A prehospital treat-and-release protocol for supraventricular tachycardia

Minhas, Rajan; Vogelaar, Gregory; Wang, Dongmei; Almansoori, Wadhah; Lang, Eddy; Blanchard, Ian E.; Lazarenko, Gerald; McRae, Andrew

doi:10.1017/cem.2014.53

Cited by 12 publications

(12 citation statements)

References 19 publications

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“…Ten of these studies described more specific flowcharts, tools, checklist or standard operating procedures for non-conveyance in general [43, 51, 72], patients who refuse conveyance [29, 40, 46], and patients who had fallen [84], with supraventricular tachycardia [39], with social problems [28], with hypoglycaemia [53], and post-ictal patients [53]. …”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported non-conveyance rates for patients with an opioid overdose , ranging from 6.0%–77.0% [ 44 , 54 ]. Non-conveyance rates for other specific patient groups were 14.0% for post-ictal patients [ 53 ], 33.2% for patients with supraventricular tachycardia [ 39 ], 10.7%–11.5% for elder people [ 69 ], and 8.6% for patients with injuries [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Repeated access to the EMS-system is measured in ten studies [ 26 , 37 , 39 , 40 , 52 , 56 , 58 , 64 , 67 , 78 ]. For general patient populations, the follow-up periods ranged from <24 h up to <7 days, and repeated access percentages varied from 6.1% (<24 h), 2.3–2.5% (<48 h) up to 7.4–13.5% (<7 days).…”

Section: Resultsmentioning

confidence: 99%

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A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

135

208

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BackgroundThis systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.MethodsWe systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.ResultsWe included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Mortality rates vary from 0.2%–3.5% after 24 h, up to 0.3%–6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).ConclusionsNon-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0409-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

135

208

View full text Add to dashboard Cite

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“…Minhas et al [15] analysed cases of paroxysmal SVT treated in a prehospital setting. They revealed that EMS agencies typically required patients treated for SVT to be transported to a hospital; however, in some uncomplicated cases, the treat-and-release protocol could be instituted.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

Sokołowski

Wawrzyńska

2019

Disaster Emerg Med J

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IntroductIon: Supraventricular tachycardia (SVT) is a wide term used to describe tachycardia with atrial and/or ventricular rates exceeding 100 bpm at rest. The underlying mechanism involves His bundle or tissue lying above. As the diagnosis of SVT is often made in the prehospital settings or in an emergency department, the relevant knowledge of all medical personnel, including paramedics, on the diagnosis and treatment procedures is crucial for the patient's outcome. It is essential to quickly assess the patient's clinical condition and make decisions based on both electrocardiographic records and the occurrence of adverse symptoms. Some procedures and pharmacological treatments can be implemented by the paramedic on their own, some require a physician's supervision. The aim of the study was to assess paramedics' and nurses' knowledge concerning emergency management in tachycardia. MethodS: The study was conducted in January 2019 in southwestern Poland among paramedics and nurses working in the Polish National Emergency Medical System (EMS). All participants received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire was developed by the authors and included 22 questions referring to gender, age, work experience, type of work in EMS, number of inhabitants in the workplace area, latest training in advanced life support, adverse events in hemodynamically unstable patients, vagal manoeuvres, European Resuscitation Council 2015 guidelines for narrow and broad complex tachycardia in stable and unstable patients with regular and irregular rhythms, indications for synchronized electrical cardioversion, performing synchronized electrical cardioversion in the past, concerns about cardioversion and self-assessed level of experience in tachyarrhythmia treatment.

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“…The participants' experiences and perspectives suggest the traditional EMS paradigm of assess and transport to the ED for further assessment may not be acceptable to many individuals who faint. Developing an assess, treat and refer-style protocol, similar to present procedures for hypoglycemia and SVT (6,7), may be important to achieving patient satisfaction in this population. Protocols that circumvent the ED may be desirable for many patients who wish to avoid feeling like a "burden" on the healthcare system.…”

Section: Limitationsmentioning

confidence: 99%

A qualitative study to identify factors that influence patients’ decisions to call Emergency Medical Services for syncope

Williamson

Runté

Runte

et al. 2020

Preprint

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BACKGROUND Emergency medical services (EMS) assessment and presentation to the emergency department (ED) for syncope (fainting) often results in hospital admission and costly diagnostic testing that rarely benefits patients. Protocols that support paramedics to assess, treat and refer low-risk syncope may allow for ED transport of only high-risk patients. The development and successful uptake of such protocols is limited by a dearth of information about factors patients consider when deciding to seek EMS care following syncope. OBJECTIVE We aimed to explore decision-making processes of individuals with syncope when deciding whether (or not) to call EMS after fainting as a starting point in the development of prehospital risk-stratification protocols. METHODS Twenty-five adults (aged 18–65 years) with a history of ≥ 1 syncopal episode were recruited across four Canadian provinces. Individual semi-structured interviews were conducted, recorded, and transcribed. Straussian grounded theory methods were used to identify common themes and a core (overarching) category. RESULTS Four common themes were identified: (a) previous experiences with the healthcare system (e.g., feeling dismissed), (b) individual patient factors (e.g., age, comorbidities), (c) attitudes and beliefs (e.g., concerns about burdening the health care system, believing syncope is “not serious enough” to seek care), and (d) contextual factors (i.e., influence of important others, symptom severity). Perceived judgement of the patient by EMS was identified as the overarching core category that influenced patients’ decision-making to seek care. CONCLUSION The decision to seek EMS care after syncope is a complex process involving patient consideration of past experiences, pre-existing attitudes and beliefs, and individual- and contextual factors. Patients’ previous experiences of judgement and dismissal by EMS for fainting may interfere with patient receptiveness to traditional EMS protocols for syncope. These barriers could be targets for training and education for paramedics and help to inform the development of prehospital protocols to improve care and satisfaction among patients with syncope.

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A prehospital treat-and-release protocol for supraventricular tachycardia

Cited by 12 publications

References 19 publications

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

A qualitative study to identify factors that influence patients’ decisions to call Emergency Medical Services for syncope

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