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In response to the COVID-19 pandemic, emergency medical services (EMS) and hospitals recognized the need for innovative programs addressing 9-1-1 utilization and ambulance transport to provide patient-centered, safe, cost-effective care. The ET3 (Emergency Triage, Treatment, and Transport) model provides flexibility and new payments to ambulance care teams for Medicare beneficiaries for alternate strategies of care. This includes providing treatment in place through telehealth after a 9-1-1 call and ambulance response. Our objective is to evaluate the implementation barriers of a telemedicine service to 9-1-1 responding ambulances providing treatment in place for low-acuity conditions. The TeleEMS program was piloted in a large, urban fire-based EMS system with eight ambulances geographically surrounding one hospital. Paramedics received training on the telemedicine software and screening criteria, which were age 1–70 and vital sign parameters. Pregnant, combative, and patients with no clear need for emergency department transport were excluded. Three emergency physicians with additional training in EMS provided the TeleEMS service from 8am to 6 pm on Monday - Friday. The telemedicine software was application-based and provided HIPAA-compliant two-way, real-time audio and video communication through the 4G network on a tablet. The TeleEMS physicians had access to a database of clinics and hospitals that coordinate health care. The TeleEMS physician contacted the patient within 24–72 hours after the encounter for follow-up. The TeleEMS pilot program ran for 12 weeks from April – June 2021. During this time, there were seven completed consults with treatment in place, one completed consult with transport to an emergency department, and five consult attempts that failed due to technological issues with resultant transport. Each of the consults (13/13) met the TeleEMS screening criteria. Post-pilot focus group sessions were held to determine paramedic feedback. Barriers to an EMS telemedicine program include paramedic buy-in, patient expectations for emergency care, technology limitations, and qualified physician resources. An EMS telemedicine program can be successfully implemented in urban fire-based EMS systems for 9-1-1 responding ambulances. Barriers to implementation should be addressed at the paramedic, patient, technology, and program levels to improve success. [ABSTRACT FROM AUTHOR]

Prehospital hypoglycemia is usually treated with oral or intravenous (IV) dextrose in a variety of concentrations. In the absence of vascular access, intramuscular (IM) glucagon is commonly administered. Occupational needle-stick injury remains a significant risk while attempting to obtain vascular access or administer medications intramuscularly in the prehospital setting. We sought to determine if intranasal (IN) glucagon is effective in the prehospital treatment of hypoglycemia. We performed a retrospective analysis of all consecutive cases where recombinant glucagon was administered IN by paramedics from January 1, 2015 through December 31, 2020. Excluded were cases without pre or post administration blood glucose documentation, and cases where another form of treatment for hypoglycemia was administered at any time during the EMS encounter. The primary outcome was clinical response to IN glucagon documented by paramedics; secondary outcomes included pre and post administration blood glucose values. Out of 44 cases that met study inclusion criteria, 14 patients (32%) had substantial improvement, 13 patients (30%) had slight improvement, and 17 patients (38%) had no improvement in mental status after administration of IN glucagon. In cases with substantial improvement (n = 14), the mean pre administration blood glucose was 33.8 mg/dl and the mean post administration blood glucose was 87.1 mg/dl (mean increase 53.3 mg/dl, 95% CI: 21.5 to 85.1). In cases with slight improvement (n = 13), the mean pre administration blood glucose was 23.9 mg/dl and the mean post administration blood glucose was 53.8 mg/dl (mean increase 29.9 mg/dl, 95% CI = 2.9 to 56.9). In case with no improvement (n = 17) the mean pre administration blood glucose was 30.1 mg/dl and the mean post administration glucose was 33.1 mg/dl (mean difference 3.1 mg/dl, 95% CI: −10.1 to 3.9). Intranasal administration of recombinant glucagon for hypoglycemia resulted in a clinically significant improvement in mental status and a corresponding increase in blood glucose levels in select cases in the prehospital setting. [ABSTRACT FROM AUTHOR]

The racial gap in U.S. homeownership has widened since the recession of 2007–2011, partly because of housing loss from foreclosure. This study uses cumulative disadvantage theory to analyse the racial dimensions of home foreclosure activity across neighbourhoods in a Southern county. The methods involved collecting and analysing 1013 foreclosures in a population almost evenly divided between white and black residents. After creating a foreclosure ratio to measure black–white dissimilarities in homeownership, we used ArcGIS to map foreclosure landscapes in all tracts and three tracts with different racial compositions. The analysis identified racial disparities that are consistent with cumulative disadvantage theory. Although the greatest disparity occurred in significantly black areas, black homeowners were more likely to experience foreclosure compared to whites in all 45 tracts of the county. We conclude that the higher rate of foreclosure among black owners relates to discriminatory lending practices and other forms of cumulative disadvantage that affect housing outcomes in this population. [ABSTRACT FROM AUTHOR]

