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Ambulance triage

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https://www.readbyqxmd.com/read/27903076/the-potential-of-optimizing-prehospital-triage-of-patients-with-suspected-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-t-and-copeptin
#1
Carsten Stengaard, Jacob T Sørensen, Søren A Ladefoged, Jens F Lassen, Martin B Rasmussnen, Claus Kjær Pedersen, Antoine Ayer, Hans Erik Bøtker, Christian J Terkelsen, Kristian Thygesen
PURPOSE: In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase. MATERIALS AND METHODS: In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristics curve area under the curve (AUC) for both biomarkers and a combined model...
December 1, 2016: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
https://www.readbyqxmd.com/read/27852453/current-use-and-outcomes-of-helicopter-transport-in-pediatric-trauma-a-review-of-18-291-transports
#2
Brian R Englum, Kristy L Rialon, Jina Kim, Mark L Shapiro, John E Scarborough, Henry E Rice, Obinna O Adibe, Elisabeth T Tracy
PURPOSE: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. METHODS: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included...
October 27, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27833455/a-decision-support-system-dss-for-municipal-nurses-encountering-health-deterioration-among-older-people
#3
Annica Kihlgren, Fredrik Svensson, Conny Lövbrand, Mervyn Gifford, Annsofie Adolfsson
BACKGROUND: This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver...
2016: BMC Nursing
https://www.readbyqxmd.com/read/27797986/ambulance-smartphone-tool-for-field-triage-of-ruptured-aortic-aneurysms-filtr-study-protocol-for-a-prospective-observational-validation-of-diagnostic-accuracy
#4
Thomas L Lewis, Rachael T Fothergill, Alan Karthikesalingam
INTRODUCTION: Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre...
October 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27789567/variables-associated-with-administration-of-analgesia-nurse-initiated-analgesia-and-early-analgesia-in-the-emergency-department
#5
David McD Taylor, Jessie Chen, Munad Khan, Marina Lee, Mani Rajee, Michael Yeoh, Joanna R Richardson, Antony M Ugoni
OBJECTIVE: To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). METHODS: We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint...
October 27, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27786390/diagnosis-based-emergency-department-alcohol-harm-surveillance-what-can-it-tell-us-about-acute-alcohol-harms-at-the-population-level
#6
Genevieve Whitlam, Michael Dinh, Craig Rodgers, David J Muscatello, Rhydwyn McGuire, Therese Ryan, Sarah Thackway
INTRODUCTION AND AIMS: Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms. DESIGN AND METHODS: We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the 'alcohol syndrome') in the New South Wales, Australia, automatic syndromic surveillance system...
October 27, 2016: Drug and Alcohol Review
https://www.readbyqxmd.com/read/27752318/a-collaborative-improvement-project-by-an-nhs-emergency-department-and-scottish-ambulance-paramedics-to-improve-the-identification-and-delivery-of-sepsis-6
#7
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27747560/the-epidemiology-of-pre-hospital-potential-spinal-cord-injuries-in-victoria-australia-a-six-year-retrospective-cohort-study
#8
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, Shelley Cox, James W Middleton, Paul A Jennings
BACKGROUND: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. METHODS: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI...
December 2016: Injury Epidemiology
https://www.readbyqxmd.com/read/27732713/evaluation-of-rural-vs-urban-trauma-patients-served-by-9-1-1-emergency-medical-services
#9
Craig D Newgard, Rongwei Fu, Eileen Bulger, Jerris R Hedges, N Clay Mann, Dagan A Wright, David P Lehrfeld, Carol Shields, Gregory Hoskins, Craig Warden, Lynn Wittwer, Jennifer N B Cook, Michael Verkest, William Conway, Stephanie Somerville, Matthew Hansen
Importance: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization...
October 12, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27726972/emergency-nursing-workload-and-patient-dependency-in-the-ambulance-bay-a-prospective-study
#10
Wayne Varndell, Elizabeth Ryan, Alison Jeffers, Nadya Marquez-Hunt
AIM: The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload. BACKGROUND: The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time...
October 7, 2016: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/27660386/factors-influencing-time-to-computed-tomography-in-emergency-department-patients-with-suspected-subarachnoid-haemorrhage
#11
Maryam Khan, Marco L A Sivilotti, Michael J Bullard, Marcel Émond, Jane Sutherland, Andrew Worster, Corinne M Hohl, Jacques S Lee, Mary Eisenhauer, Merril Pauls, Howard Lesiuk, George A Wells, Ian G Stiell, Jeffrey J Perry
BACKGROUND: CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH. METHODS: We analysed data from two large sequential prospective cohorts of ED patients with acute headache undergoing CT for suspected SAH...
