C an P Aramedics a Ccurately I Dentify P Atients W Ho D O N Ot R Equire E Mergency D Epartment C Are ?

Silvestri, Salvatore; Rothrock, Steven G.; Kennedy, Dan; Ladde, Jay; Bryant, Marsha; Pagane, Joseph

doi:10.1080/10903120290937987

Cited by 82 publications

(51 citation statements)

References 9 publications

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“…60,61 In addition, one study aimed to evaluate if paramedics could be helpful in determining if patients required emergency care showed paramedics failed to predict which patients do and do not require ED care. 62 One of the main findings is the lack of RCTs in evaluation of DSTs in prehospital care. It is very surprising that many studies are well conducted but not randomized.…”

Section: Discussionmentioning

confidence: 99%

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Hagiwara

Henricson

Jönsson

et al. 2011

Prehosp. Disaster med.

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Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease "time to definitive care" and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions:The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care. IntroductionPrehospital patient assessment is different compared to assessments provided in hospitals. Often, the ambulance personnel are sent to medical emergencies with very little background information. The person who initiates the call for help sometimes is not able to describe the situation, and therefore, the ambulance personnel have difficulties preparing themselves for the task. The ambulance personnel's work situation has been described as "extreme". "They have routinely required working in environments of extreme and constant uncertainty." 1 These environmental factors lead to great strain on the prehospital caregiver's ability when assessing patients. In addition, there have been very few randomized controlled trials (RTC) that have evaluated prehospital care. 2 When 14 ambulance nurses in Sweden were asked about factors that influence their decision-making, several factors that were crucial for the decision were elicited. Important factors included: (1) time of day; (2) season and weather; (3) amount of time before other resources could arrive to the scene; (4) if there was threat of security; (5) stress; (6) environment; (7) diagnosis and; (8) type of patient assessed. 3 A qualitative study by Wireklint Sundström described the need of an "open mind" in the performance of prehospital assessments, and noted that prehospital caregivers must put their preconceived ideas aside when they meet and assess patients. 4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task ...

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Section: Discussionmentioning

confidence: 99%

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Hagiwara

Henricson

Jönsson

et al. 2011

Prehosp. Disaster med.

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“…12 • Under/over-triage rate 62,63 • Paramedic documented decision compared to patient outcome 62,64 or expert panel decision and reported with sensitivity and specificity 62…”

Section: ;17(5)mentioning

confidence: 99%

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

Jensen

Carter

Rose

et al. 2015

CJEM

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Objectives: Emergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs. Data Source: Broad systematized bibliographic and grey literature searches were conducted. Study Selection: Inclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure. Data Extraction: The reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described. Data Synthesis: The bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n = 44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n = 4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported. Conclusions: Numerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs. RÉSUMÉObjectif: Les programmes de services médicaux d'urgence (SMU), qui offrent une solution de rechange à la répartition traditionnelle des SMU ou au transport classique des malades aux services des urgences (SU), gagnent de plus en plus de terrain. Dans l'examen d'établissement de la portée décrit ici, les auteurs ont relevé et classé tous les résultats utilisés pour mesurer l'efficacité de ces programmes novateurs de SMU. Sources des données: Les auteurs ont entrepris une vaste recherche systématisée de références bibliographiques, et effectué des recherches méthodiques dans la documentation parallèle. Sélection des études: Les critères de sélection comprenaient les appels faits aux services d'urgence 911 ou les malades examinés par les SMU, inscrits dans les rapports de solutions de rechange à la répartition traditionnelle des SMU OU au transport classique des malades au SU par les SMU, ainsi que l'existence d'un critère d'évaluation. Extraction des données: Les rapports ont été classés soit dans la catégorie des solutions de rechange à la répartition des services, soit dans la catégorie des solutions de rechange aux transports effectués par les SMU; quant aux critères d'évaluation, ils ont été classés et décrits. Synthèse...

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“…Other studies have suggested that paramedic assessment of need for transport does not correlate with a physician's decision to admit or order advanced imaging studies. 38,39 Additionally, there may be differences between patients transported by SFFD versus those who choose to be transported by other paramedic companies. Patients that have the resources to call a specific company may represent a group with a higher standard of living and less socioeconomic stressors than the population using standard dispatch services from a 9-1-1 call center.…”

Section: Limitationsmentioning

confidence: 99%

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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C an P Aramedics a Ccurately I Dentify P Atients W Ho D O N Ot R Equire E Mergency D Epartment C Are ?

Abstract: In this urban system, paramedics cannot reliably predict which patients do and do not require ED care.

Cited by 82 publications

References 9 publications

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

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