Spatial Epidemiology and Temporal Trends of Heart Attack and Stroke in Middle Tennessee

Despite declines in mortality risks of myocardial infarction (MI) and stroke in the US since the 1960’s, the burdens of these conditions remain high. These conditions require emergency and specialized care and therefore quick transportation of patients to appropriate hospitals is critical. Geographic disparities in MI and stroke burdens have been consistently reported in the US with the south-east having the highest risks. Most studies of geographic disparities have been performed at county or higher geographic units. Therefore, spatial patterns at neighborhood levels are unclear. Moreover, it’s important to investigate disparities at neighborhood levels to better understand neighborhood health needs. Therefore, the goal of this study was to investigate neighborhood disparities associated with MI and stroke in Middle Tennessee. Specific objectives were to investigate: (a) geographic disparities in timely access to emergency care; and (b) geographic disparities in MI and stroke mortality risks. Street network, hospital, population, and mortality data (1999-2007) were obtained from Streetmap USA, the Joint Commission on Accreditation of Health Organizations, US Census Bureau, and the Tennessee Department of Health, respectively. Network analysis was used to investigate and identify neighborhoods lacking timely access to emergency MI and stroke care. Moran’s I and Kulldorff’s spatial scan statistic were used to investigate geographic hot-spots of MI and stroke mortality risks at both the county and neighborhood levels. Poisson and negative binomial models were used to investigate predictors of identified geographic patterns. A temporal increase in the percentage of the population with timely geographic access to stroke and cardiac centers was observed. In 2010, about 5% of the population, located mainly in rural neighborhoods, lacked timely access to a stroke center. Significant (p\u3c0.05) hot-spots of MI and stroke mortality risks were identified at both neighborhood and county levels. However, clusters identified at the neighborhood level were more refined. Neighborhoods with higher proportions of older populations and those with lower education had significantly (p\u3c0.05) higher mortality risks. These findings are vital for guiding health planning, resource allocation and service provision in an effort to provide needs-based services to the population. This is important in reducing/eliminating neighborhood disparities and improving population health

Improving survival in out of hospital cardiac arrest a prospective synthesis of best practice

Cardiac arrest is the leading cause of death in the United States. By reviewing and analyzing the successes and failures of resuscitation efforts, it has been possible to identify critical components which have come to be known as the “Chain of Survival:” Early Recognition, Early CPR, Early Defibrillation, Early ALS, and Early Post Resuscitative Care. A failure in any one of the five links will result in a failed resuscitation. Early Recognition is the beginning of the resuscitation effort and includes a number of related components. Witnessed cardiac arrests, those that are seen or heard to occur, have a significantly higher chance of survival than those which are unwitnessed. Properly identifying agonal gasps: irregular, forceful, reflexive breaths which can occur during cardiac arrest, is key to recognition of arrest and activation of the emergency response system. Emergency dispatchers trained to recognize cardiac arrest, as well as to initiate Early CPR via telephonic instruction, have been identified as key personnel in the resuscitation effort. Once professional rescuers have been dispatched, response delays due to distance and traffic can be costly. The use of new technologies like GPS and traffic signal preemption (as well as the use of Police, Fire and EMS in conjunction) has been shown to make it possible to get qualified persons to the scene of a cardiac arrest more safely and more quickly. Once on scene, early, high quality CPR has been shown to dramatically improve survival. After just 8 minutes without assistance, a victim of cardiac arrest has a near zero percent chance of survival. CPR of high quality has been shown to help maintain survivability until more definitive care can be obtained. Early Defibrillation is another key component to survival in many cardiac arrests. While CPR can sustain organ function briefly, cardiac arrest is rarely reversed without defibrillation. Increasingly widespread prevalence of public automated external defibrillators (AEDs) has made Early Defibrillation easier. Furthermore, increased use of AEDs by lay and professional rescuers has called into question the value of more traditional, higher risk interventions like intubation and medication administration. Early ALS interventions have been a staple of resuscitation for decades, but there is little data to support the use of these interventions during cardiac arrest. Early Post-Resuscitative Care, however, has been shown to be an area where invasive ALS interventions can and do make a difference in improved survival. By looking at the body of research for links in the Chain of Survival, opportunities for improvement of resuscitation were identified. Persons who spend significant time around an individual at high risk for heart disease should be educated on possible precipitating symptoms of a myocardial infarct or other early signs of potential cardiac arrest. Persons likely to encounter a cardiac arrest should likewise be trained not only in how to recognize cardiac arrest (through the combination of unresponsiveness and abnormal breathing) but also to initiate basic care via compressions-only CPR. Emergency dispatchers should be increasingly trained to recognize cardiac arrest, as well how to effectively provide dispatcher assisted CPR. The focus of these efforts should be high quality CPR and the early deployment of defibrillation. The use of AEDs by bystanders should be encouraged whenever possible. The emphasis on CPR and use of an AED should be paramount, with invasive ALS interventions eschewed for the simpler and more effective therapies. Once ROSC has been obtained, the use of ALS interventions in unstable patients has been shown not only to prevent death due to transient hemodynamic instability, but also to improve the likelihood of survival with little to no neurological deficit. By embracing the chain of survival, and identifying the critical areas in need of research and improvement, it is possible to provide recommendations that may lead to improved survival from cardiac arrest

