Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community

Introduction: Over-triage of patients by emergency medical services (EMS) dispatch is thought to be an acceptable alternative to under-triage, which may delay how quickly life-saving care reaches a patient. Previous studies have looked at advanced life support (ALS) misutilization in urban- and county-based EMS systems and have attempted to analyze how dispatch methods either contribute to or alleviate this problem. Objective: The purpose of this study is to assess the relationship between dispatches of a cardiac nature in a Medical Priority Dispatch (MPD) system, and the actual clinical diagnosis as determined by an emergency department physician. Methods: Calls for emergency medical assistance in a suburban community outside of a major metropolitan area were surveyed over a three-month period. Medical Priority Dispatch protocols determined that 104 of these calls were cardiac-related. Of these emergency calls, 56 (53.8%) patients were transported to the local community hospital and treated by the emergency physician. A retrospective review of the medical records was conducted to determine whether the patient had a cardiac-related discharge diagnosis from the emergency department. Results: Sixteen (28.6%) of the patients in this cohort were diagnosed with a cardiac-related condition upon discharge from the emergency department. Forty (71.4%) were diagnosed with a non-cardiac-related condition. The positive, predictive value of the dispatch protocol for the detection of an actual cardiac emergency in this EMS system was 28.6%. Conclusion: In this suburban community, the MPD system may over-triage emergency medical responses to cardiac emergencies. This can result in the only ALS (paramedic) unit in the community being unavailable in certain situations. Future studies should be conducted to determine what level (in any) of over-triage is appropriate in EMS systems using a MPD system

Utilizing paramedics for in-patient critical care surge capacity

INTRODUCTION: While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in an inability of a hospital or emergency department to create surge capacity to deal with large numbers of ill or injured patients. Utilizing paramedics in acute-care hospitals or at alternate care sites could serve as expansion staff to supplement existing nursing staff allowing fewer nurses to care for a larger numbers of patients during a disaster, act of terrorism, or public health emergency. While the procedures performed for nursing do vary from hospital to hospital, there are national certifications for both emergency nursing (CEN) and critical care nursing (CCRN) that can be used to establish a standard for comparison. METHODS: A detailed review and curriculum mapping of the specific educational objectives and competencies of the U.S. Department of Transportation National Standard Curriculum for the Emergency Medical Technician-Paramedic as well as the competencies and criteria for board certification as a Certified Emergency Nurse (CEN) and Critical Care Registered Nurse (CCRN) was performed. RESULTS: Approximately 90 percent of the CEN and CCRN knowledge skills and competencies are met or exceeded by the National Standard Paramedic Curriculum. CONCLUSIONS: With appropriate training and orientation, paramedics may be used in an in-patient setting to augment emergency and critical care nursing staff during a disaster, act of terrorism, or public health emergency

Hospital Referral Patterns: How Emergency Medical Care is Accessed in a Disaster

BACKGROUND: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. METHODS: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. RESULTS: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. CONCLUSIONS: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major inciden

Lessons from Sandy — Preparing Health Systems for Future Disasters

Within hours after Hurricane Sandy’s landfall, doctors and staff at one of New York City’s premier medical centers realized that something was going terribly wrong. Lights were flickering, critical devices essential to life support for more than 200 patients, many in intensive care units, were malfunctioning. A decision had to be made by hospital leaders, senior public health officials, and emergency responders: tough it out in a hospital without power or attempt a perilous patient evacuation as an epic disaster unfolded. With little time to lose, the “go” order was given, followed by frantic calls to high-ground hospitals identifying beds for receiving New York University–Langone Medical Center’s critically ill patients. St. Luke’s–Roosevelt, Mt. Sinai, New York Presbyterian at Columbia, and many other hospitals responded immediately, opening beds, readying emergency admission procedures, and briefing staff. But questions about why these extreme measures were necessary will have to be answered in the months ahead. Although the first question may be how to prevent power failure, the nuances of backup and redundant power generation are not generally within the expertise of health professionals. And in fact, the generators themselves were probably fine; the problem appears to have been that fuel pumps supplying the generators were in the basement, highly susceptible to break- down from flooding. Ways of ensuring resiliency of backup power equipment will certainly be investigated later. For now, it’s important to understand what medical and public health challenges are to be expected after mega-disasters such as Hurricane Sandy

Public Health Department Training of Emergency Medical Technicians for Bioterrorism and Public Health Emergencies: Results of a National Assessment

Hypothesis: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. Methods: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. Results: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%- 14.9%). State health departments provided even less training (6.3%- 17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). Conclusions: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approac

A case series of premenstrual disorders presenting to the UK's National Female Hormone Clinic

Aims and method We aimed to describe the clinical characteristics of female patients presenting with premenstrual disorders to a tertiary service in the UK. We conducted a retrospective case-note review of referrals to the National Female Hormone Clinic from April 2014 to August 2020. Based on clinical assessment, we determined whether the patient met criteria for premenstrual dysphoric disorder or premenstrual exacerbation of an underlying psychiatric disorder. Results Of 146 patients seen in clinic for premenstrual disorders, an ICD-10 psychiatric diagnosis was made in 130 (89.0%); a minority 16 (11.0%) did not have a psychiatric diagnosis. Following assessment, 94 patients (64.4%) met criteria for premenstrual dysphoric disorder and 67 (45.6%) had exacerbation of a psychiatric disorder. Clinical implications Patients presenting to this specialist service had complex psychiatric comorbidity; almost half presented with exacerbation of a psychiatric disorder

Organizing the Baby Boomer Construct: An Exploration of Marketing, Social Systems, and Culture

Baby boomer trends are applied in the development of a conceptual framework that offers a social systems and cultural model for future studies. While there has been considerable recent attention paid to baby boomers, the studies lack a coherent theoretical base that would allow for more advanced and continuing research. Aging baby boomers heading into retirement present excellent research opportunities for scholars