Background: Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. Study objective: To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. Methods: This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after. Results: Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre‐MIH to 26 post‐MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11). Conclusion: In this pilot before/after study, MIH significantly reduces acute care hospitalizations.

Mobile integrated health to reduce post-discharge acute care visits: A pilot study

https://www.tandfonline.com/doi/pdf/10.1080/10903127.2021.1977877?needAccess=true

Prehospital Airway Management Training and Education: An NAEMSP Position Statement and Resource Document

Recommendations for Improving the Quality of Prehospital Evidence-Based Guidelines

Introduction: Crewmembers of the "Royal Netherlands Sea Rescue Institution" (KNRM) lifeboats must wear heavy survival suits with integrated lifejackets. This and the challenging environment onboard (boat movements, limited space) might influence Basic Life Support (BLS) performance. The primary objective of this study was to assess the impact of the protective gear on single-rescuer BLS-quality. Material and Methods: Sixty-five active KNRM crewmembers who had recently undergone a BLS-refresher course were randomized to wear either their protective gear (n = 32) or their civilian clothes (n = 33; control group) and performed five 2-min sessions of single rescuer BLS on a mannequin on dry land. BLS-quality was assessed according to Dutch and European Resuscitation guidelines. A between group analysis (Mann-Whitney U) and a repeated within group analysis of both groups (Friedman test) were performed. Results: There were no major demographic differences between the groups. The protective gear did not significant impair BLS-quality. It was also not associated with a significant increase in the perceived exertion of BLS (Borg's Rating scale). Compression depth, compression frequency, the percentage of correct compression depth and of not leaning on the thorax, and ventilation volumes in both groups were suboptimal when evaluated according to the BLS-guidelines. Conclusions: The protective gear worn by KNRM lifeboat-crewmembers does not have a significant influence on BLS-quality under controlled study conditions. The impact and significance on outcome in real life situations needs to be studied further. This study provides valuable input for optimizing the BLS-skills of lifeboat crewmembers.

/pdf/performance-of-basic-life-support-by-lifeboat-crewmembers-3zfcp5ib3m.pdf

Performance of Basic Life Support by Lifeboat Crewmembers While Wearing a Survival Suit and Life Vest : A Randomized Controlled Trial

As out‐of‐hospital medicine evolves, emergency medical services (EMS) education practices must also be updated to ensure that EMS professionals acquire and maintain the skills needed to best serve patients. We aimed to identify and rank the top 10 research priorities related to EMS education in the United States.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/emp2.12882

Defining priorities for emergency medical services education research: A modified Delphi study

EMS Curriculum Should Educate Beyond a Technical Scope of Practice: Position Statement and Resource Document.

Objective Prehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise that precludes a prolonged extrication, they may benefit from an emergent prehospital amputation. The objective was to experimentally compare three prehospital amputation techniques on porcine legs. Methods The three techniques studied were a scalpel with a Gigli saw, a hacksaw, and a reciprocating saw. For the first technique, a scalpel was used to make a circumferential incision in the soft tissue and a Gigli wire saw to cut through the bone. The second and third techniques only used a saw and did not require soft tissue incision with a scalpel. Three providers including an emergency medicine physician, a paramedic, and a medical student performed three amputations of each technique, resulting in twenty-seven total amputations. The primary outcome was amputation time. Secondary outcomes were rate of instrument malfunction and cleanliness of cut. Results The primary outcome of amputation time was different between techniques. The Gigli saw technique took 32.86 ± 16.53 s (mean ± SD), hacksaw technique 6.28 ± 0.76 s, and reciprocating saw technique 2.84 ± 0.40 s. There were no differences in amputation time between participants for a given amputation technique. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. Differences in cleanliness of cut were nonsignificant. Conclusions Prehospital limb amputation with a hacksaw or reciprocating saw may result in faster completion of the time-sensitive procedure with fewer instrument malfunctions.

/pdf/prehospital-amputation-an-experimental-comparison-of-2cq5jzllfl.pdf

Joshua D. Stilley

Papers

EMS Curriculum Should Educate Beyond a Technical Scope of Practice: Position Statement and Resource Document.

Prehospital amputation: An experimental comparison of techniques.

How Does Rescuer Fitness Affect the Quality of Prolonged Cardiopulmonary Resuscitation