The T+R protocol evaluated in this study applied to a significant proportion of patients presenting to EMS with SVT. Risk of re-presentation following T+R was low, and paramedic protocol adherence was reasonable. T+R appears to be a viable option for uncomplicated SVT in the prehospital setting.
IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model. Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta. We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission. ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals<18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%). Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.
Introduction: Outside of key conditions such as cardiac arrest and trauma, little is known about the epidemiology of mortality of all transported EMS patients. The objective of this study is to describe characteristics of EMS patients who after transport die in a health care facility. Methods: EMS transport events over one year (April, 2015-16) from a BLS/ALS system serving an urban/rural population of approximately 2 million were linked with in-hospital datasets to determine proportion of all-cause in-hospital mortality by Medical Priority Dispatch System (MPDS) determinant (911 call triage system), age in years (>=18 yrs. - adult, <=17 yrs. - pediatric), sex, day of week, season, time (in six hour periods), and emergency department Canadian Triage and Acuity Scale (CTAS). The MPDS card, patient chief complaint, and ED diagnosis category (International Classification of Disease v.10 - Canadian) with the highest proportion of mortality are also reported. Analyses included two-sided t-test or chi-square with alpha <0.05. Results: A total of 239,534 EMS events resulted in 159,507 patient transports; 141,114 were included for analysis after duplicate removal (89.1% linkage), with 127,867 reporting final healthcare system outcome. There were 4,269 who died (3.3%; 95%CI 3.2%, 3.4%). The proportion of mortality by MPDS determinant was, from most to least critical 911 call, Echo (7.3%), Delta (37.2%), Charlie (31.3%), Bravo (5.8%), Alpha (18.3%), and Omega (0.3%). For adults the mean age of survivors was less than non-survivors (57.7 vs. 75.8; p<0.001), but pediatric survivors were older than non-survivors (8.7 vs. 2.8; p<0.001). There were more males that died than females (53.0% vs. 47.0%; p<0.001). There was no statistically significant difference in the day of week (p=0.592), but there was by season with the highest mortality in winter (27.1%; p=0.045). The highest mortality occurred with patients presenting to EMS between 0600-1200 hours (34.6%), and the lowest between 0000-0600 hours (11.8%; p<0.001). Mortality by CTAS was category 1 (27.1%), 2 (36.7%), 3 (29.9%), 4 (4.3%), and 5 (0.5%). The highest mortality was seen in MPDS card 26-Sick Person (specific diagnosis) (19.1%), chief complaint shortness of breath (19.3%), and ED diagnoses pertaining to the circulatory system (31.1%). Conclusion: Significant all-cause in-hospital mortality differences were found between event, patient, and clinical characteristics. These data provide foundational and hypothesis generating knowledge regarding mortality in transported EMS patients that can be used to guide research and training. Future research should further explore the characteristics of those that access health care through the EMS system.
BackgroundThe standard response time benchmark for Emergency Medical Services (EMS) has been set at eight minutes or less for ground ambulances in many parts of the world. It has not been extensively studied, especially in paediatric patients who suffered a traumatic injury. As injury is the leading cause of death for those under the age of 18 it is important to determine if this benchmark for EMS response time may be a factor in paediatric mortality and morbidity outcomes.MethodsAll paediatric calls made to EMS between April 2010 to September 2013 in the cities of Calgary and Edmonton, Alberta, Canada were examined to select patients who had suffered a traumatic injury. These records were then linked to emergency department records and hospitalisation records using a deterministic linkage strategy using personal healthcare number, sex, and receiving facility. Patients were excluded if they were ≥18 years old, attended to outside of Calgary or Edmonton areas or suffered a medical complaint not related to an injury. Response time, the exposure, was defined as time of call to 9–1–1 to arrival of ambulance on scene. Response time was dichotomized into <8 minutes and ≥8 minutes. The main measure of morbidity was hospital admission. Adjusted risk ratios were calculated using Poisson regression.Results42 620 patients were attended to between April 2010 and September 2013. Overall, 6778 patients were included in the study. 52 patients died and 628 patients were admitted to hospital. The adjusted mortality risk ratio given a response time of ≥8 minutes was 0.635 (95% CI: 0.346–1.166; p = 0.143). The adjusted hospital admission risk ratio given a response time of ≥8 minutes was 1.165 (95% CI: 0.985–1.379; p = 0.075).ConclusionsA response time of ≥8 minutes was not associated with a difference in all cause mortality or hospital admission for paediatric patients suffering from a traumatic injury.
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