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Ambulance triage

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https://www.readbyqxmd.com/read/28513414/-prehospital-triage-in-trauma-patients-ambulance-care-and-deployment-of-a-mobile-medical-team
#1
M van Heijl, D den Hartog
- The prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and in-hospital care for trauma patients are well-organised in the Netherlands.- However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average under-triage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage.- Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multiple-trauma patients should be primarily taken to a level 1 trauma centre...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28507997/recognizing-sudden-cardiac-arrest-may-require-more-than-two-questions-during-telephone-triage-developing-a-complementary-checklist
#2
Amir Mirhaghi, Hojjat Shafaee, Javad Malekzadeh, Farzaneh Hasanzadeh
OBJECTIVE: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA). METHODS: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported...
April 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28506282/under-triage-in-telephone-consultation-is-related-to-non-normative-symptom-description-and-interpersonal-communication-a-mixed-methods-study
#3
Hejdi Gamst-Jensen, Freddy K Lippert, Ingrid Egerod
BACKGROUND: Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark...
May 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28495830/establishing-recommendations-for-stroke-systems-in-the-thrombectomy-era-the-upstate-new-york-stakeholder-proceedings
#4
Zainab Magdon-Ismail, Curtis Benesch, Jeremy T Cushman, Ian Brissette, Andrew M Southerland, Ethan S Brandler, Cemal B Sozener, Sue Flor, Roseanne Hemmitt, Kathleen Wales, Krystal Parrigan, Steven R Levine
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale...
May 11, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28494665/remote-clinical-decision-making-a-clinician-s-definition
#5
Mike Brady, Kate Northstone
Aims Remote clinical decision-making (RCDM), commonly known as 'telephone triage' or 'hear and treat', describes clinicians' non-face-to-face involvement with patient care, and is an established strategy in UK ambulance services for managing increasing demand. However, there is no suitable definition of RCDM that fully explains the roles undertaken by clinicians in 999 hubs, or for its use as an ambulance quality indicator (AQI). The aim of this study, which is part of a larger evaluation of a new RCDM module in higher education, is to determine how clinicians define RCDM...
May 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28483035/management-of-patients-brought-in-by-ambulance-to-the-emergency-department-role-of-the-advanced-musculoskeletal-physiotherapist
#6
Rita Kinsella, Tom Collins, Bridget Shaw, James Sayer, Belinda Cary, Andrew Walby, Sallie Cowan
Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED).Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED.Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis...
May 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28467581/can-we-make-an-early-do-not-resuscitate-decision-in-severe-burn-patients
#7
Yücel Yüce, Hakan Ahmet Acar, Kutlu Hakan Erkal, Erhan Tuncay
BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3...
March 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28459301/role-of-guideline-adherence-in-improving-field-triage
#8
Craig D Newgard, Rongwei Fu, E Brooke Lerner, Mohamud Daya, Jonathan Jui, Lynn Wittwer, Terri A Schmidt, Dana Zive, Eileen M Bulger, Ritu Sahni, Craig Warden, Nathan Kuppermann
OBJECTIVE: To compare the sensitivity of current field triage practices for identifying high-risk trauma patients to strict guideline adherence, including changes in triage specificity, ambulance transport patterns, and trauma center volumes. METHODS: This was a pre-planned secondary analysis of an out-of-hospital prospective cohort of injured children and adults transported by 44 EMS agencies to 28 trauma and non-trauma hospitals in 7 Northwest U.S. counties from January 1, 2011 through December 31, 2011...
May 1, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28455884/two-hour-evaluation-and-referral-model-for-shorter-turnaround-times-in-the-emergency-department
#9
John A Burke, Jaimi Greenslade, Jadwiga Chabrowska, Katherine Greenslade, Sally Jones, Jacqueline Montana, Anthony Bell, Alan O'Connor
OBJECTIVE: The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. METHODS: A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition...
June 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28420688/can-a-partnership-between-general-practitioners-and-ambulance-services-reduce-conveyance-to-emergency-care
#10
Manuel Villarreal, Jonathan Leach, Kandala Ngianga-Bakwin, Jeremy Dale
BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department (ED). METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28399897/prehospital-ambulance-stroke-test-pilot-study-of-a-novel-stroke-test
#11
Gunnar Andsberg, Magnus Esbjörnsson, Arne Olofsson, Arne Lindgren, Bo Norrving, Mia von Euler
BACKGROUND: There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS). METHODS: The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting...
