Advanced Practice Providers in the Field: Implementation of the Los Angeles Fire Department Advanced Provider Response Unit

Sanko, Stephen; Kashani, Saman; Ito, Terrance; Guggenheim, Aaron; Fei, Shangnon; Eckstein, Marc

doi:10.1080/10903127.2019.1666199

Cited by 19 publications

(24 citation statements)

References 23 publications

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“…Assistance to people with acute disease in the prehospital context has evolved rapidly in recent years, making it possible to diagnose and treat bedside pathologies on many occasions [1]. Thanks to research in this field and to the implementation of specific protocols and technological developments, we now have tools that can be employed at the scene or on the road, which can help to evaluate the actual state of a patient from the very first contact of the emergency medical services (EMS) until the arrival at the emergency department (ED) [2].…”

Section: Introductionmentioning

confidence: 99%

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Martin-Rodríguez

López-Izquierdo

Benito³

et al. 2020

JCM

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The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.

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Section: Introductionmentioning

confidence: 99%

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Martin-Rodríguez

López-Izquierdo

Benito³

et al. 2020

JCM

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“…The cross sectional study 19 is of moderate quality due to the representativeness of results, and small population. The other three studies [20][21][22] are of poor quality. Table 2).…”

Section: Quality Assessment (Extended Data 23 )mentioning

confidence: 99%

“…Study characteristics (Table 1) Designs of the included studies comprised of one cross sectional 19 , one retrospective observational 20 , one action research 21 , and one retrospective descriptive review 22 (Table 1). Two studies were performed in the UK, one in the Netherlands and one in the USA.…”

Section: Review Statisticsmentioning

confidence: 99%

“…All these studies extracted the data from ambulance run records or patient records. The focus of three of these studies 19,21,22 was primarily on ambulance care, where the retrospective observational study 20 had a broader perspective of home care, ambulance care, and emergency care. One study 19 compared the PA with a registered nurse (RN), two compared the NP with other EMS professionals (e.g., paramedics) 20,21 and one solely described the NP 22 without comparison.…”

Section: Review Statisticsmentioning

confidence: 99%

“…All four studies [19][20][21][22] reported on process of care outcomes. The outcomes used included the proportion of non-conveyance, the number of referrals in non-conveyance patients, the number of consultations, the length of on-scene treatment, the follow-up contact of non-conveyance patients, diagnostic measurements, adherence to guidelines and protocols and, number of performed interventions.…”

Section: Activities By a Np Or Pa (mentioning

confidence: 99%

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Nurse practitioners and physician assistants working in ambulance care: A systematic review

Vliet

Ebben

Diets³

et al. 2020

F1000Res

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Background: This review aims to describe the activities of nurse practitioners (NPs) and physician assistants (PAs) working in ambulance care, and the effect of these activities on patient outcomes, process of care, provider outcomes, and costs. Methods: PubMed, MEDLINE (EBSCO), EMBASE (OVID), Web of Science, the Cochrane Library (Cochrane Database of Systematic Review), CINAHL Plus, and the reference lists of the included articles were systematically searched in November 2019. All types of peer-reviewed designs on the three topics were included. Pairs of independent reviewers performed the selection process, the quality assessment, and the data extraction. Results: Four studies of moderate to poor quality were included. Activities in medical, communication and collaboration skills were found. The effects of these activities were found in process of care and resource use outcomes, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact Conclusions: This review shows that there is limited evidence on activities of NPs and PAs in ambulance care. Results show that NPs and PAs in ambulance care perform activities that can be categorized into the Canadian Medical Education Directives for Specialists (CanMED) roles of Medical Expert, Communicator, and Collaborator. The effects of NPs and PAs are minimally reported in relation to process of care and resource use, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact. No evidence on patient outcomes of the substitution of NPs and PAs in ambulance care exists. PROSPERO registration: CRD42017067505 (07/07/2017)

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Point‐of‐care testing in EMS

Carter¹

2021

Emergency Medical Services

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Advanced Practice Providers in the Field: Implementation of the Los Angeles Fire Department Advanced Provider Response Unit

Cited by 19 publications

References 23 publications

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Nurse practitioners and physician assistants working in ambulance care: A systematic review

Point‐of‐care testing in EMS

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