Objective: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), a simple assessment tool currently used by emergency medical services (EMS) providers, can be used to identify LVO. Methods: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry. Head and neck vessel imaging confirmed LVO. CPSS scores were abstracted from prehospital EMS records. Spearman's rank correlation, Wilcoxon rank-sum test, and Student's t-test were performed. Cohen's kappa was calculated between CPSS abstractors. The Youden index identified the optimal CPSS cut-off. Multivariate logistic regression controlling for age, sex, and race determined the odds ratio (OR) for LVO. Results: Of 144 eligible patients, 138 (95.8%) had CPSS scores in the EMS record and were included for analysis. The median age was 69 (IQR 58-81) years. Vessel imaging was performed in 97.9% of patients at a median of 5.9 (IQR 3.6-10.2) hours from hospital arrival, and 43.7% had an LVO. Intravenous tissue plasminogen activator was administered to 29 patients, in whom 12 had no LVO on subsequent vessel imaging. The optimal CPSS cut-off predicting LVO was 3, with a Youden index of 0.29, sensitivity of 0.41, and specificity of 0.88. The adjusted OR for LVO with CPSS = 3 was 5.7 (95% CI 2.3-14.1). Among patients with CPSS = 3, 72.7% had an LVO, compared with 34.3% of patients with CPSS ≤ 2 (p < 0.0001). Conclusions: A CPSS score of 3 reliably identifies LVO in AIS patients. EMS providers may be able to use the CPSS, a simple, widely adopted prehospital stroke assessment tool, with a cut-off score to screen for patients with suspected LVO. [ABSTRACT FROM AUTHOR]

Objectives: Identifying stroke during a 9-1-1 call is critical to timely prehospital care. However, emergency medical dispatchers (EMDs) recognize stroke in less than half of 9-1-1 calls, potentially due to the words used by callers to communicate stroke signs and symptoms. We hypothesized that callers do not typically use words and phrases considered to be classical descriptors of stroke, such as focal neurologic deficits, but that a mixed-methods approach can identify words and phrases commonly used by 9-1-1 callers to describe acute stroke victims. Methods: We performed a mixed-method, retrospective study of 9-1-1 call audio recordings for adult patients with confirmed stroke whowere transported by ambulance in a large urban city. Content analysis, a qualitative methodology, and computational linguistics, a quantitative methodology, were used to identify key words and phrases used by 9-1-1 callers to describe acute stroke victims. Because a caller's level of emotional distress contributes to the communication during a 9-1-1 call, the Emotional Content and Cooperation Score was scored by a multidisciplinary team. Results: Atotal of 110 9-1-1 calls, received between June and September 2013, were analyzed. EMDs recognized stroke in 48% of calls, and the emotional state of most callers (95%) was calm. In 77% of calls in which EMDs recognized stroke, callers specifically used the word "stroke"; however, the word "stroke" was used in only 38% of calls. Vague, non-specific words and phrases were used to describe stroke victims' symptoms in 55% of calls, and 45% of callers used distractor words and phrases suggestive of non-stroke emergencies. Focal neurologic symptoms were described in 39% of calls. Computational linguistics identified 9 key words that were more commonly used in calls where the EMD identified stroke. These words were concordant with terms identified through qualitative content analysis. Conclusions:Most 9-1-1 callers used vague, non-specific, or distractor words and phrases and infrequently provide classic stroke descriptions during 9-1-1 calls for stroke. Both qualitative and quantitative methodologies identified similar key words and phrases associated with accurate EMD stroke recognition. This study suggests that tools incorporating commonly used words and phrases could potentially improve EMD stroke recognition. [ABSTRACT FROM AUTHOR]

completed (66%). Survey respondent demographics were fire-fighter/EMTB (69%), fire-fighter/paramedic (14%), and single role paramedic (17%). The most frequent barrier to field TOR was scene safety (86%). The most common safety issue identified was family reaction to TOR (68%) and many providers felt threatened by family when trying to perform TOR (38%). Providers with a higher career numbers ofOHCA were more likely to have felt threatened by the family (OR 6.70, 95% CI 2.99-15.00) and single role paramedics were more likely than FF/EMTBs to have felt threatened (OR 3.34, 95% CI 2.65-4.22). Barriers to delivering a death noti- fication after TOR, include being uncomfortable or threatened with possible family reaction (52%) and family asking to continue the resuscitation (45%). There was lack of formal prior death notification training, the majority learned from colleagues through on the job training. Conclusions: Our study identifies scene safety, death notification delivery, and lack of formal training in death notification as barriers that EMS providers face while performing TOR in a large urban EMS system. These findings informed educational and operational initiatives to overcome the identified provider level issues and improve compliance with TORpolicies. [ABSTRACT FROM AUTHOR]