The mortality in Gaza in July-September 2014: a retrospective chart-review study

This is an Open Access article licensed under the Creative Commons Attribution License 3.0 (CC BY 3.0) and originally published in Conflict and health. You can access the article by following this link: http://dx.doi.org/10.1186/s13031-016-0077-6Dette er en vitenskapelig, fagfellevurdert artikkel som opprinnelig ble publisert i Conflict and health. Artikkelen er publisert under lisensen Creative Commons Attribution License 3.0 (CC BY 3.0). Du kan også få tilgang til artikkelen ved å følge denne lenken: http://dx.doi.org/10.1186/s13031-016-0077-6BACKGROUND: The majority of Gazans who were killed or injured in the 2014 Israel-Gaza war were civilians, and one-fourth of the population were internally displaced. As the Gaza Strip is a small territory, the whole population was exposed to the war and its effects on the health care system, supplies and infrastructure. Our aim was to assess the overall, sex and age-group mortality in Gaza for the period July-September 2014 that was not caused by war injuries, and the proportion of non-trauma deaths among adults that occurred outside hospital wards. A comparison was made with the mortality for the same period in 2013. METHOD: Date, sex, age, cause and place of each death that was not attributed to war-related physical trauma were collected from death notification forms or death records in Gaza hospitals for the period 01 July to 30 September 2014. The same information was extracted from the local death register for all deaths in the same period in 2013. RESULTS: The mean age at death was 52.4 years in 2014 and 49.7 in 2013, and about 50 % were older than 60 years in both years. The crude non-trauma death rates among adults were 11.6 per 10,000 population in 2014 and 11.3 in 2013, and the age standardised 13.2 and 12.4, respectively. Higher death rates in 2014 were observed among elderly and women. Cardiovascular disease was the most common cause of death among adults of both sexes, and infectious diseases caused less than 10 % in both periods. Three maternal deaths were observed in 2013 and six in 2014 (p = 0.17). The proportion of deaths that occurred in a hospital ward was 71.5 % in 2013 and 51.2 % in 2014. CONCLUSIONS: The mortality from communicable diseases was low in Gaza. We did not detect a higher overall background mortality in the 2014 period compared to 2013, but the observed age and sex distribution differed. The proportion of non-trauma deaths among adults that occurred in a hospital ward was markedly lower during the war. The living conditions and health care situation in Gaza point to the need for close monitoring of mortality

The EMS Deficit: A Study on the Excessive Staffing Shortages of Paramedics and its Impact on EMS Performance in the States of South Carolina and North Carolina and Interventions for Organizational Improvements.

This is a qualitative multi-case study on emergency medical services (EMS) paramedic shortages, their effects on ambulance responses, and the quality of patient care in the prehospital environment. A qualitative multi-case study was selected for this study because the nature of the methods’ design aligned with a systematic approach of life experiences (Creswell, 2015). Paramedics who participated in this study provided insight, from life experiences, as to why one prematurely leaves EMS; thus, creating a staffing shortage. The foundation of this study is the high staffing shortages of paramedics specifically in South Carolina (SC) and North Carolina (NC). Drastically reducing paramedic attrition is critical in reducing patient suffering, decreasing morbidity and mortality, and improving EMS key performance indicators. The conceptual framework for this study aligns with Fredrick Herzberg’s Two-Factor Theory of Motivation and Abraham Maslow’s Hierarchy of Needs. In conclusion, the findings from this study have shown that the number of ambulances that are unstaffed from the paramedic shortage has reached critical levels. Primarily, this review of the literature’s discovered themes has identified numerous challenges contributing to the increasing EMS paramedic shortages and their effects on patient care in the pre-hospital environment. Secondarily, the interview portion of this study solidifies the discoveries of the cited works and identifies further challenges through its semi-structured interview format. Thirdly, achievable data from previous studies, primarily from the South Carolina EMS Association, validate this study’s findings through triangulation; thus, instilling rigor on primary reasons for EMS paramedic shortages and their impact on patient outcomes

Rural Heart Attack Care

The rural and frontier populations have fewer health care resources and remain an underserved health care consumer. The purpose of the Capstone Project was to standardize care of the rural STEMI patient with an algorithm developed by teams, and using systems improvements. The nationally recognized urban algorithm for STEMI care (Kushner et al., 2009) was tested in the rural environment of Heart of the Rockies Regional Medical Center (HRRMC) in Salida Colorado. The project emphasis was process improvement. A multi-disciplinary team was developed at Heart of the Rockies Regional Medical Center (HRRMC) and the clinical practice guidelines were reviewed. A modified algorithm for STEMI care was developed. The outcomes revealed a comparison group of three STEMI patients and an interventional group of seven STEMI patients. The care delivery time was reduced from 288 minutes in 2010, without the algorithm to 150 minutes with the algorithm in 2011. The algorithm proved clinically relevant and has become a useful tool in rural heart attack care for HRRMC