C Oncordance of F Ield and E Mergency D Epartment a Ssessment in the P Rehospital M Anagement of P Atients With D Yspnea

Abstract

The authors conclude that in this EMS system, field assessment of dyspnea by paramedics is in agreement with that arrived at in the ED in a high proportion of patients with dyspnea from a single source. However, field assessment of dyspnea from multiple etiologies is less concordant.

Do Medications Affect Vital Signs in the Prehospital Treatment of Acute Decompensated Heart Failure?

“…This case definition has been used in the prehospital setting in a prior study with reasonable ED diagnostic accuracy based on ultimate ED diagnosis. 15 Demographic information, initial and repeat vital signs [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and pulse oximetry (O 2 Sat)] and medication and doses were collected. The changes in vital signs were computed as the difference between the initial vital signs and the last complete set of subsequent vital signs.…”

Paramedic Differentiation of Asthma and COPD in the Prehospital Setting Is Difficult

“…21 Concordance was high for those cases with a single cause (cardiac or respiratory) of dyspnea identified (83%-86% respectively) but was only 17% for patients assessed by EMS providers as having a combined (cardiac and respiratory) cause of dyspnea. 21 A prospective audit of the use of oxygen in acute exacerbations of COPD in the prehospital, ED and acute care setting in the UK found ambulance crews correctly identified COPD in 32% of 65 patients and asthma in 29% of 65 patients. 6 The variation in methodology between studies makes valid comparison of the results problematic.…”

“…Studies of the accuracy of coding respiratory conditions by paramedics have been limited [6][7][8][9]21 and the findings inconsistent, with no consensus on a 'gold standard' for comparisons.…”

“…The study 7 also only included patients from one hospital with its own ambulance service. Pozner et al 21 conducted a retrospective review of prehospital records in patients with dyspnea and compared the prehospital cause of dyspnea (cardiac; non-cardiac or both) to that indicated by the ED diagnosis on the 9 medical record. 21 Concordance was high for those cases with a single cause (cardiac or respiratory) of dyspnea identified (83%-86% respectively) but was only 17% for patients assessed by EMS providers as having a combined (cardiac and respiratory) cause of dyspnea.…”

“…Pozner et al 21 conducted a retrospective review of prehospital records in patients with dyspnea and compared the prehospital cause of dyspnea (cardiac; non-cardiac or both) to that indicated by the ED diagnosis on the 9 medical record. 21 Concordance was high for those cases with a single cause (cardiac or respiratory) of dyspnea identified (83%-86% respectively) but was only 17% for patients assessed by EMS providers as having a combined (cardiac and respiratory) cause of dyspnea. 21 A prospective audit of the use of oxygen in acute exacerbations of COPD in the prehospital, ED and acute care setting in the UK found ambulance crews correctly identified COPD in 32% of 65 patients and asthma in 29% of 65 patients.…”