Improving Emergency Medicine Clinician Awareness of Prehospital-Administered Medications.

Information transfer between emergency medical services (EMS) and emergency medicine (EM) is at high risk for omissions and errors. EM awareness of prehospital medication administration affects patient management and medication error. In April 2020, we surveyed emergency physicians and emergency department nurse practitioners (NPs) and physician assistants (PAs) regarding the EMS handoff process.

Accuracy of the American College of Surgeons Minimum Criteria for Full Trauma Team Activation for Children.

Objective: Pediatric trauma centers use reports from emergency medical service providers to determine if a trauma team should be sent to the emergency department to prepare to care for the patient. Little scientific evidence supports the current American College of Surgeons (ACS) indicators for trauma team activation. The objective of this study was to determine the accuracy of the ACS Minimum Criteria for Full Trauma Team Activation for children as well as the accuracy of the modified criteria used at the local sites for trauma activation.

Differential Effects of an Emergency Department-to-Home Care Transitions Intervention in an Older Adult Population: A Latent Class Analysis.

Background: Older adults frequently return to the emergency department (ED) within 30 days of a visit. High-risk patients can differentially benefit from transitional care interventions. Latent class analysis (LCA) is a model-based method used to segment the population and test intervention effects by subgroup.

Scalar Assessment of the Family Caregiver Activation in Transitions Tool: An Exploratory Factor Analysis.

The Family Caregiver Activation in Transitions (FCAT) tool in its current, non-scalar form is not pragmatic for clinical use as each item is scored and intended to be interpreted individually. The purpose of the current study was to create a scalar version of the FCAT to facilitate better care communications between hospital staff and family caregivers. We also assessed the scale's validity by comparing the scalar version of the measure against patient health measures.

Coaching older adults discharged home from the emergency department: The role of competence and emotion in following up with outpatient clinicians.

Objective: Motivating older adults to follow up with an outpatient clinician after discharge from emergency departments (ED) is beneficial yet challenging. We aimed to answer whether psychological needs for motivation and discrete emotions observed by care transition coaches would predict this behavioral outcome.

Methods: Community-dwelling older adults following ED discharge were recruited from three EDs in two U.

Multimethod Process Evaluation of a Community Paramedic Delivered Care Transitions Intervention for Older Emergency Department Patients.

Objective: We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits.

Methods: The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival.

Care transitions intervention reduces ED revisits in cognitively impaired patients.

Introduction: About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population.

Methods: We conducted a pre-planned subgroup analysis of community-dwelling, cognitively impaired older (age ≥60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED-to-home transitions.

Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy.

Background: The number of mobile stroke programmes has increased with evidence, showing they expedite intravenous thrombolysis. Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.

Objective: Our mobile stroke unit (MSU), based at an academic medical centre in upstate New York, launched in October 2018.

Machine learning-assisted screening for cognitive impairment in the emergency department.

Background/objectives: Despite a high prevalence and association with poor outcomes, screening to identify cognitive impairment (CI) in the emergency department (ED) is uncommon. Identification of high-risk subsets of older adults is a critical challenge to expanding screening programs. We developed and evaluated an automated screening tool to identify a subset of patients at high risk for CI.

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial.

Background: Improving care transitions following emergency department (ED) visits may reduce post-ED adverse events among older adults (e.g., ED revisits, decreased function).

Emergency Medical Services Communication Barriers and the Deaf American Sign Language User.

: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. : This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention).

Association between social isolation and outpatient follow-up in older adults following emergency department discharge.

Objectives: Follow-up with outpatient clinicians after discharge from the emergency department (ED) reduces adverse outcomes among older adults, but rates are suboptimal. Social isolation, a common factor associated with poor health outcomes, may help explain these low rates. This study evaluates social isolation as a predictor of outpatient follow-up after discharge from the ED.

Retrospective analysis of the hemodynamic consequences of prehospital supplemental oxygen in acute stroke.

