Medicine and Health Sciences Commons^™

Emergency Medical Services Transport Delays For Suspected Stroke And Myocardial Infarction Patients, Ashley Pedigo Golden, Agricola Odoi

Agricola Odoi

Background: Prehospital delays in receiving emergency care for suspected stroke and myocardial infarction (MI) patients have significant impacts on health outcomes. Use of Emergency Medical Services (EMS) has been shown to reduce these delays. However, disparities in EMS transport delays are thought to exist. Therefore the objective of this study was to investigate and identify disparities in EMS transport times for suspected stroke and MI patients. Methods: Over 3,900 records of suspected stroke and MI patients, reported during 2006–2009, were obtained from two EMS agencies (EMS 1 & EMS 2) in Tennessee. Summary statistics of transport time intervals were computed. …

Incident Medical Operations At The Sr530 (Oso, Wa) Slide, Richard N. Bradley

Richard N Bradley

No abstract provided.

Bystander Performance Using Automated External Defibrillators During Simulated Cardiac Arrest, Richard N. Bradley, Lynda M. Schoenstein, Wesley H. Hamilton, Mark R. Boyle

Richard N Bradley

Objective: Automated external defibrillators (AEDs) are becoming widely available to the public. This study examined the hypothesis that less than 75% of the general population can defibrillate using an AED in less than three minutes.

Methods: This was a survey of the behavior of individuals over age 12 in a major airport on Jan. 2–3, 2003. After obtaining consent, an investigator told the subject that he/she was walking down the concourse and saw a person collapse. The subject demonstrated his/her response, using only a telephone and an AED simulating ventricular fibrillation. Data were analyzed using a one-sample test of proportions. …

Harris Health System Ems Protocols And Standing Delegation Orders, Richard N. Bradley

Richard N Bradley

As the EMS Medical Director for Harris Health System-EMS, I have approved these Protocols and Standing Delegation Orders to provide a treatment plan for the various types of injuries and illnesses that may commonly occur. These Protocols and Standing Delegation Orders are not intended to replace on-line Medical Control by a qualified physician, but rather to provide standing orders for specific interventions prior to the point that establishing control with a qualified physician becomes mandatory.

Authorized personnel are those basic and/or advanced life support trained HARRIS HEALTH SYSTEM-EMS personnel who have been approved in writing by the Medical Director in …

American Red Cross Sac Advisory On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

American Red Cross Scientific Review On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

The Scientific Foundations Of The American Red Cross Cpr Training Standards, Richard N. Bradley

Richard N Bradley

The CPR (cardiopulmonary resuscitation) training and certification standards established by the ARC (American Red Cross) are based on a scientific review of the best available published literature. Minimal difference are present between the ARC and other national training organizations. These differences result from differing organizational opinions on the best way to implement standards from limited scientific evidence.

Catastrophic Incident Search And Rescue Lessons From The 2013 Colorado Floods, Thomas Miner, Richard N. Bradley

Richard N Bradley

The response to the Colorado floods is a textbook example of how to respond to catastrophic disasters Responders from hundreds of different organizations came together to form a single coordinated, unified command structure that resulted in the rapid and effective evacuation and rescue of hundreds of people in just three days. Local responders performed hundreds of highly dangerous rescues during the height of the storm. They established incident command at the county level using type 3 incident command teams. When they realized they were facing an unprecedented storm with catastrophic damage they asked for help and state and federal responders …

Ethical Questions In Emergency Medical Services: Controversies And Recommendations, Torben K. Becker, Marianne Gausche-Hill, Andrew L. Aswegan, Eileen F. Baker, Kelly J. Bookman, Richard N. Bradley, Robert A. De Lorenzo, David J. Schoenwetter

Richard N Bradley

EMS providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of ethical questions at the scene, it is important to establish protocols and policies, when possible, to address these high risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by emergency medical services (EMS) personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider …

Geographic Localization Of A Medical Oncology Unit Did Not Reduce Length-Of-Stay, Paris B. Lovett

Paris B Lovett

We report here on a pilot program in which we geographically localized all patients on a medical oncology service. The setting was a large, urban quaternary referral academic medical center. Approximately 40,000 admissions per year at the main campus, with 2,400 medical oncology admissions per year. Metrics to be measured and compared between pre-pilot and pilot periods were LOS, Time-of-Discharge (TOD) and Press Ganey overall, physician and nurse mean scores.

