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Ambulance triage

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https://www.readbyqxmd.com/read/29901800/overuse-of-air-ambulance-services-at-a-regional-burn-center
#1
Arhana Chattopadhyay, Clifford C Sheckter, Chao Long, Yvonne Karanas
Air ambulances rapidly transport burn patients to regional centers, expediting treatment. However, limited guidelines on transport introduce the risk for inappropriate triage and overuse. Given the additional costs of air vs ground transport, evaluation of transportation use is prudent. A retrospective review of all burn patients transported by helicopter to a single burn center from May 2013 to January 2016 was performed. Data gathered included patient demographics, transfer origin, burn characteristics, and inpatient hospital stay...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/29866138/capillary-and-venous-lactate-measurements-with-a-handheld-device-compared-to-venous-blood-gas-analysis-for-emergency-patients
#2
David Stoll, Erling Englund, Helene Hillborg, Stefan Vedin, Agneta Larsson
BACKGROUND/AIM: Early identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method. METHODS: Patients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study...
June 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29860960/volunteer-first-responders-for-optimizing-management-of-mass-casualty-incidents
#3
Eli Yafe, Blake Byron Walker, Ofer Amram, Nadine Schuurman, Ellen Randall, Michael Friger, Bruria Adini
OBJECTIVE: Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established. METHODS: This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016...
June 4, 2018: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/29769024/hems-inter-facility-transfer-a-case-mix-analysis
#4
Damien Di Rocco, Mathieu Pasquier, Eric Albrecht, Pierre-Nicolas Carron, Fabrice Dami
BACKGROUND: Helicopter emergency medical services (HEMS) are popular rescue systems despite inconsistent evidence in the scientific literature to support their use for primary interventions, as well as for inter-facility transfer (IFT). There is little research about IFT by HEMS, hence questions remain about the appropriateness of this method of transport. The aim of this study was to describe a case-mix of operational and medical characteristics for IFT activity of a sole HEMS base, and identify indicators of over-triage...
May 16, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29735228/direct-air-versus-ground-transport-predictors-for-rural-pediatric-trauma
#5
Andrew B Starnes, Babawale Oluborode, Curtis Knoles, Boyd Burns, Henderson McGinnis, Kenneth Stewart
OBJECTIVE: Traumatic injury is the leading cause of mortality in children and the most common cause of emergency medical services transport in pediatric populations. We aimed to identify what factors are currently associated with selection for helicopter transport (HEMS) over ground ambulance (GEMS) in a primarily rural state. METHODS: We performed a retrospective case-control study of trauma patients younger than 18 years old reported to the Oklahoma State Trauma Registry between 2005 and 2014 who received direct transport from the scene of injury to a tertiary trauma center within the state...
May 2018: Air Medical Journal
https://www.readbyqxmd.com/read/29729811/a-multicenter-program-to-implement-the-canadian-c-spine-rule-by-emergency-department-triage-nurses
#6
Ian G Stiell, Catherine M Clement, Maureen Lowe, Connor Sheehan, Jacqueline Miller, Sherry Armstrong, Brenda Bailey, Kerry Posselwhite, Jannick Langlais, Karin Ruddy, Susan Thorne, Alison Armstrong, Catherine Dain, Jeffrey J Perry, Christian Vaillancourt
STUDY OBJECTIVE: The Canadian C-Spine Rule has been widely applied by emergency physicians to safely reduce use of cervical spine imaging. Our objective is to evaluate the clinical effect and safety of real-time Canadian C-Spine Rule implementation by emergency department (ED) triage nurses to remove cervical spine immobilization. METHODS: We conducted this multicenter, 2-phase, prospective cohort program at 9 hospital EDs and included alert trauma patients presenting with neck pain or with cervical spine immobilization...
May 2, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29698341/early-hospital-discharge-after-helicopter-transport-of-pediatric-trauma-patients-analysis-of-rates-of-over-and-undertriage
#7
Aodhnait S Fahy, Stephanie F Polites, Cornelius A Thiels, Maile Parker, Michael B Ishitani, Christopher R Moir, Kathleen Berns, Scott P Zietlow, Donald H Jenkins, Martin D Zielinski
OBJECTIVES: Helicopter air ambulance (HAA) of pediatric trauma patients is a life-saving intervention. Triage remains a challenge for both scene transport and interhospital transfer of injured children. We aimed to understand whether overtriage or undertriage was a feature of scene or interhospital transfer and how in or out of state transfers affected these rates. METHODS: Children (<18 years) who underwent trauma activation at a level I trauma center between 2011 and 2013 were identified and reviewed...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29652166/ambulance-use-distance-and-outcomes-in-patients-with-suspected-cardiovascular-disease-a-registry-based-geographic-information-system-study
#8
Nariman Sepehrvand, Wendimagegn Alemayehu, Padma Kaul, Rick Pelletier, Aminu K Bello, Robert C Welsh, Paul W Armstrong, Justin A Ezekowitz
BACKGROUND: Despite guideline recommendations, the majority of patients with symptoms suggestive of acute coronary syndrome do not use emergency medical services to reach the emergency department (ED). The aim of this study was to investigate the factors associated with EMS utilisation and subsequent patient outcomes. METHODS: Using administrative data, all patients who presented to an ED in the metropolitan areas of Edmonton and Calgary in the years of 2007-2013 with main ED diagnosis of acute coronary syndrome, stable angina or chest pain were included...
