Aim The COVID-19 pandemic has significantly impacted Emergency Medical Services (EMS) operations throughout the country. Some studies described variation in total volume of out-of-hospital cardiac arrests (OHCA) during the pandemic. We aimed to describe the changes in volume and characteristics of OHCA patients and resuscitations in one urban EMS system. Methods We performed a retrospective cohort analysis of all recorded atraumatic OHCA in Marion County, Indiana, from January 1, 2019 to June 30, 2019 and from January 1, 2020 to June 30, 2020. We described patient, arrest, EMS response, and survival characteristics. We performed paired and unpaired t -tests to evaluate the changes in those characteristics during COVID-19 as compared to the prior year. Data were matched by month to control for seasonal variation. Results The total number of arrests increased from 884 in 2019 to 1034 in 2020 ( p = 0.016). Comparing 2019 to 2020, there was little difference in age [median 62 (IQR 59–73) and 60 (IQR 47–72), p = 0.086], gender (38.5% and 39.8% female, p = 0.7466, witness to arrest (44.3% and 39.6%, p = 0.092), bystander AED use (10.1% and 11.4% p = 0.379), bystander CPR (48.7% and 51.4%, p = 0.242). Patients with a shockable initial rhythm (19.2% and 15.4%, p = 0.044) both decreased in 2020, and response time increased by 18 s [6.0 min (IQR 4.5–7.7) and 6.3 min (IQR 4.7–8.0), p = 0.008]. 47.7% and 54.8% ( p = 0.001) of OHCA patients died in the field, 19.7% and 19.3% ( p = 0.809) died in the Emergency Department, 21.8% and 18.5% ( p = 0.044) died in the hospital, 10.8% and 7.4% ( p = 0.012) were discharged from the hospital, and 9.3% and 5.9% ( p = 0.005) were discharged with Cerebral Performance Category score ≤ 2. Conclusion Total OHCA increased during the COVID-19 pandemic when compared with the prior year. Although patient characteristics were similar, initial shockable rhythm, and proportion of patients who died in the hospital decreased during the pandemic. Further investigation will explore etiologies of those findings.
The emergence of thrombectomy for large vessel occlusions has increased the importance of accurate prehospital identification and triage of acute ischemic stroke (AIS). Despite available clinical scores, prehospital identification is suboptimal. Our objective was to improve the sensitivity of prehospital AIS identification by combining dispatch information with paramedic impression. We performed a retrospective cohort review of emergency medical services and hospital records of all patients for whom a stroke alert was activated in 1 urban, academic emergency department from January 1, 2018, to December 31, 2019. Using admission diagnosis of acute stroke as outcome, we calculated the sensitivity and specificity of dispatch and paramedic impression in identifying AIS and large vessel occlusion. We identified factors that, when included together, would improve the sensitivity of prehospital AIS identification. Two-hundred twenty-six stroke alerts were activated by emergency department physicians after transport by Indianapolis emergency medical services. Forty-four percent (99/226) were female, median age was 58 years (interquartile range, 50–67 years), and median National Institutes of Health Stroke Scale was 6 (interquartile range, 2–12). Paramedics demonstrated superior sensitivity (59% vs. 48%) but inferior specificity (56% vs. 73%) for detection of stroke as compared with dispatch. A strategy incorporating dispatch code of stroke, or paramedic impression of altered mental status or weakness in addition to stroke, would be 84% sensitive and 27% specific for identification of stroke. To optimize rapid and sensitive stroke detection, prehospital systems should consider inclusion of patients with dispatch code of stroke and provider impression of altered mental status or generalized weakness.
Audience: This low-cost, reusable ultrasound pericardiocentesis simulation model is designed to instruct emergency medicine residents and emergency medicine-bound students.Introduction: Cardiac tamponade is a time sensitive, life-threatening condition that requires prompt intervention. Cardiac tamponade has an incidence of 2 per 10,000 in the U.S. population. 1 Ultrasound-guided pericardiocentesis is a critical treatment for cardiac tamponade that can be safely performed with high success rates. 2 With such a rare likelihood of encountering this condition in clinical practice, deliberate practice is vital for practitioners to be proficient in this life-saving procedure when the need does occur. Simulation training improves fund of knowledge, comfort in procedures, and performance within simulated scenarios. 3 A key component of simulation training involves utilization of training models that thoughtfully reflect true clinical pictures. The use of clinically realistic models affords residents the opportunity to develop the hand-eye coordination and cognitive sense needed to perform the procedure safely on real patients, all in a no-risk, low-stress setting. Unfortunately, currently available simulation models for training can be expensive and limited in scope.Educational Objectives: Through the use of this model and skill session, learners will be able to: 1) discuss the indications, contraindications, and complications associated with ultrasound guided pericardiocentesis; 2) demonstrate an ability to obtain subxiphoid and parasternal long views of the heart; 3) demonstrate an ability to identify pericardial fluid in these two views; and 4) demonstrate proper probe and needle placement to successfully perform an ultrasound guided pericardiocentesis in these two views.Educational Methods: We have developed a reusable, ultrasound-guided pericardiocentesis simulation model that costs approximately $20.00 in materials and takes 10 minutes to construct. The model utilizes a INNOVATIONS 2 Section break fluid-filled balloon inside a press and seal bag that is covered with pork or beef ribs.Research Methods: To evaluate the model's efficacy and learner experience, we created a 5-point Likert scale survey to determine whether respondents believed the model was realistic enough to improve their comfort with performing an ultrasound-guided pericardiocentesis. The survey assessed prior experience with the simulation model, whether different models had been used, and individual experience including its utility in representing both subxiphoid and parasternal approaches to the procedure.Results: From a total of 16 completed surveys, one respondent had performed the procedure clinically, and two had used other simulation models. On a 5-point scale, average comfort level to model usage significantly increased 1.38 points from pre-to post-simulation (P<0.0001). On average, respondents rated the model useful in learning the anatomy and ultrasound image acquisition of the procedure and felt better prepared to perform the procedure po...
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