A cost-aware framework for the development of AI models for healthcare applications.

Accurate artificial intelligence (AI) for disease diagnosis could lower healthcare workloads. However, when time or financial resources for gathering input data are limited, as in emergency and critical-care medicine, developing accurate AI models, which typically require inputs for many clinical variables, may be impractical. Here we report a model-agnostic cost-aware AI (CoAI) framework for the development of predictive models that optimize the trade-off between prediction performance and feature cost.

Prehospital Noninvasive Ventilation: An NAEMSP Position Statement and Resource Document.

Noninvasive ventilation (NIV), including bilevel positive airway pressure and continuous positive airway pressure, is a safe and important therapeutic option in the management of prehospital respiratory distress. NAEMSP recommends:NIV should be used in the management of prehospital patients with respiratory failure, such as those with chronic obstructive pulmonary disease, asthma, and pulmonary edema.NIV is a safe intervention for use by Emergency Medical Technicians.

Cardiac Arrest in Flight: A Retrospective Chart Review of 92 Patients Transported by a Critical Care Air Medical Service.

Objective: The purpose of this study was to describe the incidence, characteristics, and outcomes of cardiac arrest in the air medical environment so that we can begin to understand predictors of in-flight cardiac arrest and identify opportunities to improve care.

Methods: This retrospective observational study was undertaken at Airlift Northwest from 2013 to 2017. Descriptive statistics of adult patients with medical and traumatic etiologies of cardiac arrest were analyzed and compared.

Psychiatric Outcomes of Patients With Severe Agitation Following Administration of Prehospital Ketamine.

Background: Ketamine is an emerging drug used in the management of undifferentiated, severe agitation in the prehospital setting. However, prior work has indicated that ketamine may exacerbate psychotic symptoms in patients with schizophrenia. The objective of this study was to describe psychiatric outcomes in patients who receive prehospital ketamine for severe agitation.

Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations.

Purpose: In hospital-based studies, patients intubated by physicians while in an inclined position compared to supine position had a higher rate of first pass success and lower rate of peri-intubation complications. We evaluated the impact of patient positioning on prehospital endotracheal intubation in an EMS system with rapid sequence induction capability. We hypothesized that patients in the inclined position would have a higher first-pass success rate.

Emerging and Future Technologies in Out-of-Hospital Cardiac Arrest Care.

The care for victims of out-of-hospital cardiac arrest is evolving and will be influenced by future and emerging technologies that will play a role in the systems of care for these patients. Recent advances in extracorporeal life support and point-of-care ultrasound imaging, both in-hospital and out-of-hospital, may offer a therapeutic solution in some systems for patients with refractory or recurrent cardiac arrest. Drones capable of delivering automated external defibrillators to the scene of an out-of-hospital cardiac arrest, advances in digital and mobile technologies to notify and leverage bystander response, and wearable life detection technologies may improve survival.

Ten Steps to Improve Cardiac Arrest Survival in Your Community.

Creating a system of care for out of hospital cardiac arrest (OHCA) is not a simple task. It must be a multifaceted approach that encompasses a variety of teams from call takers, to bystanders, to emergency medical service (EMS) personnel, to hospital personnel. All of these teams must line up and perform their individual task successfully to yield a survivor of OHCA and return a loved one to his or her family.

Prehospital Lactate Predicts Need for Resuscitative Care in Non-hypotensive Trauma Patients.

Introduction: The prehospital decision of whether to triage a patient to a trauma center can be difficult. Traditional decision rules are based heavily on vital sign abnormalities, which are insensitive in predicting severe injury. Prehospital lactate (PLac) measurement could better inform the triage decision.

Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes.

Background: International guidelines recommend administration of 1 mg of intravenous epinephrine every 3-5 min during cardiac arrest. The optimal dose of epinephrine is not known. We evaluated the association of reduced frequency and dose of epinephrine with survival after out-of-hospital cardiac arrest (OHCA).

The impact of first responder turnout and curb-to-care intervals on survival from out-of-hospital cardiac arrest.

Purpose: Patients with out-of-hospital cardiac arrest (OHCA) more likely survive when emergency medical services (EMS) arrive quickly. We studied time response elements in OHCA with attention to EMS intervals before wheels roll and after wheels stop to understand their contribution to total time response and clinical outcome.

Methods: We analyzed EMS responses to OHCA from 2009-2014 in an urban, fire department based system.

Briefer activation time is associated with better outcomes after out-of-hospital cardiac arrest.

Background: Treatment of out-of-hospital cardiac arrest (OHCA) requires prompt intervention. Better outcomes are associated with briefer time from dispatch of emergency medical services (EMS) providers to arrival on scene, application of a defibrillator or insertion of an advanced airway. We assessed whether time from receipt of a call by a telecommunicator to dispatch of EMS providers was associated with outcomes.

Impact of Building Height and Volume on Cardiac Arrest Response Time.

Emergency medical services (EMS) care may be delayed when out-of-hospital cardiac arrest (OHCA) occurs in tall or large buildings. We hypothesized that larger building height and volume were related to a longer curb-to-defibrillator activation interval. We retrospectively evaluated 3,065 EMS responses to OHCA in a large city between 2003-13 that occurred indoors, prior to EMS arrival, and without prior deployment of a defibrillator.

A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.

Background: The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history.

Methods: All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries.

Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes.

Background: We hypothesized that standardized withdrawal of care (WOC) practices and an aggressive long-term acute care facility (LTAC) discharge protocol could change hospital mortality and national ranking among trauma centers.

Study Design: Patients who died while admitted to the trauma service at a level 1 trauma center were classified as either an "LTAC candidate" or "not a LTAC candidate" at 4 time points before death.

Results: A total of 216 patients died, and 48% had WOC.

In-house direct supervision by an attending is associated with differences in the care of patients with a blunt splenic injury.

Background: There continues to be controversy over the added value of direct supervision of residents, particularly its effect on patient outcomes. The purpose of this study was to compare direct and indirect resident supervision for the management of blunt spleen injuries and to evaluate differences in patient care.

Methods: All patients with blunt splenic injury admitted off hours over a 6.

Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death.

Background: The purpose of this study was to evaluate long-term mortality after trauma, and to determine risk factors and possible disparities related to mortality after hospital discharge.

Study Design: Level I trauma center registry data from a 6-year period (2000 through 2005) were linked to patient electronic medical records, the National Death Index with cause of death codes, and census data using geographic information science (GIS) methodologies. Census data provided supplemental demographic and socioeconomic information from patient neighborhoods.