Showing papers by "Remle P. Crowe published in 2022"
TL;DR: In this article , ACE-CPR was shown to improve neurological survival after out-of-hospital cardiac arrest (OHCA) compared with conventional (C) CPR in animal models.
9 citations
TL;DR: Existing EMS workforce research demonstrates continued underrepresentation of women and non-White personnel, which raises concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities.
5 citations
TL;DR: The authors conducted a scoping review of the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group.
4 citations
TL;DR: SDOH documentation in the EMS narrative was rare among pediatric encounters; however, children with documented SDOH were more likely to be transported.
4 citations
TL;DR: In this paper , the frequency of AEs following emergent prehospital sedation with three types of sedative agents: ketamine, benzodiazepines and antipsychotics was investigated.
2 citations
TL;DR: In this paper , the authors provide an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care.
Abstract: Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
2 citations
TL;DR: While Black patients were less likely than White patients to receive pain medications and receive pain medication within 20 minutes, Hispanics were more likely to receivePain medication administration is uncommon for non-traumatic pain complaints.
2 citations
TL;DR: The authors found that feeling called to a job makes professionals more vulnerable to the negative effects of acute stressors, such as mental exhaustion, sleep quality, and alcohol consumption, and that these indirect effects were stronger among those with higher (vs. lower) levels of calling intensity.
Abstract: The burgeoning occupational callings literature has shown that feeling called to a job is associated with an array of positive job-, career-, and health-related outcomes. However, recent studies have begun to indicate that there may also be a "negative side" of callings. The present study builds on this emerging perspective to examine whether feeling called to a job makes helping professionals more vulnerable to the negative effects of acute stressors. Specifically, we integrated identity, cognitive rumination, and psychological detachment theories to explain how feeling called to one's job (i.e., the strength of one's calling intensity) might bolster the negative, indirect relationship between emotionally disturbing work and strain (i.e., mental exhaustion, sleep quality, and alcohol consumption) through negative work rumination. Results from a 10-week diary study with a national U.S. sample of 211 paramedics revealed that on weeks that paramedics experienced more emotionally disturbing work, they engaged in greater levels of negative work rumination, which in turn was associated with greater mental exhaustion and worse sleep quality, but not greater alcohol consumption. In addition, calling intensity moderated the indirect effect of emotionally disturbing work on both mental exhaustion and sleep quality, such that these indirect effects were stronger among those with higher (vs. lower) levels of calling intensity. These results provide evidence that employees who feel most called to their jobs may be particularly vulnerable to short-term negative outcomes associated with emotionally disturbing work. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
2 citations
TL;DR: In this paper , the authors examined the association between duration and depth of pre-hospital post return of spontaneous circulation (ROSC) hypotension and survival, using multivariable logistic regression.
2 citations
TL;DR: NLP holds promise as a tool for use in predictive models with the goal to increase evidence-based management of pediatric OHCA and incorporate those terms into machine learning models of prehospital ROSC improves predictive ability.
2 citations
TL;DR: In this article , the association of bicarbonate administration in out-of-hospital cardiac arrest (OHCA) is investigated. But, there is limited clinical evidence to support its routine administration.
TL;DR: This study aimed to assess the feasibility of prehospital bolus dose esmolol for patients with RVF treated by a high‐volume, ground‐based emergency medical services (EMS) agency.
Abstract: Esmolol may increase survival for patients with refractory ventricular fibrillation (RVF); however, information related to esmolol use in the prehospital environment is limited. We aimed to assess the feasibility of prehospital bolus dose esmolol for patients with RVF treated by a high‐volume, ground‐based emergency medical services (EMS) agency.
TL;DR: Ketamine was primarily used for analgesia, but was frequently used for other indications, and most patients were observed to improve after ketamine use, with most injured patients reporting decreases in pain scores.
TL;DR: Metcalf et al. as mentioned in this paper conducted a series of qualitative interviews with front-line emergency personnel regarding attitudes and beliefs toward people who use opioids and found that they struggle with (1) compassion, stigma, and professionalism.