Analysis United Kingdom And United States Healthcare, Joyce K. Kutin

Joyce K Kutin RN, MSN, MOL

United Kingdom and the United States are two dissimilar health systems each having uniquely differing focuses, where the primary differences are a parliamentary verses a republic government application toward the socioeconomic requirements of the populace. The United Kingdom’s National Health Service interprets health care as a public service rather than the commodity. The United States healthcare system is riddled with disparities regarding quality, access and cost. The socioeconomic poor and or homeless are less likely to utilize the healthcare system when compared to others who are more fortunate. Health care systems are facing the same challenges around the world with …

Cardiopulmonary Resuscitation With Rescue Breathing Is Superior To Hands-Only Cardiopulmonary Resuscitation For Children And Infants: Results Of A Systematic Review, Joseph W. Rossano, Richard N. Bradley

Richard N Bradley

Introduction

Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “In children and infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?”

Results

Sixty-nine records were identified and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we assessed …

Existing Research Is Inadequate For The Development Of Guidelines For The Basic Lifesupport Management Of Airway Obstruction In Adults: Results Of A Systematic Review, Richard N. Bradley, Joseph W. Rossano, Siobán Kennedy

Richard N Bradley

Introduction

There has been considerable controversy and several changes in guidelines for the basic life support (BLS) management of choking since the introduction of the Heimlich procedure in 1974.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “For adults, either conscious or unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently recommended techniques, lead to different outcomes?”

Results

We identified 475 records after duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed for eligibility; we excluded 19 of …

The Impact Of Health Care Reform On Emergency Medical Services, Richard N. Bradley, Sabina A. Braithwaite

Richard N Bradley

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The reforms introduced through PPACA present a paradigm shift in the future delivery model of all health care, including Emergency Medical Services (EMS). Changes embodied in this law offer a variety of opportunities to improve the delivery of care in urgent and emergent medical situations in the out-of-hospital setting. PPACA offers a number of avenues for EMS to engage at a much higher level as professional members of the health care team going forward. Certain components of the law stand to facilitate and …

Attacking Patient Flow From All Angles: Combining Multiple Strategies In A Single Implementation, Paris B. Lovett

Paris B Lovett

Background

EDs across the US have experienced increased patient volumes and high levels of boarding and crowding. Several strategies have been described, including immediate bedding, bedside triage, bedside registration, use of vertical space, and attending-in-triage. ED and hospital leadership must choose whether to implement such changes one-at-a-time (piecemeal) or all at once. We describe the results of a combined approach, first piloting changes in piecemeal fashion, then introducing these strategies all at once, in a single permanent implementation.

Intervention Detail:

We conducted a series of pilots introducing each of these steps on a temporary basis. These pilots yielded data, and …

Arc Sac Advisory Pulse Check For Cardiac Arrest, Sarah Clarke, Richard N. Bradley, Siobán Kennedy

Richard N Bradley

One good quality study (LOE 4) supports omitting a pulse check after defibrillation for patients in cardiac arrest.

One fair quality study (LOE 4) opposes the performance of simultaneous as opposed to sequential pulse and breathing check to determine cardiac arrest.

There is insufficient evidence to support a recommendation on the preferred method for the initial determination of cardiac arrest.

CPR courses should specifically teach the recognition of agonal breathing and the understanding that agonal breathing is not normal breathing and that it indicates the need for CPR.

Boarding And Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying The Relationship, Paris B. Lovett

Paris B Lovett

Boarding and Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying the Relationship

Paris B. Lovett, Frederick T. Randolph, Rex G. Mathew

Thomas Jefferson University, Philadelphia, PA

Background: Long wait times, long length of stay, use of hallway beds, and physical crowding have all been reported to negatively affect patient satisfaction. There is a need for quantitative assessment of the relationship among patients discharged from the ED.

