Tag: Research

EMS1 | 2021 EMS Trend Report

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

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Study | EMS education research priorities during COVID-19

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

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

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

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

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

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 flyerstudy overview from JEMS, or the study link with your employees and/or social media.

Texas A&M Study | Anonymous Survey for EMS

Dr. Joyce Hnatek, Timothy Fan, and Logan DuBose from the Texas A&M College of Medicine are conducting a research study to assess the awareness of an often overlooked patients’ right – the right to not be hospitalized/transported against one’s will. You were selected to receive this invitation because you may provide healthcare to patients with decreased ability to communicate.
We respectfully request that you complete this brief anonymous survey. It should take < 5 minutes to complete. Thank you in advance for your time and support. The informed consent is included in the survey link (https://tamu.qualtrics.com/jfe/form/SV_6LvpSzXslKzRz1z)
Sincerely,

Timothy (fan@tamu.edu) and Logan (logandubose960@tamu.edu)

JAMA | Ontario | Economic Analysis of MIH Delivered by EMS

From JAMA on February 24, 2021

Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams

Question  Is mobile integrated health care (MIH) delivered by emergency medical services more efficient than regular ambulance responses in addressing the needs of urgent care in the community?

Findings  This economic evaluation compared 1740 calls serviced by MIH in 2018 to 2019 with propensity score–matched ambulance calls for the same period and 2 years prior and found that MIH was associated with a decrease in the proportion of patients transported to the emergency department and saved health care costs compared with regular ambulance responses.

Meaning  These findings suggest that MIH is a promising and viable solution to meeting urgent health care needs while improving the efficiency in using emergency care resources.

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EMS Trend Report Survey Extended Through Feb. 21

From Fitch & Associates on February 17

EMS Trend Report Survey Extended!

Share your impression on key industry topics and receive a Pinnacle discount as well as a chance to win an Amazon gift card

With the challenges those in EMS have faced this past year and continue to confront, it is as important as ever that we harness the data and information we have to prepare for the future. The EMS Trend Report, now in its sixth year, provides essential information for us to understand the impact of these challenges and continue to improve the health of our organizations. Your input is vital to this effort.

We encourage all members of the EMS community to weigh in on the EMS Trend Report survey with their perceptions, attitudes, and practices. The questionnaire will only take about 10 minutes to complete online, and you won’t need to review or access detailed data from your agency to complete it.

To show our appreciation for your participation, you will be automatically entered into our drawing for a $50 Amazon gift card. In addition, you can take advantage of a $50 discount on the 2021 Pinnacle main conference being held August 9-13, 2021 in Phoenix, Arizona (the discount code can be found upon completing the survey.) The survey closes Feb 21.

Take the Survey

Rural Policy Research Institute EMS Study

From RUPRI in January 2021

Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations

Rural ambulance agencies, a fundamental component of the rural emergency medical services (EMS) system, are challenged by the following issues:

  • long distances and challenging terrain that prolong emergency response and transport times,
  • insufficient payment by insurers to cover standby and fixed costs,
  • a changing workforce that has historically relied on volunteers but increasingly must include paid personnel,
  • a lack of regional EMS plans to coordinate services, and
  • insufficient State and Federal policy coordination across oversight agencies.

Specific public policies to address rural ambulance agency challenges could include the following:

  • Increase ambulance payment to adequately cover reasonable standby and fixed costs.
  • Consider EMS an essential service, the same as firefighting and law enforcement.
  • Collect rural ambulance agency workforce data to better understand workforce needs.
  • Expand the scope and authority of the Federal Interagency Committee on EMS to address rural ambulance agency payment and workforce challenges.

Download PDF Report

BMJ | Pfizer Second Dose Efficacy 95%

Covid-19: Pfizer vaccine efficacy was 52% after first dose and 95% after second dose, paper shows
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4826 (Published 11 December 2020)
Cite this as: BMJ 2020;371:m4826

The Pfizer and BioNTech covid-19 vaccine may provide some early protection, starting 12 days after the first dose, the peer reviewed results of a phase III trial have found.

The study, published in the New England Journal of Medicine,1 found that vaccine efficacy between the first and second doses was 52% (95% credible interval 29.5% to 68.4%), with 39 cases of covid-19 in the vaccine group and 82 cases in the placebo group.

Seven or more days after the second dose, vaccine efficacy then rose to 95% (90.3% to 97.6%), with eight covid-19 cases reported in the vaccine group and 162 cases in the placebo group.

