Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest

Introduction: Field information available to emergency medical services (EMS) about a patient’s chronic health conditions or medication therapies could help direct patient care or be used to investigate outcome disparities. However, little is known about the field availability or accuracy of information of chronic health conditions or chronic medication treatments in emergent circumstances, especially when the patient cannot serve as an information resource. We evaluated the prehospital availability and accuracy of specific chronic health conditions and medication treatments among out-of-hospital cardiac arrest (OHCA) patients. Methods: The investigation was a retrospective cohort study of adult persons suffering ventricular fibrillation OHCA treated by EMS in a large metropolitan county from January 1, 2007, to December 31, 2013. The study was designed to determine the availability and accuracy of EMS ascertainment of selected chronic health conditions and medication treatments. We evaluated chronic health conditions of “any heart disease,” congestive heart failure (CHF), and diabetes and medication treatments of beta blockers and loop diuretics using two distinct sources: 1) EMS report, and 2) hospital record specific to the OHCA event. Because hospital information was considered the gold standard, we restricted the primary analysis to those who were admitted to hospital. Results: Of the 1,496 initially eligible patients, 387 could not be resuscitated and were pronounced dead in the field, one patient was left alive at scene due to Physician’s Orders for Life-sustaining Treatment (POLST) orders, 125 expired in the emergency department (n=125), and 983 were admitted to hospital. A total of 832 of 1,496 (55.6%) had both sources of data for comparison and comprised the primary analytic group. Using the hospital record as the gold standard, EMS ascertainment had a sensitivity of 0.79 (304/384) and a specificity of 0.88 (218/248) for any prior heart disease; sensitivity 0.45 (47/105) and specificity 0.87 (477/516) for CHF; sensitivity 0.71 (143/201) and specificity 0.98 (416/424) for diabetes; sensitivity 0.70 (118/169) and specificity 0.94 (273/290) for beta blockers; sensitivity 0.70 (62/89) and specificity 0.97 (358/370) for loop diuretics. Conclusion: In this cohort of OHCA, information about selected chronic health conditions and medication treatments based on EMS ascertainment was available for many patients, generally revealing moderate sensitivity and greater specificity

Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest

Introduction: Field information available to emergency medical services (EMS) about a patient’schronic health conditions or medication therapies could help direct patient care or be used toinvestigate outcome disparities. However, little is known about the field availability or accuracy ofinformation of chronic health conditions or chronic medication treatments in emergent circumstances,especially when the patient cannot serve as an information resource. We evaluated the prehospitalavailability and accuracy of specific chronic health conditions and medication treatments among outof-hospital cardiac arrest (OHCA) patients.Methods: The investigation was a retrospective cohort study of adult persons suffering ventricularfibrillation OHCA treated by EMS in a large metropolitan county from January 1, 2007, to December31, 2013. The study was designed to determine the availability and accuracy of EMS ascertainmentof selected chronic health conditions and medication treatments. We evaluated chronic healthconditions of “any heart disease,” congestive heart failure (CHF), and diabetes and medicationtreatments of beta blockers and loop diuretics using two distinct sources: 1) EMS report, and 2)hospital record specific to the OHCA event. Because hospital information was considered the goldstandard, we restricted the primary analysis to those who were admitted to hospital.Results: Of the 1,496 initially eligible patients, 387 could not be resuscitated and were pronounceddead in the field, one patient was left alive at scene due to Physician’s Orders for Life-sustainingTreatment (POLST) orders, 125 expired in the emergency department (n=125), and 983 wereadmitted to hospital. A total of 832 of 1,496 (55.6%) had both sources of data for comparisonand comprised the primary analytic group. Using the hospital record as the gold standard, EMSascertainment had a sensitivity of 0.79 (304/384) and a specificity of 0.88 (218/248) for any priorheart disease; sensitivity 0.45 (47/105) and specificity 0.87 (477/516) for CHF; sensitivity 0.71(143/201) and specificity 0.98 (416/424) for diabetes; sensitivity 0.70 (118/169) and specificity 0.94(273/290) for beta blockers; sensitivity 0.70 (62/89) and specificity 0.97 (358/370) for loop diuretics.Conclusion: In this cohort of OHCA, information about selected chronic health conditions andmedication treatments based on EMS ascertainment was available for many patients, generallyrevealing moderate sensitivity and greater specificity. [West J Emerg Med. 2017;18(5)864-869.

Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest

AbstractThe effect of coronary bypass surgery on recurrent cardiac arrest was estimated in 265 patients resuscitated from out of hospital cardiac arrest between 1970 and 1988. From this cohort, 85 patients (32%) underwent coronary bypass surgery after recovery from cardiac arrest and 180 patients (68%) were treated medically. A multivariate Cox analysis was used to estimate the effect of coronary bypass surgery on subsequent survival after adjusting for effects of age, prior cardiac history, ejection fraction, year of the event, history of angina, antiarrhythmic drug use and whether the arrest was related to acute myocardial infarction.The use of coronary bypass surgery had a significant effect in reducing the incidence of subsequent cardiac arrest daring follow-up study (risk ratio [RR] 0.48, 95% confidence interval [CI] 0.24 to 0.97, p < 0.04). There was also a trend consistent with a reduction in total cardiac mortality (RR 0.65, 95% CI 0.39 to 1.10, p = 0.10). These findings suggest that coronary bypass surgery may reduce the incidence of sudden death in suitable patients resuscitated from an episode of ventricular fibrillation

Coordinating Care for Falls via Emergency Responders: A Feasibility Study of a Brief At-Scene Intervention

Falls account for a substantial portion of 9-1-1 calls, but few studies have examined the potential for an emergency medical system role in fall prevention. We tested the feasibility and effectiveness of an emergency medical technician (EMT)-delivered, at-scene intervention to link elders calling 9-1-1 for a fall with a multifactorial fall prevention program in their community. The intervention was conducted in a single fire department in King County, Washington and consisted of a brief public health message about the preventability of falls and written fall prevention program information left at scene. Data sources included 9-1-1 reports, telephone interviews with intervention department fallers and sociodemographically comparable fallers from three other fire departments in the same county, and in-person discussions with intervention department EMTs. Interviews elicited faller recall and perceptions of the intervention, EMT perceptions of intervention feasibility, and resultant referrals. Sixteen percent of all 9-1-1 calls during the intervention period were for falls. The intervention was delivered to 49% of fallers, the majority of whom (75%) were left at scene. Their mean age (N=92) was 80±8 years; 78% were women, 39% had annual incomes under $20K, and 34% lived alone. Thirty-five percent reported that an EMT had discussed falls and fall prevention (vs. 8% of comparison group, P<0.01); 84% reported that the information was useful. Six percent reported having made an appointment with a fall prevention program (vs. 3% of comparison group). EMTs reported that the intervention was worthwhile and did not add substantially to their workload. A brief, at-scene intervention is feasible and acceptable to fallers and EMTs. Although it activates only a small percent to seek out fall prevention programs, the public health impact of this low-cost strategy may be substantial

Common Variation in Fatty Acid Genes and Resuscitation From Sudden Cardiac Arrest

BACKGROUND: Fatty acids provide energy and structural substrates for the heart and brain and may influence resuscitation from sudden cardiac arrest (SCA). We investigated whether genetic variation in fatty acid metabolism pathways was associated with SCA survival. METHODS AND RESULTS: Subjects (mean age 67, 80% male, Caucasian) were out-of-hospital SCA patients found in ventricular fibrillation in King County, WA. We compared subjects who survived to hospital admission (n=664) with those who did not (n=689), and subjects who survived to hospital discharge (n=334) with those who did not (n=1019). Associations between survival and genetic variants were assessed using logistic regression adjusting for age, gender, location, time to arrival of paramedics, whether the event was witnessed, and receipt of bystander CPR. Within-gene permutation tests were used to correct for multiple comparisons. Variants in five genes were significantly associated with SCA survival. After correction for multiple comparisons, SNPs in ACSL1 and ACSL3 were significantly associated with survival to hospital admission. SNPs in ACSL3, AGPAT3, MLYCD, and SLC27A6 were significantly associated with survival to hospital discharge. CONCLUSIONS: Our findings indicate that variants in genes important in fatty acid metabolism are associated with SCA survival in this population