Objectives: To describe the association between total boarding hours for given calendar days, and mean Press Ganey patient satisfaction raw scores (PGs) on those days. To determine a quantitative coefficient for the …

Attending In Triage: Impact On Resident Experience, Paris B. Lovett

Paris B Lovett

Attending in Triage: Impact on Resident Experience

Paris B. Lovett, Jamie A. Kahn, Linda Davis- Moon, Rex G. Mathew, Frederick T. Randolph, Bernard L. Lopez

Thomas Jefferson University, Philadelphia, PA

Background: EDs commonly face increasing volume with resultant significant boarding and crowding. New operational measures to improve patient flow in response to these challenges have been developed. One measure is to have a physician evaluate the patient during triage (Attending-in-Triage, AIT). This results in a Medical Screening Examination (MSE) early in the patient visit. Residents in training, as part of their education, participate in medical decision-making for the undifferentiated patient. …

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms Of Unusual Fatigue And Insomnia Are Too Prevalent Among Adult Women Visiting The Ed To Be Useful In Diagnosing Acs Acutely, Paris B. Lovett

Paris B Lovett

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms of Unusual Fatigue and Insomnia Are Too Prevalent Among Adult Women Visiting the ED to be Useful in Diagnosing ACS Acutely

Paris B. Lovett1, Yvonne N. Ezeala1, Rex G. Mathew1, Julia L. Moon2 1

Thomas Jefferson University, Philadelphia, PA; 2Drexel University, School of Public Health, Philadelphia, PA

Background: In 2003, McSweeney et al. reported surveys on ‘‘prodromal’’ symptoms recalled by women who had experienced myocardial infarctions (MI). Unusual fatigue was reported by 70.7% (severe 29.7%) and insomnia by 47.8% (severe 21.0%). These findings have led to risk management recommendations to consider these symptoms as …

Improvement In Satisfaction Scores With Operational Improvements From Front-End Redesign And Attenting-In-Triage, Paris B. Lovett

Paris B Lovett

Improvement in Satisfaction Scores with Operational Improvements from Front-End Redesign and Attenting-in-Triage

Linda Davis-Moon, MSN, CRNP, Paris B. Lovett, MD MBA, Jamie A. Kahn, MD MBA, Rex G. Mathew, MD, Frederick T. Randolph, MD MBA, Logan J. Harper, BS

Thomas Jefferson University Hospitals. Philadelphia, PA.

Background: With ED volumes increasing, and with boarding and overcrowding problems, many EDs have introduced an Attending-in-Triage (AIT) to improve patient flow. One of the aims of AIT is to improve patient satisfaction.

Objectives: To report changes in patient satisfaction scores associated with introduction of AIT and resultant operational improvements.

Methods: The study design was …

Building A Nerve Center For Patient Flow: Outcomes From A Comprehensive Integration Of Services At An Academic Medical Center, Paris B. Lovett

Paris B Lovett

Building a Nerve Center for Patient Flow: Outcomes from a Comprehensive Integration of Services at an Academic Medical Center

Paris B. Lovett, MD MBA, Brian E. Sweeney, RN, MBA, FACHE, Megan L. Johnston, , MHSA, Lewis J. DeEugenio Jr, MD, FACP, BSME, Holly Meisner, RN, BSN

Patient Flow Management Center. Thomas Jefferson University Hospitals. Philadelphia, PA

Background: Improving patient flow metrics (inpatient length-of-stay (LOS), bed utilization, process cycle times and discharge efficiency) requires collaboration and coordination between multiple disciplines and departments within a hospital.

Objectives: To report outcomes from a comprehensive geographic and organizational integration of disciplines and services with …

Medical Direction Of Wilderness And Other Operational Emergency Medical Services Programs, Craig R. Warden, Michael G. Millin, Seth C. Hawkins, Richard N. Bradley

Richard N Bradley

Within a healthcare system, operational emergency medical services (EMS) programs provide prehospital emergency care to patients in austere and resource-limited settings. Some of these programs are additionally considered to be wilderness EMS programs, a specialized type of operational EMS program, as they primarily function in a wilderness setting (eg, wilderness search and rescue, ski patrols, water rescue, beach patrols, and cave rescue). Other operational EMS programs include urban search and rescue, air medical support, and tactical law enforcement response. The medical director will help to ensure that the care provided follows protocols that are in accordance with local and state …

That’S All It Took- Just One Look. Can A Five Second Look At A Patient Predict Disposition, Paris B. Lovett

Paris B Lovett

Study Objectives •To determine whether a five-second viewing of a patient contributes to prediction of disposition. Conclusion •For all but the resident group, a five second viewing of a patient contributes to prediction of disposition status. •The effect size is small, however. Such quick visual impressions may provide a piece of the overall decision-making process in the final disposition of patients.