Objective: Hyperoxia, the delivery of high levels of supplemental oxygen (sO) despite normoxia, may increase cerebral oxygenation to penumbral tissue and improve stroke outcomes. However, it may also alter peripheral hemodynamic profiles with potential negative effects on cerebral blood flow (CBF). This study examines the hemodynamic consequences of prehospital sO in stroke.

Predictors of Older Adult Adherence With Emergency Department Discharge Instructions.

Objective: Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients.

Evidence-based crisis standards of care for out-of-hospital cardiac arrests in a pandemic.

Background & Purpose: Pandemics such as COVID-19 can lead to severe shortages in healthcare resources, requiring the development of evidence-based Crisis Standard of Care (CSC) protocols. A protocol that limits the resuscitation of out-of-hospital cardiac arrests (OHCA) to events that are more likely to result in a positive outcome can lower hospital burdens and reduce emergency medical services resources and infection risk, although it would come at the cost of lives lost that could otherwise be saved. Our primary objective was to evaluate candidate OHCA CSC protocols involving known predictors of survival and identify the protocol that results in the smallest resource burden, as measured by the number of hospitalizations required per favorable OHCA outcome achieved.

Public knowledge and attitudes towards bystander cardiopulmonary resuscitation (CPR) in Ghana, West Africa.

Background And Objectives: Early bystander cardiopulmonary resuscitation (CPR) is one of the most important predictors of out-of-hospital cardiac arrests (OHCA) survival. There is a dearth of literature on CPR engagement in countries such as Ghana, where cardiovascular events are increasingly prevalent. In this study, we sought to evaluate Ghanaians' knowledge of and attitudes towards bystander CPR, in the context of the country's nascent emergency medicine network.

Does Mechanism of Injury Predict Trauma Center Need for Children?

Objective: To determine if the Mechanism of Injury Criteria of the Field Triage Decision Scheme (FTDS) are accurate for identifying children who need the resources of a trauma center.

Methods: EMS providers transporting any injured child ≤15 years, regardless of severity, to a pediatric trauma center in 3 midsized communities over 3 years were interviewed. Data collected through the interview included EMS observed physiologic condition, suspected anatomic injuries, and mechanism.

Degree of Bystander-Patient Relationship and Prehospital Care for Opioid Overdose.

Background: Across the spectrum of patient care for opioid overdose, an important, yet frequently overlooked feature is the bystander, or witness to the overdose event. For other acute medical events such as cardiac arrest and stroke, research supports that the presence of a bystander is associated with better outcomes. Despite the similarities, however, this well-established conceptual framework has yet to be applied in the context of overdose patient outcomes.

Prehospital time intervals and management of ischemic stroke patients.

Objective: Quantify prehospital time intervals, describe prehospital stroke management, and estimate potential time saved if certain procedures were performed en route to the emergency department (ED).

Methods: Acute ischemic stroke patients who arrived via emergency medical services (EMS) between 2012 and 2016 were identified. We determined the following prehospital time intervals: chute, response, on-scene, transport, and total prehospital times.

A woman's worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa.

Background: Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for "timely access to emergency obstetric care." This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region.

Implementation of a Prehospital Patella Dislocation Reduction Protocol.

Acute patella dislocations account for up to 3% of all knee injuries. Prehospital care of patella dislocation often includes knee immobilization and pain management, but in the wilderness environment patella reductions are often performed by basic life support providers. Given the potential benefits of early reduction, the perceived low risk of harm and precedent with which the procedure can be performed, patella reduction was added to the EMT scope of practice in New York State.

Prehospital supplemental oxygen for acute stroke - A retrospective analysis.

Objective: Brief early administration of supplemental oxygen (sO) to create hyperoxia may increase oxygenation to penumbral tissue and improve stroke outcomes. Hyperoxia may also result in respiratory compromise and vasoconstriction leading to worse outcomes. This study examines the effects of prehospital sO in stroke.

Effect of Fluctuating Extreme Temperatures on Tranexamic Acid.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.