EMS Management of Acute Stroke—Out-of-Hospital Treatment andStroke System Development (Resource Document to NAEMSP Position Statement)

Millin, Michael G.; Gullett, Travis; Daya, Mohamud

doi:10.1080/10903120701347885

Cited by 23 publications

(11 citation statements)

References 89 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(19-24) There may be multiple barriers preventing greater participation by EMS, including inadequate understanding of sepsis by EMS as well as insufficient appreciation for the optimal EMS role in early triage and care for sepsis patients. (15) The current investigation focused on the EMS understanding of sepsis.…”

Section: Discussionmentioning

confidence: 99%

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Seymour

Carlbom

Engelberg

et al. 2012

The Journal of Emergency Medicine

View full text Add to dashboard Cite

Background Emergency medical services (EMS) personnel commonly encounter sepsis, yet little is known about their understanding of sepsis. Study Objectives To determine the awareness, knowledge, current practice, and attitudes about sepsis among EMS personnel. Methods We performed an anonymous, multi-agency, online survey of emergency medical technicians (EMTs), firefighter-emergency medical technicians (FF-EMTs), and paramedics in a metropolitan, 2-tier EMS system. We compared responses according to the level of EMS training, and used multivariable logistic regression to determine the odds of correctly identifying the definition of sepsis, independent of demographic and professional factors. Results Overall response rate of study participants was 57% (786/1390), and greatest among EMTs (78%; 276/350). A total of 761 respondents (96%) had heard of the term sepsis. EMTs and FF-EMTs were at significantly reduced odds of correctly defining sepsis compared to paramedics, independent of age, sex, and years of experience (EMTs, OR=0.44, 95%CI:0.3,0.8; FF-EMTs, OR=0.32, 95%CI:0.2,0.6,). Overall, knowledge of the clinical signs and symptoms and recommended treatments for sepsis was typically greater than 75%, though best among paramedics than EMTs or FF-EMTs (p<0.01). The majority of respondents believed sepsis is not recognized by EMS “some” or “a lot” of the time (76%, 596/786). Conclusions EMS personnel demonstrated an overall sound awarenessof sepsis. Knowledge of sepsis was less among firefighter-EMTs and EMTs compared to paramedics. These results suggest that paramedics could be integrated into strategies of early identification and treatment of sepsis while EMTs may benefit from focused education and training.

show abstract

Section: Discussionmentioning

confidence: 99%

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Seymour

Carlbom

Engelberg

et al. 2012

The Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Pre‐hospital stroke assessment tools such as the Cincinnati Pre‐hospital Stroke Scale and the Los Angeles Pre‐hospital Stroke Screen effectively identify stroke patients in the field 21,22 . These instruments have demonstrated sensitivities of greater than 90% 21,22 and should be used for the assessment of all patients considered to be having a stroke 23 …”

Section: Stroke Treatmentmentioning

confidence: 99%

Impact of regional pre‐hospital emergency medical services in treatment of patients with acute ischemic stroke

Sozener

Barsan

2012

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Stroke is a major public health concern afflicting an estimated 795,000 Americans annually. The associated morbidity and mortality is staggering. Early treatment with thrombolytics is beneficial. The window for treatment is narrow and minimization of the time from symptom onset to treatment is vital. The general population is not well informed as to the warning signs or symptoms of stroke, leading to substantial delays in emergency medical services (EMS) activation. Ambulance transport of stroke patients to the hospital has demonstrated improvements in key benchmarks such as door to physician evaluation, door to CT initiation, and increased thrombolytic treatment. Pre-hospital notification of the impending arrival of a stroke patient allows for vital preparation in the treating emergency department, and improving timely evaluation and treatment upon arrival of the stroke patient. EMS systems are a vital component of the management of stroke patients, and resources used to improve these systems are beneficial.

show abstract

“…Myocardial infarction has been presumptively diagnosed by out-of-hospital providers for over two decades, 1,2 with improved survival achieved through both prehospital notification and medical treatment in the out-of-hospital phase. 3–8 Early identification during out-of-hospital care and prompt notification to the emergency department (ED) have been feasible and improved outcomes in patients with acute stroke, 9–12 traumatic injury, 13,14 and out-of-hospital cardiac arrest. 1,18,21 …”

Section: Introductionmentioning

confidence: 99%

Out-of-Hospital Fluid in Severe Sepsis: Effect on Early Resuscitation in the Emergency Department

Seymour

Cooke

Mikkelsen

et al. 2010

Prehospital Emergency Care

View full text Add to dashboard Cite

Background Early identification and treatment of patients with severe sepsis improves outcome, yet the role of out-of-hospital intravenous (IV) fluid is unknown. Objective To determine if the delivery of out-of-hospital fluid in patients with severe sepsis is associated with reduced time to achievement of goal-oriented resuscitation in the emergency department (ED). Methods We performed a secondary data analysis of a retrospective cohort study in a metropolitan, tertiary care, university-based medical center supported by a two-tiered system of out-of-hospital emergency medical services (EMS) providers. We studied the association between delivery of out-of-hospital fluid by advanced life support (ALS) providers and the achievement of resuscitation endpoints (central venous pressure [CVP] ≥8 mmHg, mean arterial pressure [MAP] ≥65 mmHg, and central venous oxygen saturation [ScvO2] ≥70%) within six hours after triage during early goal-directed therapy (EGDT) in the ED. Results Twenty five (48%) of 52 patients transported by ALS with severe sepsis received out-of-hospital fluid. Data for age, gender, source of sepsis, and presence of comorbidities were similar between patients who did and did not receive out-of-hospital fluid. Patients receiving out-of-hospital fluid had lower out-of-hospital mean (± standard deviation) systolic blood pressure (95 ± 40 mmHg vs. 117 ± 29 mmHg; p = 0.03) and higher median (interquartile range) Sequential Organ Failure Assessment (SOFA) scores in the ED (7 [5–8] vs. 4 [4–6]; p = 0.01) than patients not receiving out-of-hospital fluid. Despite greater severity of illness, patients receiving out-of-hospital fluid approached but did not attain a statistically significant increase in the likelihood of achieving MAP ≥65 mmHg within six hours after ED triage (70% vs. 44%, p = 0.09). On average, patients receiving out-of-hospital fluid received twice the fluid volume within one hour after ED triage (1.1 L [1.0–2.0 L] vs. 0.6 L [0.3–1.0 L]; p 0.01). No difference in achievement of goal CVP (72% vs. 60%; p = 0.6) or goal ScvO2 (54% vs. 36%; p = 0.25) was observed between groups. Conclusions Less than half of patients with severe sepsis transported by ALS received out-of-hospital fluid. Patients receiving out-of-hospital IV access and fluids approached but did not attain a statistically significant increase in the likelihood of achieving goal MAP during EGDT. These preliminary findings require additional investigation to evaluate the optimal role of out-of-hospital resuscitation in treating patients with severe sepsis.

show abstract

EMS Management of Acute Stroke—Out-of-Hospital Treatment andStroke System Development (Resource Document to NAEMSP Position Statement)

Cited by 23 publications

References 89 publications

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Understanding of Sepsis among Emergency Medical Services: A Survey Study

Impact of regional pre‐hospital emergency medical services in treatment of patients with acute ischemic stroke

Out-of-Hospital Fluid in Severe Sepsis: Effect on Early Resuscitation in the Emergency Department

Contact Info

Product

Resources

About