Background The Office of the National Coordinator for Health Information Technology has outlined the benefits of health information exchange in emergency medical services (EMSs) according to the SAFR model—search, alert, file, and reconcile—developed in collaboration with the California Emergency Medical Services Authority. Objective This scoping review aims to identify and characterize progress toward the adoption of prehospital health information exchange, as reported in the peer-reviewed literature. Methods A structured review of literature in MEDLINE-indexed journals was conducted using the “Electronic Health Records” topic-specific query, the “Emergency Medical Services” Medical Subject Headings descriptor, and a prehospital identifier. Results Our initial search yielded 368 nonduplicative, English-language articles; 131 articles underwent full-text review and 11 were selected for analysis according to pre-established inclusion criteria. Original research was thematically grouped according to the SAFR model. Conclusion Within isolated systems, there has been limited progress toward the adoption of prehospital health information exchange. Interoperability, accurate match algorithms, security, and wireless connectivity have been identified as potential barriers to adoption. Additional research is required to evaluate the role of health information exchange within EMSs.
Introduction: Each year, Brown University holds Spring Weekend (SWE), an outdoor concert drawing 6,000 attendees per day. Mass gatherings are prone to developing into mass casualty incidents (MCIs) due to unplanned events and attacks. Though campus venues face comparable risks, collegiate resources are more commonly and predictably overwhelmed by medical surge from trauma and/or toxicological emergencies. These 'planned MCIs' offer unique training opportunities and inform disaster planning. Brown EMS (BEMS) provides primary medical coverage for SWE and develops annual response plans using data-driven evaluation. Program Development & Implementation: BEMS establishes EMS Operations during major events using a modified ICS structure. Whereas our ALS/BLS-licensed ambulance and non-transport SUV are routinely in-service, venue resources are augmented by dedicated apparatuses and pairs of EMTs assigned to ground details. By increasing its resources, BEMS aims to increase venue capacity, optimize response, and limit mutual-aid requirements. The number and proportion of transports by external agencies consistently increased over 2014-2016: 25.0% (3/12), 31.3% (5/16), and 45.0% (9/20) during the six-hour Friday concert, respectively. For SWE 2017, we hypothesized that renting and staffing an additional ALS ambulance with BEMS personnel would decrease mutual-aid utilization. Program Evaluation: To control for annual variations, we compared mutual-aid utilization in 2017 against aggregate utilization during the three prior years and observed no significant difference: 20.8% (5/24) vs. 35.4%(17/48) (p=0.21). This suggests that in response planning, the temporal density of patient presentations during surge conditions may better predict mutual-aid requirements than historical call volume. Discussion/Conclusion: Though mutual-aid is a cornerstone of MCI management, collegiate systems may face unique pressures to decrease its utilization if students are exposed to additional billing. Expanding our transport sector in 2017 did not significantly decrease the proportion of patients requiring mutual-aid transport. To optimize incident response, collegiate services may instead consider establishing on-site triage/treatment areas and concurrently transporting low-acuity patients.
Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.
Introduction Protocolized automation of critical, labor-intensive tasks for out-of-hospital cardiac arrest (OHCA) resuscitation may decrease Emergency Medical Services (EMS) provider workload. A simulation-based assessment method incorporating objective and self-reported metrics was developed and used to quantify workloads associated with standard and experimental approaches to OHCA resuscitation. Methods Emergency Medical Services-Basic (EMT-B) and advanced life support (ALS) providers were randomized into two-provider mixed-level teams and fitted with heart rate (HR) monitors for continuous HR and energy expenditure (EE) monitoring. Subjects' resting salivary α-amylase (sAA) levels were measured along with Borg perceived exertion scores and multidimensional workload assessments (NASA-TLX). Each team engaged in the following three OHCA simulations: (1) baseline simulation in standard BLS/ALS roles; (2) repeat simulation in standard roles; and then (3) repeat simulation in reversed roles, ie, EMT-B provider performing ALS tasks. Control teams operated with standard state protocols and equipment; experimental teams used resuscitation-automating devices and accompanying goal-directed algorithmic protocol for simulations 2 and 3. Investigators video-recorded resuscitations and analyzed subjects' percent attained of maximal age-predicted HR (%mHR), EE, sAA, Borg, and NASA-TLX measurements. Results Ten control and ten experimental teams completed the study (20 EMT-Basic; 1 EMT-Intermediate, 8 EMT-Cardiac, 11 EMT-Paramedic). Median %mHR, EE, sAA, Borg, and NASA-TLX scores did not differ between groups at rest. Overall multivariate analyses of variance did not detect significant differences; univariate analyses of variance for changes in %mHR, Borg, and NASA-TLX from resting state detected significant differences across simulations (workload reductions in experimental groups for simulations 2 and 3). Conclusions A simulation-based OHCA resuscitation performance and workload assessment method compared protocolized automation-assisted resuscitation with standard response. During exploratory application of the assessment method, subjects using the experimental approach appeared to experience reduced levels of physical exertion and perceived workload than control subjects.
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