Managing Patient Flow: Is High Hospital Occupancy A Root Cause Of Ambulance Diversion?, Paris B. Lovett

Paris B Lovett

Inefficient patient flow through an

emergency department (ED) causes

long wait times, reduced patient satisfaction,

and increased walkouts (that is,

leaving without being seen, or LWBS).

Ste Sidebar 1 on page 5 for a look at

related Joint Commission requirements.

Poor patient flow may also lead to ambulance diversion- a request by an attending physician for ambulances to transport patients to other hospitals (while continuing to accept walk-in patients). EDs may go on ambulance diversion when they reach a critical state in which the volume of patients exceeds its capacity to see and treat them.

Stuart E. Greene, M.B.A., Paris …

Environmental Toxins: Biological, Chemical And Radiological Terrorism, Richard N. Bradley

Richard N Bradley

Children have greater risk of harm than adults after exposure to chemical, biological or radiological weapons, as may be seen following some acts of terrorism. This chapter reviews potential chemical agents, separating them into four categories: nerve agents, blister agents, cyanides, and choking agents. It reviews both recognition and treatment. The chapter also reviews symptoms, modes of transmission and treatment for the following biological agents: smallpox, plague, tularemia, anthrax, botulism, and viral hemorrhagic fevers.

International Strategy For Disaster Reduction – World Health Organization 2008-09 Campaign On Safer Healthcare Facilities, Richard N. Bradley

Richard N Bradley

Many recent emergencies highlight the need for hospitals that are safer and more resistant to disasters. The International Strategy for Disaster Reduction, an instrument of the United Nations General Assembly, and the World Health Organization have addressed the need for safer and more disaster-resistant healthcare facilities by making this priority the theme of their 2008 – 2009 biennial World Campaign on Disaster Reduction.

Shelter Care, Richard N. Bradley

Richard N Bradley

Unless exclusively serving an adult population, shelters must ensure that the physical and mental health needs of children are appropriately addressed, and that children remain with their families or caregivers to the maximum extent possible.

Smallpox, Richard N. Bradley

Richard N Bradley

Description Viral infection of the human respiratory tract. Causes Infection by variola virus. Risk Factors Exposure to a biological warfare or bioterror attack or contact with an infected person. Symptoms

Fever, cough and body aches, followed by a spotted, bumpy rash.

Diagnosis

Confirmed by testing blood or the fluid from the blisters.

Treatments

None currently approved but experts are testing some medications.

Pathogenesis

The virus enters and multiplies in the respiratory passages.

Prevention

Avoid those with the disease. During an outbreak a vaccine is available that will prevent the disease or lessen its severity.

Epidemiology

Completely eradicated from nature, but …

Is It Useful To Measure Sedimentation Rate (Esr) As A Broad Screening Test In The Emergency Department?, Paris B. Lovett

Paris B Lovett

Is It Useful to Measure Sedimentation Rate (ESR) as a Broad Screening Test in the Emergency Department? Breen LM, Lovett PB, Greenwald RA NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY; Long Island Jewish Medical Center, New Hyde Park, NY Background: Multiple studies have reported that markedly elevated sedimentation rates (ESR_100) are associated with several groups of diagnoses: infection, systemic inflammatory disorders, malignancy, and renal disease. These associations are largely drawn from case series. ESR is sometimes used as a screening test in the emergency department (ED), yet the clinical value of such screening is uncertain. Study Objectives: Our …

Applicants Report That Their Rankings Of Em Programs Are Most Driven By Wellness, Morale, Happiness And Rapport, Paris B. Lovett

Paris B Lovett

Applicants Report That Their Rankings of EM Programs Are Most Driven by Wellness, Morale, Happiness and Rapport

Lovett PB, Sayan OR, Glassman GD, Petrik R

New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY

Study Objectives: Our objectives were to (1) determine which factors are considered most important to residency applicants as they choose between residency programs in emergency medicine (EM) and (2) compare the response rates on this electronic/Web survey against response rates in prior comparable paper/mail surveys.

Methods: We surveyed all 118 applicants who interviewed at an urban, academic PGY1-4 EM program in 2005-6. A Web …