National Characteristics of Emergency Medical Services Responses in the United States
TL;DR: An analysis of the 2010 National Emergency Medical Services Information System research data set, encompassing EMS emergency response data from 29 states, estimated the national number and incidence of EMS responses and characterizedEMS responses and the patients receiving care.
About: This article is published in Prehospital Emergency Care.The article was published on 2013-01-01. It has received 85 citations till now. The article focuses on the topics: Population & Emergency medical services.
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TL;DR: Immediate intervention with methylene blue was effective in reducing neuroinflammation and improving behavioral recovery after diffuse brain injury, and may reduce life-threatening complications of TBI, including edema and neuro inflammation, and protect against the development of neuropsychiatric complications.
Abstract: Traumatic brain injury (TBI) is associated with cerebral edema, blood brain barrier breakdown, and neuroinflammation that contribute to the degree of injury severity and functional recovery. Unfortunately, there are no effective proactive treatments for limiting immediate or long-term consequences of TBI. Therefore, the objective of this study was to determine the efficacy of methylene blue (MB), an antioxidant agent, in reducing inflammation and behavioral complications associated with a diffuse brain injury. Here we show that immediate MB infusion (intravenous; 15–30 minutes after TBI) reduced cerebral edema, attenuated microglial activation and reduced neuroinflammation, and improved behavioral recovery after midline fluid percussion injury in mice. Specifically, TBI-associated edema and inflammatory gene expression in the hippocampus were significantly reduced by MB at 1 d post injury. Moreover, MB intervention attenuated TBI-induced inflammatory gene expression (interleukin [IL]-1β, tumor ne...
82 citations
TL;DR: In this article, the authors analyze prehospital management of pain using NEMSIS data, and assess if variables such as patient age and/or race/ethnicity are associated with disparity in pain treatment.
80 citations
TL;DR: Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time and add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future.
Abstract: The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the whole Swiss population. We observed a 40% increase in the number of requests to PEMS between 2001 and 2010. The overall rate of requests was 35/1000 inhabitants for ambulance services and 10/1000 for medical interventions (SMUR), with the highest rate among people aged ≥ 80. Most frequent reasons for the intervention were related to medical problems, predominantly unconsciousness, chest pain respiratory distress, or cardiac arrest, whereas severe trauma interventions decreased over time. Overall, 89% were alive after 48 h. The survival rate after 48 h increased regularly for cardiac arrest or myocardial infarction. Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time. The results we found add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future. More comprehensive analysis of the quality of services and patient safety supported by indicators are also required, which might help to develop prehospital emergency services and new processes of care.
74 citations
Cites background or methods from "National Characteristics of Emergen..."
...These results are most likely related to demographic changes and to the gradual ageing of the Swiss population, leading to increasing PEMS interventions for elderly patients, especially those aged 80–89 [8,30]....
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...Detailed activities of PEMS were previously described [4-9]....
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TL;DR: The annual NEMSIS Public-Release Research Dataset is a valuable resource for evaluating the U.S. EMS activation population and can be used to conduct in-depth descriptions of the care of specific populations, however, the utility of the data are limited until the number of null values can be diminished and reporting becomes universal.
70 citations
Additional excerpts
...Bleeding 315,549 (3) Breathing problem 858,174 (8) Change in responsiveness 1,045,767 (10) Choking 14,040 (<1) Death 32,186 (<1) Device/equipment problem 7,443 (<1) Diarrhea 41,738 (<1) Drainage/discharge 13,104 (<1) Fever 107,007 (1) Malaise 172,018 (2) Mass/lesion 4,728 (<1) Mental/psych 406,834 (4) Nausea/vomiting 318,046 (3) None 338,943 (3) Pain 2,767,050 (26) Palpitations 57,122 (1) Rash/itching 25,143 (<1) Swelling 75,086 (1) Transport only 164,189 (2) Weakness 675,792 (6) Wound 147,343 (1) Null values 3,146,623 (29)...
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...Abdominal pain 406,615 (4) Allergies 72,358 (1) Animal bite 11,973 (<1) Assault 107,697 (1) Back pain 13,669 (1) Breathing problem 1,033,236 (10) Burns 17,641 (<1) CO poisoning/hazmat 6,359 (<1) Cardiac arrest 64,130 (1) Chest pain 842,940 (8) Choking 19,045 (<1) Convulsions/seizure 341,495 (3) Diabetic problem 163,343 (2) Drowning 3,092 (<1) Electrocution 2,192 (<1) Eye problem 8,225 (<1) Fall victim 826,394 (8) Headache 68,930 (1) Heart problems 132,603 (1) Heat/cold exposure 13,526 (<1) Hemorrhage/laceration 182,732 (2) Industrial accident 3,343 (<1) Ingestion/poisoning 161,028 (2) MCI (mass casualty incident) 3,267 (<1) Pregnancy/childbirth 80,404 (1) Psychiatric problem 272,986 (3) Sick person 1,498,937 (14) Stab/gunshot wound 25,625 (<1) Stroke/CVA 226,685 (2) Traffic accident 537,618 (5) Traumatic injury 283,094 (3) Unconscious/fainting 465,848 (4) Unknown problem man down 387,075 (4) Transfer/interfacility/palliative care 481,962 (4) Null values 1,844,830 (17)...
