Can prehospital personnel detect hypoxemia without the aid of pulse oximeters? Lawrence H Brown, Erik A Manring, Hervy B Kornegay, N.Heramba Prasad
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90012-1
The American Journal of Emergency Medicine , Vol. 14 , Issue 1 ,
Published in issue: January 1996
x Although pulse oximeters have been proven accurate in the prehospital environment, they have not been proven to be necessary. This study was undertaken to determine if emergency medical services (EMS) providers can identify hypoxemia without pulse oximetry. An oximeter was placed at the ambulance entrance to the emergency department (ED), and EMS personnel obtained saturation levels on all patients on arrival. Hypoxemia was defined as a saturation level of 95% or less. The hypoxemia was classified as “recognized” if the patient received aggressive intervention and “unrecognized” if the patient did not.
The use of TRISS methodology to validate prehospital intubation by urban EMS providers Heidi Frankel, Grace Rozycki, Howard Champion, J.Duncan Harviel, Robert Bass
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90174-1
The American Journal of Emergency Medicine , Vol. 15 , Issue 7 ,
Published in issue: November 1997
x The purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05).
GPS computer navigators to shorten EMS response and transport times Floyd S. Ota, Russ S. Muramatsu, Blake H. Yoshida, Loren G. Yamamoto
DOI: http://dx.doi.org/10.1053/ajem.2001.22662
The American Journal of Emergency Medicine , Vol. 19 , Issue 3 ,
Published in issue: May 2001
x GPS (global positioning satellite system to determine one's position on earth) units have become inexpensive and compact. The purpose of this study is to assess the effectiveness of a GPS enhanced computer street map navigator to improve the ability of EMS drivers in an urban setting to locate their destination and shorten response times. For part I, residential addresses in the city were randomly selected from a telephone directory. Two driver/navigator teams were assigned to drive to the address adhering to speed limits.
Language disparities in patients transported by emergency medical services N.R. Weiss, S.J. Weiss, R. Tate, S. Oglesbee, A.A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 6 2015
x The population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital.
The prehospital and hospital costs of emergency care for frequent ED patients Robert G. Solberg, Brandy L. Edwards, Jeffrey P. Chidester, Debra G. Perina, William J. Brady, Michael D. Williams
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.066
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care.
Factors associated with the safety of EMS helicopters Ronald B. Low, Mary Jo Dunne, Ira J. Blumen, Gail Tagney
DOI: http://dx.doi.org/10.1016/0735-6757(91)90167-I
The American Journal of Emergency Medicine , Vol. 9 , Issue 2 ,
Published in issue: March 1991
x The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions.
Wilderness emergency medical services: The experiences at Sequoia and Kings Canyon National Parks Jeffrey Johnson, Mark Maertins, Marc Shalit, Tucker J. Bierbaum, Douglas E. Goldman, Robert A. Lowe
DOI: http://dx.doi.org/10.1016/0735-6757(91)90078-X
The American Journal of Emergency Medicine , Vol. 9 , Issue 3 ,
Published in issue: May 1991
x This article describes the National Park Service wilderness emergency medical services (EMS) system, as implemented at Sequola-Kings Canyon National Park. EMS records on all 434 patients in the period from August 1, 1986, to July 31, 1987, were reviewed. Most patients had minor problems. Overall, 77% of patients contacting the EMS system were released at the scene, and base hospital contact was made in only 28% of cases. However, there were three deaths, 44 (10%) patients who received advanced life support, and 292 (67%) patients who received basic life support.
Staffing and equipping emergency medical services systems: Rapid identification and treatment of acute myocardial infarction National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee
DOI: http://dx.doi.org/10.1016/0735-6757(95)90245-7
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x Each year, about 1,250,000 people in the United States experience an acute myocardial infarction (AMI). Emergency medical services (EMS) systems play a key part in the prehospital care and transportation of AMI patients. Rapid, state-of-the-art treatment by EMS personnel is essential for improving AMI survival and outcomes, as dramatized by the patient who is the victim of out-of-hospital cardiac arrest. In order to improve the prehospital care provided to AMI patients, this article by the Access to Care Subcommittee of the National Heart Attack Alert Program Coordinating Committee makes a number of recommendations regarding the staffing and equipping of EMS systems.
A geographic information system simulation model of EMS: reducing ambulance response time Kobi Peleg, Joseph S. Pliskin
DOI: http://dx.doi.org/10.1016/j.ajem.2004.02.003
The American Journal of Emergency Medicine , Vol. 22 , Issue 3 ,
Published in issue: May 2004
x Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. All calls that were pinpointed geographically by the GIS were included, and their data were stratified by weekday and by daily shifts.
Improving emergency medical services for children with special health care needs: Does training make a difference? Daniel W. Spaite, Carol Conroy, Katherine J. Karriker, Marsha Seng, Norma Battaglia
DOI: http://dx.doi.org/10.1053/ajem.2001.27146
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses.
Emergency medical services' use of poison control centers for unintentional drug ingestions Scott A. Bier, Douglas J. Borys
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.015
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: March 10 2010
x Every year, emergency medical services (EMS) providers respond to thousands of calls for toxic ingestions. Many systems have begun using poison control centers (PCCs) when unsure of disposition. We sought to determine the type of exposures EMS personnel were using the PCCs for and treatments suggested. Secondary end points included transport rate after consulting the PCC and amount of money saved by avoiding unnecessary transports.