The vaccine has so far been approved in Canada and in the UK, where it is already being rolled out to people over 80 and healthcare workers. In the US the Food and Drug Administration’s independent panel has voted in favour of emergency use authorisation for the vaccine, and the agency is expected to approve it within days.2

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NPR | COVID-19 In U.S. Weeks Earlier Than Previously Known

From NPR

Coronavirus Was In U.S. Weeks Earlier Than Previously Known, Study Says

The coronavirus was present in the U.S. weeks earlier than scientists and public health officials previously thought, and before cases in China were publicly identified, according to a new government study published Monday.

The virus and the illness that it causes, COVID-19, was first identified in Wuhan, China, in December 2019, but it wasn’t until Jan. 19 that the first confirmed COVID-19 case, from a traveler returning from China, was found in the U.S.

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EMS Sleep Health Study—Agencies Wanted

From the National Association of State EMS Officials

OMB Control Number: 2127-0742
ICR Reference Number: 201811-2127-003
Expiration Date: 08/31/2022

Who?

Daniel Patterson, PhD, NRP from the University of Pittsburgh Department of Emergency Medicine is leading a research study that seeks to examine the impact of a sleep health and fatigue education and training program tailored to Emergency Medical Services (EMS) clinicians. This research study has financial support from the National Highway Traffic Safety Administration to the National Association of State EMS Officials (NASEMSO). The University of Pittsburgh has partnered with the NASEMSO as a sub-contractor for purposes of conducting this research study.

What?

This research study is an experiment that will test the impact of a new sleep health and fatigue training education program. The program is designed to improve the individual EMS clinician’s sleep health and reduce work-related fatigue through education and training. The program will be administered entirely online (via the internet) and will be accessible to EMS clinicians located at the EMS agencies that agree to participate in this research study.

When?

The study team will begin recruiting EMS agencies to participate in this study in late January 2020. Each agency will be asked to participate for a total of 24 weeks. Participation is voluntary.

How?

Researchers will ask EMS agency administrators to help recruit individual EMS clinicians at their agency to participate in this research study. Participation will be completely voluntary and confidential. The study team will mostly use data collection tools available via the Internet. Some data collection will involve mobile phone text messages. The research study’s website will be secure and require a unique login (username and password) from each individual EMS clinician. Some EMS clinicians may be asked to wear a wrist actigraph to measure sleep and complete a reaction time test at the start and end of a few scheduled work shifts during the study period.

Who is Eligible?

The study team is seeking participation from EMS agencies located in the United States (including Alaska and Hawaii). Criteria for eligibility include: [1] The EMS agency provides EMS services (including 911 response and transport). [2] The EMS agency provides ground-based EMS services 24-hours a day. Agencies limited to air-medical services only are not eligible. [3] The EMS agency employs between 50 and 300 EMS paid full-time and part-time clinicians/personnel. Agencies that use an all-volunteer staffing model are not eligible. [4] Agencies restrict their EMS clinicians to use their personal mobile phones/smartphones during shifts are not eligible. [5] Operations that provide both fire suppression and EMS 911 response and transport are eligible and encouraged to participate.

Remuneration

Those who qualify for the study and choose to participate will receive remuneration worth approximately $35 U.S. dollars. All individual participants will receive remuneration in the form of a gift card totaling approximately $35 in value. A $5 gift card will be distributed at the beginning, when the individual enrolls, every month the individual is involved in the study, and at the end of the study (month 6). All gift cards will be distributed via U.S. Mail directly to individual participants.

Interested?

If you are the administrator/manager of an EMS agency that is eligible to participate, and wish to participate or wish to know more about this study, please contact the study principal investigator (Daniel Patterson, PhD, NRP) at: pdp3@pitt.edu or 412-864-3830.

Tracking the reach of COVID-19 kin loss

From the Proceedings of the National Academy of Sciences

“Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States”

Ashton M. Verdery, Emily Smith-Greenaway, Rachel Margolis, and Jonathan Daw
PNAS July 28, 2020 117 (30) 17695-17701; first published July 10, 2020 https://doi.org/10.1073/pnas.2007476117
Edited by Douglas S. Massey, Princeton University, Princeton, NJ, and approved June 19, 2020 (received for review April 18, 2020)

COVID-19 has created a mortality shock throughout the world, and it may yield a second wave of population health concerns tied to bereavement and social support reductions. We created the COVID-19 bereavement multiplier, an indicator that clarifies one downstream impact of COVID-19 mortality and can be applied to different epidemiological projections of death counts: How many people are at risk for losing a grandparent, parent, sibling, spouse, or child for each COVID-19 death. In the United States, we estimate that on average, under diverse epidemiological circumstances, every death from COVID-19 will leave approximately nine bereaved. Studying how acute mortality crises reverberate through a population in the form of bereavement multipliers expands understandings of the social impacts of health crises.

