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Prehospital Emergency Care | 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care

Written by AAA Staff on . Posted in Operations, Patient Care.

From Prehospital Emergency Care

Introduction

Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel.

Objectives

We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel.

Methods

We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

Results

We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing.

Conclusions

This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.

Read Full Research Paper

Christian Martin-Gill, Kathleen M. Brown, Rebecca E. Cash, Rachel M. Haupt, Benjamin T. Potts, Christopher T. Richards, P. Daniel Patterson & for the Prehospital Guidelines Consortium (2022) 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care, Prehospital Emergency Care, DOI: 10.1080/10903127.2022.2143603

EMS1 | 2021 EMS Trend Report

Written by AAA Staff on . Posted in News, Press.

From EMS1

The 2021 EMS Trend Report, produced in collaboration with Fitch & Associates and the National EMS Management Association, and sponsored by Pulsara, continues our effort to identify how those in EMS perceive growth, change and the challenges impacting the sustainability and future of the industry.

Last year, we said that 2020 would be a “defining year” for EMS. Even at the time, soon after the emergence of the new coronavirus in the U.S., we didn’t realize how much that might be true. It certainly was a defining year for EMS, for healthcare and for the entire global community.

A year later, the long-term impacts of the pandemic on our profession remain uncertain. What we do know is how the pandemic highlighted the adaptability of EMS. The sixth annual EMS Trend Report dives into the impact COVID-19 had, and didn’t have, the changes we’re embracing and the change providers want to see, as we explore the opinions, concerns and hopes of your colleagues across EMS at this critical moment in history.

Download your copy to read:

  • The state of the profession: The more things change, the more they stay the same
  • Roundtable: Incremental change through transformative events
  • Is poor leadership more dangerous than a pandemic?
  • Why EMS systems that scale represent the future of EMS
  • 8 Places to invest in provider safety

Download on EMS1

Study | EMS education research priorities during COVID-19

Written by AAA Staff on . Posted in Events, Professional Standards.

From the Journal of the American College of Emergency Physicians
Emergency medical services education research priorities during COVID-19: A modified Delphi study
Rebecca E. Cash PhD, MPH, William J. Leggio EdD, Jonathan R. Powell MPA, Kim D. McKenna PhD, Paul Rosenberger EdD, Elliot Carhart EdD, Adrienne Kramer PhD, Juan A. March MD, Ashish R. Panchal MD, PhD, for the Pandemic Educational Effects Task Force

Objective

Our objective was to identify research priorities to understand the impact of COVID-19 on initial emergency medical services (EMS) education.

Methods

We used a modified Delphi method with an expert panel (n = 15) of EMS stakeholders to develop consensus on the research priorities that are most important and feasible to understand the impact of the COVID-19 pandemic on initial EMS education. Data were collected from August 2020 to February 2021 over 5 rounds (3 electronic surveys and 2 live virtual meetings). In Round 1, participants submitted research priorities over 9 specific areas. Responses were thematically analyzed to develop a list of research priorities reviewed in Round 2. In Round 3, participants rated the priorities by importance and feasibility, with a weighted score (2/3*importance+1/3*feasibility) used for preliminary prioritization. In Round 4, participants ranked the priorities. In Round 5, participants provided their agreement or disagreement with the group’s consensus of the top 8 research priorities.

Results

During Rounds 1 and 2, 135 ideas were submitted by the panel, leading to a preliminary list of 27 research priorities after thematic analysis. The top 4 research priorities identified by the expert panel were prehospital internship access, impact of lack of field and clinical experience, student health and safety, and EMS education program availability and accessibility. Consensus was reached with 10/11 (91%) participants in Round 5 agreeing.

Conclusions

The identified research priorities are an important first step to begin evaluating the EMS educational infrastructure, processes, and outcomes that were affected or threatened through the pandemic.

Study | Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation

Written by AAA Staff on . Posted in Operations, Patient Care.

Thank you to Dr. John Russell of Cape County Private Ambulance for sharing this resource.

Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting

Hilary A. Hewes, Andrea L. Genovesi, Rachel Codden, Michael Ely, Lorah Ludwig, Charles G. Macias, Patricia Schmuhl & Lenora M. Olson (2021) Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting, Prehospital Emergency Care, DOI: 10.1080/10903127.2021.1942340

Abstract

Objectives: Treating pediatric patients often invokes discomfort and anxiety among emergency medical service (EMS) personnel. As part of the process to improve pediatric care in the prehospital system, the Health Resources and Services Administration (HRSA) Emergency Services for Children (EMSC) Program implemented two prehospital performance measures -access to a designated pediatric care coordinator (PECC) and skill evaluation using pediatric equipment-along with a multi-year plan to aid states in achieving the measures. Baseline data from a survey conducted in 2017 showed that less than 25% of EMS agencies had access to PECC and 47% performed skills evaluation using pediatric equipment at least twice a year. To evaluate change over time, the survey was again conducted in 2020, and agencies that participated in both years are compared.