Out-of-hospital resuscitation in Tartu: Effect of reorganization of Estonian EMS system Aleksander Sipria, Raul Talvik, Ago Kõrgvee, Silver Sarapuu, Aare Ööpik
DOI: http://dx.doi.org/10.1053/ajem.2000.7350
The American Journal of Emergency Medicine , Vol. 18 , Issue 4 ,
Published in issue: July 2000
x The objective of this study was to evaluate the effect of reorganization of Estonian emergency medical services (EMS) system. The outcomes of out-of-hospital resuscitation in the Tartu urban area were investigated during the 6-year study period. The main aim of reorganization was to provide rapid access to early defibrillation with simultaneous advanced cardiac life support (ACLS) procedures on the scene. The changes were implemented since summer 1994 in Tartu at first. Quick availability of a mobile intensive care unit for high-risk calls; implementation of standards for resuscitation, and routine systematic, realistic, compulsory ACLS training for all ambulance staff were established.
The role of paramedics in resuscitation of patients with prehospital cardiac arrest from coronary artery disease Richard P. Lewis, John M. Stang, James V. Warren
DOI: http://dx.doi.org/10.1016/0735-6757(84)90003-2
The American Journal of Emergency Medicine , Vol. 2 , Issue 3 ,
Published in issue: May 1984
x Columbus, Ohio added prehospital coronary care to its Emergency Medical Services System (EMS) in 1969. The EMS System, which is citizen activated and tax supported ($5 per citizen per year), currently sees 32,000 patients a year in a city with a population of 650,000. Ninety-six per cent of the population is aware of the system. Over two thirds of patients with ischemic sudden death or myocardial infarction are seen by advanced life support paramedic (EMT-P) units. The EMT-Ps operate by protocol without telemetry and carry all standard resuscitative drugs and devices.
Effect of a social services intervention among 911 repeat users Steven J. Weiss, Amy A. Ernst, Margaret Ong, Ray Jones, Debra Morrow, Rosemary Milch, Katie O'Neil, Jay Glass, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.003
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x To determine whether emergency medical services (EMS) 911 frequent users would benefit from social services intervention.
Patients who initially refuse prehospital evaluation and/or therapy Geraldine Stark, Jerris R. Hedges, Keith Neely, Robert Norton
DOI: http://dx.doi.org/10.1016/0735-6757(90)90152-P
The American Journal of Emergency Medicine , Vol. 8 , Issue 6 ,
Published in issue: November 1990
x The authors performed a retrospective descriptive and analytical cohort study of prehospital patient initial refusal of care (PIRC) cases to characterize the types of patients encountered and to assess factors associated with their dispositions. During a 6-month period, 169 of 1715 (9.9%) base station calls in an urban emergency medical service (EMS) system were for physician involvement in a PIRC. Patients' dispositions were as follows: left at scene against medical advice (53%); taken by ambulance to the hospital (28%); left with friend (13%); other disposition (5%).
The relationship between paramedics' level of education and degree of commitment Melissa Alexander, Steven Weiss, Darren Braude, Amy A. Ernst, Lynne Fullerton-Gleason
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.039
The American Journal of Emergency Medicine , Vol. 27 , Issue 7 ,
Published in issue: September 2009
x Emergency medical services (EMS) personnel attrition is a serious concern. Two fundamental psychological constructs linked to attrition are organizational and occupational commitment.
The 911 emergency telephone number: Impact on emergency medical systems access in a metropolitan area Ray Mayron, Robert S. Long, Ernest Ruiz
DOI: http://dx.doi.org/10.1016/0735-6757(84)90070-6
The American Journal of Emergency Medicine , Vol. 2 , Issue 6 ,
Published in issue: November 1984
x The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. Paul provides a unique opportunity to examine this assumption. Prior to the introduction of the 911 emergency telephone number on December 1, 1982, the area was serviced by over 100 different seven-digit emergency telephone numbers.
Resource reallocation in an emergency medical service system using computer simulation Syi Su, Chung-Liang Shih
DOI: http://dx.doi.org/10.1053/ajem.2002.35453
The American Journal of Emergency Medicine , Vol. 20 , Issue 7 ,
Published in issue: November 2002
x Emergency medical service (EMS) policy makers must seek to achieve maximum effectiveness with finite resources. This research establishes an EMS computer simulation model using eM-Plant software. The simulation model is based on Taipei city's EMS system with input data from prehospital care records from December 2000; it manipulates resource allocation levels and rates of idle errands. Presently, EMS ambulance utilization is about 8.78%. On average, 20.89 minutes are required to transport a patient to the hospital.
Pattern of basic life support ambulance use in an urban pediatric population William J Brady Jr, Halim Hennes, Ann Wolf, Kent N Hall, Marsha Davis
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90168-0
The American Journal of Emergency Medicine , Vol. 14 , Issue 3 ,
Published in issue: May 1996
x To evaluate the pattern of use of basic life support (BLS) ambulances in a pediatric population, emergency medical service (EMS) and pediatric emergency department (PED) records from an urban hospital PED for all children transported to PED by ambulance during a 1-month study period were retrospectively reviewed. Excluded were: (1) advanced life support transport, (2) transport from other medical facility, (3) patients with chronic medical disability without acute decompensation, and (4) patients in police custody.
Circadian, day-of-week, and age patterns of the occurrence of acute coronary syndrome in Beijing's emergency medical services system Yi Li, Tiekuan Du, Matthew R. Lewin, Houli Wang, Xu Ji, Yanping Zhang, Tengda Xu, Lingjie Xu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.033
The American Journal of Emergency Medicine , Vol. 28 , Issue 6 ,
Published online: March 26 2010
x Previous in-hospital studies suggest that there are significant circadian rhythms associated with the incidence of acute coronary syndromes (ACSs). No study to date has examined the presentation of ACS in the prehospital setting. Our goal was to examine circadian, day-of-week, and age patterns of occurrence in ACS in a large, urban emergency medical services (EMS) system.