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Income Disparities In Access To Critical Care Services

From Health Affairs

Income Disparities In Access To Critical Care Services

Genevieve P. Kanter, Andrea G. Segal, and Peter W. Groeneveld

ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of intensive care unit (ICU) beds in preventing death from the severe respiratory illness associated with COVID-19. However, the availability of ICU beds is highly variable across the US, and health care resources are generally more plentiful in wealthier communities. We examined disparities in community ICU beds by US communities’ median household income. We found a large gap in access by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds. Income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas. Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the COVID-19 pandemic on mortality rates in low-income communities.

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JAMA | COVID-19 Medical Leave for EMS in NYC

From JAMA Network Open

Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City

In New York, New York, from March 1 to May 31, 2020, 201 102 individuals were diagnosed with coronavirus disease 2019 (COVID-19), resulting in 51 085 hospitalizations and 16 834 deaths.1 The Fire Department of the City of New York (FDNY), the largest in the US, responds to nearly 1.5 million emergency medical calls per year in a city of more than 8.4 million people. Active paid FDNY responders include 4408 emergency medical service (EMS) responders and 11 230 firefighters. These FDNY responders are required to don personal protective equipment before patient contact per US Centers for Disease Control and Prevention guidelines.2 In this cohort study, we compared medical leave of FDNY responders during the pandemic with prior years.

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Citation

Prezant DJ, Zeig-Owens R, Schwartz T, et al. Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City. JAMA Netw Open. 2020;3(7):e2016094. doi:10.1001/jamanetworkopen.2020.16094

ESO Announces Peer-Reviewed COVID-19 EMS Research

From Yahoo Finance via Cision

ESO Announces Peer-Reviewed Research Describing Characteristics of COVID-19 EMS Encounters with Linked Hospital Diagnoses

Key Findings from the Report Include:

  • COVID-19 Diagnoses and Ailments: Those with COVID-19 hospital diagnoses were more likely to present with elevated heart and respiratory rate, hypoxia and fever during the EMS encounter.
  • COVID-19 Suspicion: A COVID-19 EMS suspicion was documented for 78 percent of hospital-diagnosed COVID-19 patients.
  • Patient Origin: EMS responses for patients with COVID-19 were more likely to originate from a skilled nursing or assisted living facility.
  • PPE Usage: PPE usage by EMS was more frequently documented on records of patients who had hospital diagnosed COVID-19.
  • Dispatch Complaints: While dispatch complaints for hospital-confirmed COVID-19 patients most commonly included general illness and breathing difficulties, there were also cases dispatched as falls, chest pain, and strokes.
  • Demographic Insights: Consistent with reported in-hospital findings, African American and Hispanic patients made up a disproportionately larger number of COVID-19 diagnoses.

Colorado Natural Hazards Center Grants

The Colorado Natural Hazards Center is offering three grants of $4000 for original research.

  • 1) Communications, the Pandemic, and Local Transportation Resources: What strategies are being implemented, and how effective are they? What are best practices in communicating and messaging by transportation organizations?
  • 2) Transportation, Vulnerable Populations, and COVID-19: What are best practices in providing useful and safe transportation for various socially and economically vulnerable population groups that are traditionally heavily reliant on public transit such as low-income people and racial and ethnic minorities? What about newly vulnerable populations, such as seniors, transportation workers, bus drivers, and so forth? How can the needs of all be met while assuring health and safety among particularly medically fragile or economically marginalized people?
  • 3) Transportation and Emergency Management Policy: How should transportation leaders and emergency managers work together to deliver community services? Including but also beyond ESF-1, what are innovative ways and best practices within and among communities and transportation services to accomplish community objectives during the pandemic? For example: transit agencies have launched food delivery services for vulnerable populations using their idled vehicles and drivers; state DOT facilities have been used a COVID-19 testing sites; Wi-Fi equipped vehicles have been used as local community hot spots.

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