Methods: A web-based survey was sent to EMS agency administrators in 58 states and territories from January to March 2020. Descriptive statistics, odds ratios, and 95% confidence intervals were conducted.

Results: The response rate was 56%. A total of 5,221 agencies participated in both survey periods representing over 250,000 providers. The percentage of agencies reporting the presence of a PECC increased from 24% to 34% (p= <0.001). However, some agencies reported that they no longer had a PECC, while others reported having a PECC for the first time. Fifty percent (50%) of agencies conduct pediatric psychomotor skills evaluation at least twice/year, a 2% increase over time (p = 0.041); however, a third (34%) evaluate skills using pediatric equipment less than once a year. The presence of a PECC continues to be the variable associated with the highest odds (AOR 2.15, 95% CI 1.91–2.43) of conducting at least semiannual skills evaluation.

Conclusions: There is an increase in the presence of pediatric care coordination and the frequency of pediatric psychomotor skills evaluation among national EMS agencies over time. Continued efforts to increase and sustain PECC presence should be an ongoing focus to improve pediatric readiness in the prehospital system.

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JEMS | Quality of Handoffs from EMS to ED

Written by AAA Staff on . Posted in Operations, Patient Care.

Quality of Handoffs from Emergency Medical Services to Emergency Department Providers

Literature and study team experience indicate emergency medical services (EMS) to emergency department provider handoffs could be an opportunity for improvement in emergency medical care. To date, no study has been published to specifically determine the perceived quality of handoffs between EMS and emergency department providers in the state of Minnesota. This exploratory project could help provide insight toward improving handoffs and guide future research and quality improvement projects.

Read at JEMS

NEMSIS 2020 Public-Dataset Now Available

Written by AAA Staff on . Posted in News, Press, Regulatory.

From NEMSIS on May 28, 2021

FOR IMMEDIATE RELEASE

NEMSIS 2020 Public-Dataset Now Available

Salt Lake City, Utah, May 11, 2021 – The National Emergency Medical Services Information System Technical
Assistance Center (NEMSIS TAC) today announced the availability of the 2020 Public-Release Research Dataset,
the largest publicly available dataset of emergency medical service activations in the United States. With this
release, NEMSIS aims to improve understanding of, confidence in, and support for EMS data collection and
analysis that will lead to data being utilized more effectively to improve patient care.

“The 2020 dataset is a powerful asset for researchers looking into all manner of conditions that affect different
aspects of EMS service.,” said Dr. N. Clay Mann, Professor in the Department of Pediatrics at the University of
Utah School of Medicine and Principal Investigator for the NEMSIS Technical Assistance Center. “Hopefully, the
information gathered during the COVID-19 pandemic will help give EMS agencies valuable insight on their work
improving EMS services under all sorts of conditions.”

The 2020 Public-Release Research Dataset is a subset of the National EMS Database that is the repository for
EMS data collected from U.S. States and Territories. NEMSIS maintains the national standard for how patient
care information resulting from an emergency 9-1-1 call for medical assistance is collected. The dataset includes
43,488,767 EMS activations submitted by 12,319 EMS agencies servicing 50 states and territories.

Those interested in requesting a copy of the 2020 Public-Release Research Dataset can contact the NEMSIS TAC
and fill out a request form at their website https://nemsis.org/using-ems-data/request-research-data. A
password-protected USB drive containing the dataset, the 2020 NEMSIS Data User Manual, NEMSIS Data
Dictionary v3.4.0, Extended Data Definitions v3.4.0, and sample SAS code file will be sent via postal service.

ABOUT NEMSIS

The National Emergency Medical Services Information System (NEMSIS) is the national health information
exchange and database used to collect and store EMS data from states and territories. NEMSIS is a universal
standard for how patient care information resulting from an emergency 9-1-1 call for medical assistance is
collected. It is a collaborative system to improve patient care through the standardization, aggregation, and
utilization of point-of-care EMS data at a local, state, and national level.
NEMSIS is a program of NHTSA’s Office of EMS and is hosted at the University of Utah.

HealthAffairs | Boston OHCA Outcomes During the Pandemic

Written by AAA Staff on . Posted in News, Patient Care, Press.

From HealthAffairs

Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care

Abstract

Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic. In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients’ reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (−27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (−17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston’s fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.

More At HealthAffairs

Study | EMS Super-Utilizers

Written by AAA Staff on . Posted in Operations, Patient Care, Professional Standards, Publications.

The Penn State College of Medicine is conducting a national study of social needs in EMS patients, particularly in regards to potential interventions for EMS super-utilizers (frequent flyers). The study consists of an approximately 7 minute online survey with questions about provider (911-EMT, Paramedic, EMS Physician) knowledge of social needs, recognition of patient needs, perceptions of possible interventions, and background information. Those who participate will have the option to enter into a drawing for a $50 gift card.

With the implementation of programs such as ET3, we are hoping to hear from as many EMS providers as possible to give them a voice in how to best to address social needs and EMS super-utilizers. As such, we are hoping you consider sharing our study flyer, study overview from JEMS, or the study link with your employees and/or social media.

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