April 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28315728/can-ambulance-telephone-triage-using-nhs-pathways-accurately-identify-paediatric-cardiac-arrest
#12
Charles D Deakin, Simon England, Debbie Diffey, Ian Maconochie
BACKGROUND: Most out-of-hospital paediatric cardiac arrests (CA) are not identified until a call is made to the emergency medical services. Accurate identification increases overall survival by enabling immediate ambulance dispatch and delivery of bystander CPR. European ambulance services use a variety of didactic telephone scripts to interrogate the caller and rapidly identify paediatric CA. The performance of these scripts has not been reported. This study aims to evaluate the diagnostic accuracy of the NHS Pathways as a telephone triage tool to identify patients less than 16 years age in cardiac arrest...
July 2017: Resuscitation
https://www.readbyqxmd.com/read/28294704/a-systematic-review-of-the-implementation-challenges-of-telemedicine-systems-in-ambulances
#13
Hunter Rogers, Kapil Chalil Madathil, Sruthy Agnisarman, Shraddhaa Narasimha, Aparna Ashok, Aswathi Nair, Brandon M Welch, James T McElligott
BACKGROUND: Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances. METHODS: A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances...
March 15, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28291697/early-prehospital-assessment-of-non-urgent-patients-and-outcomes-at-the-appropriate-level-of-care-a-prospective-exploratory-study
#14
Glenn Larsson, Anders Holmén, Kristina Ziegert
INTRODUCTION: The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. METHODS: The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000...
March 10, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28288619/medication-related-calls-received-by-a-national-telenursing-triage-and-advice-service-in-australia-a-retrospective-cohort-study
#15
Ling Li, Rebecca Lake, Magdalena Z Raban, Mary Byrne, Maureen Robinson, Johanna Westbrook, Melissa T Baysari
BACKGROUND: Telenursing triage and advice services are increasingly being used to deliver health advice. Medication-related queries are common, however little research has explored the medication-related calls made to these services. The aim of this study was to examine the profile of medication-related calls to a national telenursing triage and advice service and the medications involved. METHODS: This was a retrospective cohort study of medication-related calls received by Australia's national helpline (healthdirect helpline) in 2014, which provides free advice from registered nurses...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28259232/guillain-barr%C3%A3-syndrome
#16
REVIEW
Eelco F M Wijdicks, Christopher J Klein
Guillain-Barré syndrome is an acute inflammatory immune-mediated polyradiculoneuropathy presenting typically with tingling, progressive weakness, and pain. Variants and formes frustes may complicate recognition. The best known variant is the sensory ataxic form of Miller Fisher syndrome, which also affects the oculomotor nerves and the brain stem. Divergent pathologic mechanisms lead to demyelinating, axonal, or mixed demyelinating-axonal damage. In the demyelinating form, yet to be identified antigens are inferred by complement activation, myelin destruction, and macrophage-activated cleanup...
March 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28238290/a-determination-of-emergency-department-pre-triage-times-in-patients-not-arriving-by-ambulance-compared-to-widely-used-guideline-recommendations-corrigendum
#17
https://www.readbyqxmd.com/read/28229894/mobile-stroke-units-for-prehospital-thrombolysis-triage-and-beyond-benefits-and-challenges
#18
REVIEW
Klaus Fassbender, James C Grotta, Silke Walter, Iris Q Grunwald, Andreas Ragoschke-Schumm, Jeffrey L Saver
In acute stroke management, time is brain. Bringing swift treatment to the patient, instead of the conventional approach of awaiting the patient's arrival at the hospital for treatment, is a potential strategy to improve clinical outcomes after stroke. This strategy is based on the use of an ambulance (mobile stroke unit) equipped with an imaging system, a point-of-care laboratory, a telemedicine connection to the hospital, and appropriate medication. Studies of prehospital stroke treatment consistently report a reduction in delays before thrombolysis and cause-based triage in regard to the appropriate target hospital (eg, primary vs comprehensive stroke centre)...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28151752/influences-on-emergency-department-length-of-stay-for-older-people
#19
Maryann Street, Mohammadreza Mohebbi, Debra Berry, Anthony Cross, Julie Considine
OBJECTIVE: The aim of this study was to examine the influences on emergency department (ED) length of stay (LOS) for older people and develop a predictive model for an ED LOS more than 4 h. METHODS: This retrospective cohort study used organizational data linkage at the patient level from a major Australian health service. The study population was aged 65 years or older, attending an ED during the 2013/2014 financial year. We developed and internally validated a clinical prediction rule...
February 1, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28103892/prehospital-intravenous-fentanyl-to-patients-with-hip-fracture-an-observational-cohort-study-of-risk-factors-for-analgesic-non-treatment
#20
Kristian D Friesgaard, Erika F Christensen, Hans Kirkegaard, Mette D Bendtsen, Flemming B Jensen, Lone Nikolajsen
BACKGROUND: Patients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment...
January 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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