Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

Bashiri, Azadeh; Savareh, Behrouz Alizadeh; Ghazisaeedi, Marjan

doi:10.15441/ceem.18.032

Cited by 30 publications

(27 citation statements)

References 47 publications

(87 reference statements)

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“…1 On-site resolution: either the ALS physician has been able to stabilize the patient on the scene and his/her condition was no longer serious or once the patient has been evaluated it was found that he/she does not needed any type of manoeuvre or be transferred to the ED. 2 Risk on scene: situations with weapons on the scene, aggressive patients, traffic accidents with risk of fire or explosion, etc In order to study pLA triggers or cut-off points we used already described thresholds. 10,11 The accuracy of pLA triggers presented relevant results which are consistent with previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…1 Such scenarios are faced by the EMS workers with very limited diagnostic information which hampers their clinical decisions. 2 There is today a growing interest in detecting bed-side situations which require rapid clinical responses. To this end, different early warning biomarkers have been developed in the last years with some of them already encompassed into the common clinical practices in the emergency department (ED) and intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

“…Emergency medical services (EMS) deal on the scene and en route with complex patients suffering from acute pathologies usually presenting several comorbidities 1 . Such scenarios are faced by the EMS workers with very limited diagnostic information which hampers their clinical decisions 2 …”

Section: Introductionmentioning

confidence: 99%

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Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Martin-Rodríguez

López-Izquierdo

Medina-Lozano

et al. 2020

Eur J Clin Investigation

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Background: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decisionmaking processes. The present study aims at characterizing the validity of point-ofcare lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. Materials and methods: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). Results: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cutoff point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. Conclusions: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients. K E Y W O R D S clinical clerkship, critical care, emergency medical services, lactate, point-of-care testing 2 of 10 | MARTÍN-RODRÍGUEZ ET Al.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Martin-Rodríguez

López-Izquierdo

Medina-Lozano

et al. 2020

Eur J Clin Investigation

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“…Also, pre-hospital emergency care personnel should have access to the clinical consultation of an emergency doctor stationed at the emergency care center. Likewise, Bashiri et al report that evidence-based clinical guidelines and instructions and having access to advice from a doctor in emergency care departments play a key role in improving the process of clinical decision-making by emergency care personnel and will result in higher quality care [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

et al. 2021

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Background Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. Methods The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. Results The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues. Conclusion The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel’s professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel’s clinical decision-making skill.

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“…Decisions made by paramedics during PEC have the potential to impact patient health outcomes and represent both a professional risk for individual staff members, and a reputational risk to with regards to patient trust [16]. In PEC, clinical decision support systems are not designed to replace humans, but can help healthcare providers to remember relevant diagnostics and checklists (i.e., treatment options) to improve the quality of PEC [17]. The checklists for PEC may help to improve adherence to treatment guidelines [3], although the optimal PEC management is still under study [12].…”

Section: Related Workmentioning

confidence: 99%

A Decision Support Method for Prehospital Emergency Care Based on Ranking the Importance of Physiological Variables

Zhang

Zhao

et al. 2020

Healthcare

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To the on-site nursing staff or field management in prehospital emergency care, it seems baffling to conduct more targeted checklist tests for a specific disease. To address this problem, we proposed a decision support method for prehospital emergency care based on ranking the importance of physiological variables. We used multiple logistic regression models to explore the effects of various physiological variables on diseases based on the area under the curve (AUC) value. We implemented the method on the intensive care database (i.e., the Medical Information Mart for Intensive Care (MIMIC-III) database) and explored the importance of 17 physiological variables for 24 diseases, both chronic and acute. We included 33,798 adult patients, using the full physiological dataset as experiment data. We ranked the importance of the physiological variables related to the diseases according to the experiments’ AUC value. We discussed which physiological variables should be considered more important in adult intensive care units (ICUs) for prehospital emergency care conditions. We also discussed the relationships among the diseases based on ranking the importance of physiological variables. We used large-scale ICU patient data to obtain a cohort of physiological variables related to specific diseases. Ranking a cohort of physiological variables is a cost-effective means of reducing morbidity and mortality under prehospital emergency care conditions.

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Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

Cited by 30 publications

References 47 publications

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

A Decision Support Method for Prehospital Emergency Care Based on Ranking the Importance of Physiological Variables

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