Categorization, Designation, and Regionalization of Emergency Care: Definitions, a Conceptual Framework, and Future Challenges

This article reflects the proceedings of a breakout session, “Beyond ED Categorization—Matching Networks to Patient Needs,” at the 2010 Academic Emergency Medicine consensus conference, “Beyond Regionalization: Integrated Networks of Emergency Care.” It is based on concepts and areas of priority identified and developed by the authors and participants at the conference. The paper first describes definitions fundamental to understanding the categorization, designation, and regionalization of emergency care and then considers a conceptual framework for this process. It also provides a justification for a categorization system being integrated into a regionalized emergency care system. Finally, it discusses potential challenges and barriers to the adoption of a categorization and designation system for emergency care and the opportunities for researchers to study the many issues associated with the implementation of such a system.ACADEMIC EMERGENCY MEDICINE 2010; 17:1306–1311 © 2010 by the Society for Academic Emergency MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79324/1/j.1553-2712.2010.00932.x.pd

Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke

Background With recent trials demonstrating benefit of endovascular thrombectomy (EVT) up to 24 hours from last known well time (LKWT), emergency medical services systems must consider stroke center routing for patients with LKWT ≤24 hours. We sought to determine the frequency of thrombectomy by prehospital‐determined LKWT using retrospective data from a tiered regional stroke care system. Methods During the July 2018 to March 2019 study period, patients with potential large‐vessel occlusion, based on a Los Angeles Motor Scale of 4 or 5, were routed directly to a designated EVT center if within 30 minutes. We determined the frequency of thrombectomy by time intervals from prehospital‐determined LKWT to first medical contact. Results Emergency medical services transported 830 patients with acute ischemic stroke with documented prehospital‐determined LKWT ≤24 hours to EVT centers. The ≤6 hours, >6 to ≤16 hours, and >16 to ≤24 hours epochs accounted for 75%, 20%, and 5% of transports to EVT centers, respectively. Men accounted for 47% of the study population, with a median age of 77 years (interquartile range, 64–86 years) and National Institutes of Health Stroke Scale median of 11 (interquartile range, 4–20). Overall, 28.2% (234/830) received EVT. Time window–specific EVT frequencies were: ≤6 hours (29.8% of patients [187/627]); >6 to ≤16 hours (24.1% of patients [39/162]); and >16 to ≤24 hours (19.5% of [8/41]). Conclusion In this regional stroke system with 2‐tiered routing, patients in the >6‐ to 24‐hour postonset window accounted for nearly one fourth of transports to EVT centers and 23% received thrombectomy

Artificial intelligence to support out-of-hospital cardiac arrest care: A scoping review.

BACKGROUND: Artificial intelligence (AI) has demonstrated significant potential in supporting emergency medical services personnel during out-of-hospital cardiac arrest (OHCA) care; however, the extent of research evaluating this topic is unknown. This scoping review examines the breadth of literature on the application of AI in early OHCA care. METHODS: We conducted a search of PubMed®, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Articles focused on non-traumatic OHCA and published prior to January 18th, 2023 were included. Studies were excluded if they did not use an AI intervention (including machine learning, deep learning, or natural language processing), or did not utilize data from the prehospital phase of care. RESULTS: Of 173 unique articles identified, 54 (31%) were included after screening. Of these studies, 15 (28%) were from the year 2022 and with an increasing trend annually starting in 2019. The majority were carried out by multinational collaborations (20/54, 38%) with additional studies from the United States (10/54, 19%), Korea (5/54, 10%), and Spain (3/54, 6%). Studies were classified into three major categories including ECG waveform classification and outcome prediction (24/54, 44%), early dispatch-level detection and outcome prediction (7/54, 13%), return of spontaneous circulation and survival outcome prediction (15/54, 20%), and other (9/54, 16%). All but one study had a retrospective design. CONCLUSIONS: A small but growing body of literature exists describing the use of AI to augment early OHCA care

Advancing Emergency Medical Services’ (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles County’s Performance Improvement Initiative

IntroductionBehavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders.MethodsA Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement.ResultsThe committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities' capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport.ConclusionThis paper describes a comprehensive performance improvement initiative in LAC-EMSA's 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs