BackgroundPatients with mental health-related complaints are a key driver of increasing emergency medical service (EMS) demand; however, they require minimal intervention by EMS personnel. We describe the outcomes of a video telehealth study by mental health nurses (MHNs) in an EMS call-taking centre.MethodsThis was a prospective study of adult (≥18 years) EMS callers with non-urgent mental health concerns in Victoria, Australia who underwent secondary triage between 1 March 2020 and 31 May 2021. Multivariable logistic regression models were used to compare the influence of video telehealth with voice-only triage by an MHN or secondary triage practitioner on the need for ambulance dispatch. One-week follow-up was conducted with video telehealth patients. Interviews were conducted with MHNs and a cost analysis was performed.ResultsA total of 9588 patients were included of which 738 (7.7%) completed video consultation. The median age of video telehealth patients was 34 years (Q1: 24, Q3: 47), 62% were female and the most common complaint was suicidal or self-harm ideation (50.0%). After multivariable adjustment, video telehealth was associated with reduced odds of emergency ambulance dispatch (OR=0.173, 95% CI 0.144 to 0.209) when compared with voice-only triage by a secondary triage practitioner, but not voice-only triage by an MHN (OR=1.009, 95% CI 0.827 to 1.232). Video triage was associated with increased referrals to alternative services (excluding EDs) when compared with voice-only triage by an MHN (OR=1.321, 95% CI 1.087 to 1.606). Among those responding to 1-week follow-up, 92.8% were satisfied with the telehealth service and MHNs viewed it favourably. The average cost per video telehealth case was half that of a traditional secondary triage.ConclusionThe use of video telehealth by MHNs was associated with fewer emergency ambulance dispatches when compared with voice-only triage by secondary triage practitioners, and increased referrals to alternative services. This cost-effective technology was viewed favourably by patients and MHNs. Expansion of video technology in EMS call taking warrants exploration.
professionals due to different barriers. This study aims at reviewing if the use of pharmacological methods for pain provided during the emergency care of pediatric trauma patients is proper. Method Retrospective study of 560 consecutive clinical records of trauma patients, aged from 0 to 18, assisted from March to December 2017 by Advanced Life Support Units. Minor injuries excluded. Results Median age was 12 years (IQR 8-15). 71.8% ( 402) males. The most common diagnoses were upper limbs fractures and dislocations 38.4% (215), 6.3% (35) major traumas. Pain assessment scales were used in 16.6% (93). Children received analgesia in 44.1% (247),>6 years were 50.5% (221) and £6 210.3% (26), p<0001. Fentanil was used in 78.5%(194) followed by Acetaminophen 20.6%(51), Ketorolac 17%(42) and Ketamine 8.9 (22). Midazolam was associated in 35.2%(84). Analgesia in major trauma was 74.3% with respect to serious wounds and brain injuries 10.8% p<0,001. Intravenous route was favourite 74% (183), followed by intranasal, 20.2% (50). Conclusion The study demonstrates that, according to international guidelines, major trauma analgesia is greater than another groups, but not generalized. Intravenous infusion opioids are the main pharmacological method. However, pain scales are insufficiently applied and there is often a pain undertreatment, particularly in the youngest. Promoting suitable pain scales and alternatives to intravenous route like intranasal could increase treatment.
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