April 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29618372/prehospital-triage-of-patients-diagnosed-with-perforated-peptic-ulcer-or-peptic-ulcer-bleeding-an-observational-study-of-patients-calling-1-1-2
#9
Kasper Bonnesen, Kristian D Friesgaard, Morten T Boetker, Lone Nikolajsen
BACKGROUND: Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB)...
April 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29540611/ambulance-clinical-triage-for-acute-stroke-treatment-paramedic-triage-algorithm-for-large-vessel-occlusion
#10
Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
April 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29525968/informing-prehospital-care-planning-using-pilot-trauma-registry-data-in-yaound%C3%A3-cameroon
#11
Obieze Chiemeka Nwanna-Nzewunwa, Marquise Kouo Ngamby, Elinor Shetter, Georges Alain Etoundi Mballa, Isabelle Feldhaus, Martin Ekeke Monono, Adnan A Hyder, Rochelle Dicker, Kent A Stevens, Catherine Juillard
INTRODUCTION: About 54% of deaths in low- and middle-income countries (LMICs) are attributable to lack of prehospital care. The single largest contributor to the disability-adjusted life years due to poor prehospital care is injury. Despite having disproportionately high injury burdens, most LMIC trauma systems have little prehospital organization. An understanding of existing prehospital care patterns in LMICs is warranted as a precursor to strengthening prehospital systems. METHODS: In this retrospective pilot study, we collected demographic and injury characteristics, therapeutic itinerary, and transport data of patients that were captured by the trauma registry at the Central Hospital of Yaoundé (CHY) from April 15, 2009 to October 15, 2009...
March 10, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29511537/pre-hospital-national-early-warning-score-news-is-associated-with-in-hospital-mortality-and-critical-care-unit-admission-a-cohort-study
#12
Tom E F Abbott, Nicholas Cron, Nidhi Vaid, Dorothy Ip, Hew D T Torrance, Julian Emmanuel
Background: National Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay. Methods: Planned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study...
March 2018: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/29450938/hot-off-the-press-peripheral-intravenous-cannula-insertion-and-use-in-the-emergency-department
#13
Sahaana Rangarajan, Justin Morgenstern, William K Milne, Corey Heitz
This is a prospective before-after study comparing peripheral intravenous cannulation (PIVC) placement and usage rates following a 10-week-long multimodal intervention provided to medical and nursing staff working in a tertiary emergency department (ED). The intervention focused on improving appropriate use of PIVCs in an emergency setting by emphasizing to clinicians that a PIVC should only be placed if it was believed there was more than an 80% chance that it would be used. Patients were eligible for the study if they presented to the ED and were >18 years of age...
February 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29450701/burden-characteristics-and-process-of-care-among-the-pediatric-and-adult-trauma-patients-in-botswana-s-main-hospitals
#14
Michael B Mwandri, Timothy C Hardcastle
BACKGROUND: Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower-middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends 'Essential Trauma Care' in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system. METHOD: Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults...
February 15, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29440876/research-of-an-emergency-medical-system-for-mass-casualty-incidents-in-shanghai-china-a-system-dynamics-model
#15
Wenya Yu, Yipeng Lv, Chaoqun Hu, Xu Liu, Haiping Chen, Chen Xue, Lulu Zhang
Objectives: Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. Methods: This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program...
2018: Patient Preference and Adherence
https://www.readbyqxmd.com/read/29433441/ambulance-use-is-not-associated-with-patient-acuity-after-road-traffic-collisions-a-cross-sectional-study-from-addis-ababa-ethiopia
#16
Yonas Abebe, Tolesa Dida, Engida Yisma, David M Silvestri
BACKGROUND: Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS: This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months...
February 13, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29386096/cost-analysis-of-an-integrated-aged-care-program-for-residential-aged-care-facilities
#17
Rod Ling, Andrew Searles, Jacqueline Hewitt, Robyn Considine, Catherine Turner, Susan Thomas, Kelly Thomas, Keith Drinkwater, Isabel Higgins, Karen Best, Jane Conway, Carolyn Hullick
Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District...
February 1, 2018: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29345508/response-by-twin-italian-hub-hospitals-in-a-double-seismic-event-a-retrospective-observational-investigation
#18
Alberto Barbieri, Gabriele Melegari, Valentina Lob, Lorenzo Mazzali, Luca D'Amelio, Andrea Giovannoni, Enrico Giuliani
INTRODUCTION: The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012. METHODS: Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage)...
January 18, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29321074/patient-and-case-characteristics-associated-with-no-paramedic-treatment-for-low-acuity-cases-referred-for-emergency-ambulance-dispatch-following-a-secondary-telephone-triage-a-retrospective-cohort-study
#19
Kathryn Eastwood, Amee Morgans, Johannes Stoelwinder, Karen Smith
BACKGROUND: Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage. METHODS: A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012...
January 10, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29284734/impact-of-prehospital-triage-scales-to-detect-large-vessel-occlusion-on-resource-utilization-and-time-to-treatment
#20
Ludwig Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres
BACKGROUND AND PURPOSE: Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. METHODS: Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale...
February 2018: Stroke; a Journal of Cerebral Circulation
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