2017
2017-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1080/10903127.2016.1263369" target="_blank" rel="noreferrer noopener">10.1080/10903127.2016.1263369</a>
Characteristics of Prehospital ST-segment Elevation Myocardial Infarctions.
Female; Male; Prospective Studies; Emergency Medical Services; Demography; Data Collection; Patient Care; Academic Medical Centers; Confidence Intervals; Human; Data Analysis; Middle Age; Outcomes (Health Care); Emergency Service; Databases; Angioplasty; Race Factors; Prehospital Care; Percutaneous Coronary; Transluminal; Myocardial Infarction – Diagnosis; Myocardial Infarction – Therapy; Cardiac Patients – Evaluation; Chest Pain – Diagnosis; Myocardial Infarction – Symptoms; ST Segment – Evaluation
Introduction. Despite attention directed at treatment times of ST-segment elevation myocardial infarctions (STEMIs), little is known about the types of STEMIs presenting to the emergency department (ED). Objective. The purpose of this study was to determine the relative frequencies and characteristics of emergency medical services (EMS) STEMIs compared with those in patients who present to the ED by walk-in. This information may be applied in EMS training, system planning, and public education. Methods. This was a query of a prospectively gathered database of all STEMIs in patients presenting to Summa Akron City Hospital ED in 2009 and 2010. We collected demographic information, chief complaint, mode and time of arrival, and STEMI pattern (anterior, lateral, inferior, or posterior). We excluded transfers and in-hospital STEMIs. We calculated means, percentages, significance, and 95% confidence intervals (CIs) ± 10%. Results. We analyzed data from 308 patients. Most patients (241/308, 78%, CI 73%-83%) arrived by EMS, were male (203/308, 66%, CI 60%-71%), and were white (286/308, 93%, CI 89%-96%). Patients arriving by EMS were older (average 63 years, range 35-95) than walk-in patients (average 57 years, range 24-92). Two percent (5/241, 2%, CI 1%-5%) of EMS STEMI patients were under 40 years of age, compared with 10% (7/67, 10%, CI 4%-20%) of walk-in patients (p = 0.0017). The most common chief complaint was chest pain (278/308, 90%, CI 86%-93%). Inferior STEMIs were most common (167/308, 54%, CI 49%-60%), followed by anterior (127/308, 41%, CI 48%-60%), lateral (8/308, 3%, CI 1%-5%), and posterior (6/308, 2%, CI 1%-4%). A day-of-the-week analysis showed that no specific day was most common for STEMI presentation. Forty percent (122/308, 40%, CI 34%-45%) of patients presented during open catheterization laboratory hours (Monday through Friday, 0730-1700 hours). There was no significant statistical difference between EMS and walk-in patients with regard to STEMI pattern or patient demographics. Conclusions. In this study, 95% (294/308) of all STEMIs were inferior or anterior infarctions, and these types of presentations should be stressed in EMS education. Most STEMI patients at this institution arrived by ambulance and during off-hours. Younger patients were more likely to walk in. We need further study, but we may have identified a target population for future interventions. Key words: emergency medical services; allied health personnel; electrocardiography; myocardial infarction; heart catheterization; STEMI
Celik Daniel H; Mencl Francis R; DeAngelis Anthony; Wilde Joshua; Steer Sheila H; Wilber Scott T; Frey Jennifer A; Bhalla Mary Colleen
Prehospital Emergency Care
2013
2013-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/10903127.2013.785619" target="_blank" rel="noreferrer noopener">10.3109/10903127.2013.785619</a>