Abstract: More than 2 decades into the ongoing opioid epidemic, an estimated 2.1 million people are affected by opioid use disorder with a recordhigh number of deaths exceeding 93,000 in 2020 in the United States alone.1,2 First responders, including police, firefighters, and emergency medical services clinicians are often the first to provide assistance in opioid-relatedemergencies.However, the system inwhich first responders operate is poorly equipped to manage these encounters. Structurally, the protocol-based approach of first-responder care is not designed to manage the chronic and complex nature of addiction. As emergency care practices are rarely coupled with a clear path to effective long-term treatment options, emergency personnel provide frequent (and often repeated) care to these persons, repeatedly bearing witness to the devastating social and physical effects of opioid addiction. As a result, many emergency personnel feel frustrated and helplesswhen it comes to encounters involving opioid use disorder. In these trying circumstances, it is critical to understand emergency professionals’ attitudes and beliefs toward people who use opioids. In this issue, Metcalf et al’s “Compassion, Stigma, and Professionalism among Emergency Personnel Responding to the Opioid Crisis: An Exploratory Study in New Hampshire, USA” presents findings from a series of qualitative interviews with front-line emergency personnel regarding attitudes and beliefs toward people who use opioids. This study provides an important look at the experiences of emergency personnel in caring for those affected by opioid use disorder and offers a framework for exploring how these experiences may shape their beliefs and attitudes. This investigation is critically needed as emergency personnel often provide the first—and often the only—care for those struggling with opioid use disorder. From this exploratory work emerge 3 core themes: when caring for opioid abuse victims, emergency personnel struggle with (1) compassion, (2) stigma, and (3) professionalism. Compassionate beliefs included those that reflected a desire to alleviate suffering following the witnessing of another’s distress. Stigmatizing beliefs, defined as negative biases toward those who use opioids, also included the more nuanced categories of suspicious and cynical attitudes. Interestingly, these categorieswere notmutually exclusive among participants.
TL;DR: In this paper , the authors performed hierarchical logistic regression and 2-stage least squares regression using agency treatment patterns as an instrument to examine the effectiveness of midazolam in a national out-of-hospital cohort.
TL;DR: In this large national sample of 9-1-1 transports, rural location was associated with significantly longer EMS interval for patients with suspected STEMI, even after accounting for loaded mileage.
TL;DR: In this paper , the authors examined the association of pre-hospital post-ROSC hypoxia and hyperoxia with the primary outcome of survival to discharge home, and explored the associationof these measures with survival using multivariable logistic regression.
TL;DR: In this article , the authors evaluate emergency medical services professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics, and describe the differences in behaviours by characteristics.
Abstract: To evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics.
TL;DR: This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record.
TL;DR: M Males, older age groups, and Hispanic/Latino patients had higher odds of non-transport among this population of community-dwelling adults age 60 or greater, and these findings may inform development of future targeted falls-related mobile integrated health or community paramedic services and referrals to community intervention programs.
TL;DR: In this article , the authors examined the association between duration and depth of pre-hospital post return of spontaneous circulation (ROSC) hypotension and survival using multivariable logistic regression.
Abstract:
Introduction:
Hypotension following resuscitation from out-of-hospital cardiac arrest (OHCA) may cause harm by exacerbating secondary brain injury; however, limited research has explored this relationship. Our objective was to examine the association between duration and depth of prehospital post return of spontaneous circulation (ROSC) hypotension and survival.
Hypothesis:
We hypothesized that increased severity and duration of post-ROSC hypotension in the prehospital setting would be associated with unfavorable patient outcomes.
Methods:
We utilized the 2019 and 2020 ESO Data Collaborative public use research data sets for this study (ESO, Austin, TX). Hypotension dose (mmHg*min.), average prehospital systolic blood pressure (SBP), and lowest recorded prehospital SBP were calculated. The association of these measures with survival to home (STH) and rearrest were explored using multivariable logistic regression. Time to hypotension resolution analyses were conducted using Cox proportional hazards models adjusted for known prognostic factors according to the Utstein template. We also assessed the association of hypotension management strategy (push dose vasopressors, vasopressor infusion, or fluid only) with survival, rearrest, and time to hypotension resolution.
Results:
17,280 OHCA patients met inclusion criteria, of which 3,345 had associated hospital outcome data. Over one-third (37.8%; 6,526/17,280) of all patients had at least one recorded SBP below 90 mmHg. When modeled continuously, average prehospital SBP (1.19 [1.15, 1.23] per 10 mmHg), lowest prehospital SBP (1.20 [1.17, 1.24] per 10 mmHg), and hypotension dose (0.995 [0.993, 0.996] per mmHg*min.) were independently correlated with STH. Differences in hypotension management were not associated with differences in survival, rearrest, or time to hypotension resolution.
Conclusion:
Severity and duration of hypotension were significantly associated with poorer outcomes in this dataset. The incidence of hypotension was significantly associated with known unfavorable prognostic factors. Defining a threshold for hypotension requiring treatment above the classical SBP threshold of 90 mmHg may be warranted in the setting of prehospital post-resuscitation care.
TL;DR: In this article , the types of EMS agencies administering whole blood or the patients who receive whole blood from EMS were investigated, and the results showed that whole blood administration in military settings has led to adoption by some emergency medical services (EMS) agencies.