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TL;DR: The high estimated prevalence of burnout among EMS professionals represents a significant concern for the physical and mental well-being of this critical healthcare workforce and the strong association between burnout and variables that negatively impact the number of available EMS professionals signals an important workforce concern.
64 citations
Cites background from "National Characteristics of Emergen..."
...4% (1,374) Years of EMS Experience Less than 5 years 64....
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...2% (1,237) Community Size Rural (<25,000 residents) 45....
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References
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TL;DR: It has been shown perhaps for the first time that the correction of cardiac arrest outside hospital is a practicable proposition and no death has occurred in transit in a fifteen-month period.
593 citations
TL;DR: A statewide program focused on regional systems for reperfusion for STEMI can significantly improve quality of care and lead to reductions in mortality and morbidity from STEMI.
Abstract: ContextDespite 2 decades of evidence demonstrating benefits from prompt coronary reperfusion, registries continue to show that many patients with ST-segment elevation myocardial infarction (STEMI) are treated too slowly or not at all.ObjectiveTo establish a statewide system for reperfusion, as exists for trauma care, to overcome systematic barriers.Design and SettingA quality improvement study that examined the change in speed and rate of coronary reperfusion after system implementation in 5 regions in North Carolina involving 65 hospitals and associated emergency medical systems (10 percutaneous coronary intervention [PCI] hospitals and 55 non-PCI hospitals).PatientsA total of 1164 patients with STEMI (579 preintervention and 585 postintervention) eligible for reperfusion were treated at PCI hospitals (median age 61 years, 31% women, 4% Killip class III or IV). A total of 925 patients with STEMI (518 preintervention and 407 postintervention) were treated at non-PCI hospitals (median age 62 years, 32% women, 4% Killip class III or IV).InterventionsEarly diagnosis and the most expedient coronary reperfusion method at each point of care: emergency medical systems, emergency department, catheterization laboratory, and transfer. Within 5 regions, PCI hospitals agreed to provide single-call catheterization laboratory activation by emergency medical personnel, accept patients regardless of bed availability, and improve STEMI care for the entire region regardless of hospital affiliation.Main Outcome MeasuresReperfusion times and rates 3 months before (July to September 2005) and 3 months after (January to March 2007) a year-long implementation.ResultsMedian reperfusion times significantly improved according to first door-to-device (presenting to PCI hospital 85 to 74 minutes, P < .001; transferred to PCI hospital 165 to 128 minutes, P < .001), door-to-needle in non-PCI hospitals (35 to 29 minutes, P = .002), and door-in to door-out for patients transferred from non-PCI hospitals (120 to 71 minutes, P < .001). Nonreperfusion rates were unchanged (15%) in non-PCI hospitals and decreased from 23% to 11% in the PCI hospitals. For patients presenting to or transferred to PCI hospitals, clinical outcomes including death, cardiac arrest, and cardiogenic shock did not significantly change following the intervention.ConclusionsA statewide program focused on regional systems for reperfusion for STEMI can significantly improve quality of care. Further research is needed to ensure that programs that result in improved application of reperfusion treatments will lead to reductions in mortality and morbidity from STEMI.Published online November 4, 2007 (doi:10.1001 /jama.298.20.joc70124).
342 citations
TL;DR: In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.
340 citations
TL;DR: A detailed conceptual framework for MI, comparative examples of MI versus naive methods for handling incomplete data, plus a practical user's guide to implementing MI, including sample statistical software MI code and a deidentified precoded database for use with the sample code.
Abstract: In part 1 of this series, the authors describe the importance of incomplete data in clinical research, and provide a conceptual framework for handling incomplete data by describing typical mechanisms and patterns of censoring, and detailing a variety of relatively simple methods and their limitations. In part 2, the authors will explore multiple imputation (MI), a more sophisticated and valid method for handling incomplete data in clinical research. This article will provide a detailed conceptual framework for MI, comparative examples of MI versus naive methods for handling incomplete data (and how different methods may impact subsequent study results), plus a practical user's guide to implementing MI, including sample statistical software MI code and a deidentified precoded database for use with the sample code.
232 citations
TL;DR: Describing current use of ED ambulance transports and likelihood of diversions should help policymakers plan for demographic changes in the population during the next 15 years.
203 citations