Background. Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. Objective. We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose. Methods. We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics. Results. Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%%) had complete response, 62 (59%%) had partial response, and 20 (19%%) had no response. Eleven cases (10%%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993. Conclusion. Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations. [ABSTRACT FROM AUTHOR]

Age-related vision loss is one of the most commonly cited disabling impairments of adult life. Stressors presented by vision loss can create barriers, threatening the well-being of the individual. This qualitative study of 30 older adults (65 to 95 years of age) investigated vision loss and coping strategies. All participants experienced unexpected sight loss during their adult years. The Adaptation to Age-Related Vision Loss (AVL) Scale was used in this study to examine psychosocial adaptation to vision impairment. The coping strategies of vision impairment were assessed by collecting self-reported reflections toward vision loss and how the change impacted the participant's life. Given the correct balance of support, confidence, and acceptance, older adults can confront the existing barriers and focus on the ability to optimize function with vision loss. Health care service providers and practitioners can provide needed assistance and a helpful guide to assist older adults in successfully coping with vision impairment. [ABSTRACT FROM AUTHOR]

Placing a relative who has Alzheimer's disease or other dementia into an assisted living facility is one of the most stressful events a caregiver will experience. In this study, focus groups were used as a means for Alzheimer's caregivers (N = 20) to discuss pre- and postplacement needs. Alzheimer's caregivers openly discussed their experiences and recounted their successes, coping strategies, and overcoming of barriers. Focus group dialogue generated three main areas of discussion that included (1) choosing a facility, (2) advice for the first day of placement, and (3) ongoing issues and concerns of post-placement. From the information shared by caregivers, practical solutions indicated the value of incorporating current and former caregivers into a support network or mentor program for new caregivers coping with placement decisions. [ABSTRACT FROM AUTHOR]

Grandparents want to share family stories and memories with grandchildren. Implementing a classroom “memory box” assignment, allows grandparents and grandchildren a structured opportunity to discuss and explore family memories. What types of information do grandparents want to share with their grandchildren? This course assignment was implemented with college age students in a gerontology course with 100 grandparents to explore the types of memories they would like to leave with their grandchildren. Topics discussed were family history, family stories, grandparent's role, and advice grandparents would give to their grandchildren. Common themes that emerged suggested that grandparents wanted their grandchildren to know the importance of love in the family, spirituality, and morals such as honesty and trust. The “memory box” class assignment provides teachers and faculty with an educational learning exercise that can be incorporated into a current course to provide an intergenerational gerontology component into their curriculum. [ABSTRACT FROM PUBLISHER]

Families in which grandparents are raising grandchildren (N = 38) were interviewed to explore the relationships between grandparents, their adult children and grandchildren. Semi-structured interviews were conducted using an instrument that included questions about family issues and factors affecting grandparent caregivers. Data was analyzed using QSR NUD*IST software for qualitative research. This study provides insight about three major themes: blended grandparent-parent roles, parent-child relationships, and collateral family relationships. Parent-child relationships were ongoing despite sometimes infrequent and sporadic contacts. Implications for social work practice include the need for an increased awareness of multiple family problems and the long-term influence of intergenerational family relationships. [ABSTRACT FROM AUTHOR]

As the middle generation attempts to deal with the challenges of unemployment, increasing divorce rates and substance abuse, it is becoming increasingly common for the older generation to be called upon to raise grandchildren. The purpose of this qualitative study was to explore the complex problems grandparents have when raising their grandchildren. Grandparents reported their relationships with adult children, becoming surrogate parents and legal issues as major areas of stress. [ABSTRACT FROM AUTHOR]

Presents the results of a survey of 94 graduates of the Master of Education Gerontology Option program at the University of Central Oklahoma. Focus on the Gerontology Student Employment Survey; Response rate; Employment opportunities; Salaries; Involvement of gerontology students in the business community.

Studies the impact of preretirement planning on life satisfaction during retirement. Sampling of 322 retirees; Self-planned retirement; Company-sponsored retirement preparatory programs; Effective programming.

Life satisfaction was compared with knowledge about aging and bias toward the aged. Adaptations of the Life Satisfaction Index A (LSIA) and the Facts on Aging Quiz (FAQ) were administered to 56 middle and older adult members of a Protestant church in a southwestern city. Bias was determined from FAQ responses using Palmore's (1988) methods. A weak positive relationship was found between LSIA and bias scores (r = .29555, p < .05). Subjects also answered open-ended questions which reflected a high degree of happiness and life satisfaction. Implications for ministry are proposed. [ABSTRACT FROM PUBLISHER]