September 22, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27437517/some-ethical-issues-in-prehospital-emergency-medicine
#12
REVIEW
Hasan Erbay
Prehospital emergency medical care has many challenges including unpredictable patient profiles, emergency conditions, and administration of care in a non-medical area. Many conflicts occur in a prehospital setting that require ethical decisions to be made. An overview of the some of ethical issues in prehospital emergency care settings is given in this article. Ethical aspects of prehospital emergency medicine are classified into four groups: the process before medical interventions, including justice, stigmatization, dangerous situations, and safe driving; the treatment process, including triage, refusal of treatment or transport, and informed consent; the end of life and care, including life-sustaining treatments, prehospital cardiopulmonary resuscitation (CPR), withholding or withdrawal of CPR, and family presence during resuscitation; and some ambulance perception issues, including ambulance misuse, care of minors, and telling of bad news...
December 2014: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27332396/early-assessment-of-patient-s-medical-condition-in-ambulance-care-affects-the-level-of-care-of-non-urgent-patients
#13
Glenn Larsson, Anders Holmén, Kristina Ziegert
The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medical condition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition...
2016: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/27294853/urban-telemedicine-the-applicability-of-teleburns-in-the-rehabilitative-phase
#14
Yuk Ming Liu, Katie Mathews, Andrew Vardanian, Taylan Bozkurt, Jeffrey C Schneider, Jaye Hefner, John T Schulz, Shawn P Fagan, Jeremy Goverman
Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014...
June 2, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27282963/the-first-single-responders-in-sweden-evaluation-of-a-pre-hospital-single-staffed-unit
#15
Eric Carlström, Lars Fredén
BACKGROUND: Single responder (SR) systems have been implemented in several countries. When the very first SR system in Sweden was planned, it was criticised because of concerns about sending single emergency nurses out on alerts. In the present study, the first Swedish SR unit was studied in order to register waiting times and assess the working environment. METHOD: Quantitative data were collected from the ambulance dispatch register. Data on the working environment were collected using a questionnaire sent to the SR staff...
June 6, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27276761/practical-approach-to-the-management-of-the-severely-injured
#16
T O Adekoya-Cole, G O Enweluzo, O E Oguche, O I Akinmokun
Events associated with severely injured victims are common occurrences. These injured patients should be properly managed to achieve good outcome. Trauma algorithm protocols are known to improve therapeutic process and outcome. However, most hospitals in our subregion that attend to severely injured patients are yet to develop an algorithm treatment protocols for the management of these patients. The ambulance system in Nigeria is still un-coordinated and unsupervised. Most of the existing ambulances are not well equipped and usually not manned by experienced paramedics...
October 2013: Nigerian Quarterly Journal of Hospital Medicine
https://www.readbyqxmd.com/read/27245307/continuity-matters-examining-the-information-gap-in-transfer-from-residential-aged-care-ambulance-to-emergency-triage-in-southern-tasmania
#17
Briony Campbell, Christine Stirling, Elizabeth Cummings
BACKGROUND: Transfer of older people from Residential Aged Care Facilities to Emergency Departments requires multiple comprehensive handovers across different services. Significant information gaps exist in transferred information despite calls for standards. AIM: To investigate: (1) presence of minimum standard elements in the transfer text written by RACF nurses, paramedics and ED triage nurses, and (2) the transfer documentation used by services. METHODS: We analysed retrospective cross-sectional transfer narratives from the digital medical record system of an Australian tertiary referral hospital using the mnemonic SBAR (Situation, Background, Assessment Recommendation) as the measure of comprehensiveness...
May 28, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27232532/patient-perspectives-on-ems-alternate-destination-models
#18
Kevin G Munjal, Siri Shastry, George T Loo, Daniel Reid, Corita Grudzen, Manish N Shah, Hugh H Chapin, Brandon First, Sasilada Sirirungruang, Erin Alpert, Kevin Chason, Lynne D Richardson
INTRODUCTION: Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement...
May 27, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27212424/attitudes-towards-and-experience-of-the-use-of-triage-tags-in-major-incidents-a-mixed-method-study
#19
Monica Rådestad, Kristina Lennquist Montán, Anders Rüter, Maaret Castrén, Leif Svensson, Dan Gryth, Bjöörn Fossum
UNLABELLED: Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs). METHODS: A mixed method design was used...
August 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27173359/characteristics-of-older-people-with-cognitive-impairment-attending-emergency-departments-a-descriptive-study
#20
Linda M Schnitker, Elizabeth R A Beattie, Melinda Martin-Khan, Ellen Burkett, Leonard C Gray
OBJECTIVE: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). METHODS: This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools...
May 2016: Australasian Emergency Nursing Journal: AENJ
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