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Disparities have been observed in the treatment of pain in emergency department patients. However, few studies have evaluated such disparities in emergency medical services (EMS). We describe pain medication administration for trauma indications in an urban EMS system and how it varies with patient demographics. We performed a retrospective review of the electronic medical records of adult patients transported for isolated trauma (without accompanying medical complaint) from 1/1/18 to 6/30/2020 by a third service EMS agency in a major United States metropolitan area. We performed descriptive statistics on epidemiology, type of pain medications administered, and pain scores. Kruskall-Wallis and chi-square or Fisher's exact tests were used to compare continuous and categorical variables, respectively. We constructed a logistic regression model to estimate the odds of nontreatment of pain by age, race, sex, transport interval, pain score, and Glasgow Coma Scale (GCS) score for patients with pain scores of at least four on a one to ten scale, the threshold for pain treatment per the EMS protocol. Of 32,463 EMS patients with traumatic injuries included in the analysis, 40% (12,881/32,463) were African American, 50% (16,284/32,463) were female, the median age was 27 years (IQR 45-64), and the median initial pain score was 5 (IQR 2-8). Fifteen percent (4,989/32,463) received any analgesic. Initial pain scores were significantly higher for African American and female patients. African American patients were less likely to receive analgesia compared to White and Hispanic patients (19% versus 25% and 23%, respectively, p < 0.0001). Adjusting for age, pain score, transport interval, and GCS, African American compared to White, and female compared to male patients were less likely to be treated for pain, OR 1.59 (95% CI 1.47-1.72) and OR 1.20 (95% CI 1.11-1.28), respectively. Among patients with isolated traumatic injuries treated in a single, urban EMS system, African American and female patients were less likely to receive analgesia than White or male patients. Analgesics were given to a small percentage of patients who were eligible for treatment by protocol, and intravenous opioids were used in the vast majority patients who received treatment. [ABSTRACT FROM AUTHOR]

To describe interfacility transfer (IFT) intervals, transfer vehicle type, and levels of care in patients with large vessel occlusion (LVO) strokes transferred for emergent endovascular therapy (EVT). We included all patients transferred by a single IFT agency in the state of Indiana from July 1, 2018 to December 1, 2020 to a comprehensive stroke center in Indianapolis for emergent EVT. Data were collected from the transfer center electronic medical records and matched to IFT and receiving hospital data. Two hundred eighty-eight patients were included, of which 150 (52.0%) received EVT. The median call-to-needle interval (from call to the transfer center to EVT needle puncture) was 155.5 minutes (IQR 135.8-195.3). The median resource activation interval (call to the transfer center to IFT deployment) was 16 minutes (IQR 10-27 minutes); the median IFT response interval (call to IFT to arrival of the transferring unit) was 34 minutes (IQR 25-43 minutes); the median pre-transfer interval (call to the transfer center until departure from the sending hospital) was 60.4 minutes (IQR 47.1-72.6); and the median sending hospital interval at bedside was 25 minutes (IQR 20-30 minutes). Most patients (197, 68.4%) were sent via critical care rotor. Only 61 (21.2%) required interventions other than tissue plasminogen administration, such as titration of actively transfusing medications (e.g., nicardipine, propofol) (37 of 61, 59.7%), or intubation or ventilator management (25 of 61, 40.3%). Patients sent via critical care rotor had longer sending hospital intervals (26 minutes, IQR 22-32, vs 19 minutes, IQR 16-25; p < 0.001) but shorter transfer intervals than those sent via critical care ground. At longer distances, rotor transport saved significant time specifically in the total IFT interval of patients with LVO strokes. Emphasizing processes to reduce the resource activation interval and the sending hospital interval may help reduce the overall time-to-EVT. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is a constellation of risk factors associated with the development of cardiovascular disease and increased all-cause mortality. Data examining the prevalence of metabolic syndrome among emergency medical services (EMS) clinicians are limited. We conducted a cross-sectional study of EMS clinicians and firefighters from three fire departments with transport-capable EMS divisions. Data were collected from compulsory annual physical exams for 2021 that included age, sex, race, body mass index (BMI), waist circumference, blood pressure, cholesterol levels, and hemoglobin A1c level. These data were used to determine the prevalence of meeting metabolic syndrome criteria. We calculated descriptive statistics of demographics, anthropometrics, and metabolic syndrome criteria for EMS clinicians and firefighters. We used chi-square tests to compare the proportion of EMS clinicians and firefighters meeting criteria for the whole group and among age groups of <40 years old, 40 to 59 years old, and ≥60 years old. We used logistic regression to estimate the odds of meeting criteria in EMS clinicians compared to firefighters, adjusted for age, sex, race, and BMI. We reviewed data for 65 EMS clinicians and 239 firefighters. For the combined cohort, 13.2% (40/304) were female and 95.1% (289/304) were White. The median age for EMS clinicians was 34 years versus 45 years in firefighters (p < 0.0001). Metabolic syndrome criteria were met in 27.3% (83/304) of the entire group. The prevalence of meeting criteria among EMS clinicians and firefighters was 33.9% (22/65) and 25.5% (61/239), respectively (p = 0.18). Of the participants who were younger than age 40, 36.6% (15/41) of EMS clinicians versus 9.1% (7/74) of firefighters met criteria for metabolic syndrome (p < 0.001). EMS clinicians had significantly higher odds of meeting criteria [OR 4.62 (p = 0.001)] compared to firefighters when adjusted for age, sex, race, and BMI. EMS clinicians had a high prevalence of metabolic syndrome at an early age, and had a higher adjusted odds of having metabolic syndrome compared to firefighters. [ABSTRACT FROM AUTHOR]

Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. We performed a retrospective cohort analysis of all patients in Marion County, Indiana, from March 23, 2020 to May 25, 2020 for whom a novel non-transport protocol was used by EMS for patients with low-acuity COVID-19 symptoms. We assessed paramedic compliance with the protocol to determine numbers and types of deviations. We further reviewed a statewide health information exchange database to identify any patients with emergency department (ED) visits, hospital admissions, or death within 30 days of the EMS non-transport. For ED and hospital visits, we collected ED or admission diagnoses to determine if the etiologies were COVID-related. Between March 24, 2020 and May 25, 2020, 222 patients were documented as "Treated, Released (per protocol)." The protocol was correctly applied 144 times (64.8%). The other 78 times, although the EMS clinicians documented use of the protocol, it was not actually used (e.g., another protocol such as "no medical emergency" was used). Of the 144 patients for whom the protocol was used, in 55 cases (38.2%), the clinicians documented patient factors that should have contraindicated use of the protocol (e.g., chest pain, past medical history of asthma). The protocol was applied 5 times (3.5%) in pediatric patients. Two patients were admitted to the hospital within 72 hours of incorrect application of the protocol; both were for COVID-related complaints. Two patients were admitted to the hospital within 72 hours of correct protocol use; one was for a COVID-related complaint. In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly. [ABSTRACT FROM AUTHOR]

BACKGROUND: Emergency Medical Services (EMS) professionals frequently experience job-related injuries, most commonly overexertion or movement injuries. Data on injury reduction in EMS professionals is limited. The Functional Movement Screen (FMS) is a movement analysis tool suggested to predict musculoskeletal injury, but it has not previously been evaluated for EMS professionals. OBJECTIVE: To evaluate the effectiveness of the FMS to predict musculoskeletal injury among EMS professionals. METHODS: In October 2014, EMS professionals employed in an urban third-service EMS agency volunteered to participate in FMS administered by certified screeners. Age, sex, height and weight were recorded. After screening, participants were instructed on exercises to correct movement deficiencies. We reviewed recorded injuries from 2013 to 2016. We performed descriptive statistics. With logistic regression modeling, we described factors that predicted musculoskeletal injury. We generated a receiver operating curve (ROC) for FMS prediction of musculoskeletal injury. RESULTS: 147 of 240 full-time employees participated in the FMS. Participants' mean age was 33.7 years (SD = 9.6) and the majority (65%) were male. The median initial FMS score was 14 (IQR 11–16). Area under the ROC curve was 0.603 (p = 0.213) for FMS ability to predict any musculoskeletal injury within two years. Female sex was associated higher odds of injury (OR 3.98, 95% CI 1.61–9.80). Increasing age, body mass index (BMI) category, and FMS score≤14 did not predict musculoskeletal injury. CONCLUSION: The FMS did not predict musculoskeletal injury among EMS professionals. [ABSTRACT FROM AUTHOR]

Background: Studies have reported COVID-19 as an independent risk factor for arterial thromboemboli. Methods: From a cross-sectional sample, we determined the incidence and location of arterial thromboemboli (myocardial infarction, ischemic stroke, peripheral artery), stratified by COVID-19 status, in the RECOVER database, which included data on patients at 45 United States medical centers in 22 states. Epidemiological factors, clinical characteristics and outcomes were collected through a combination of individual chart review and automatic electronic query and recorded in REDCap®. We investigated the association of baseline comorbidities on the development of arterial thromboemboli and analyzed results based on the presence or absence of concomitant COVID-19 infection, testing this association with Chi-squared. We also described use of anticoagulants and statins. Results: Data were collected on 26,974 patients, of which 13,803 (51.17%) tested positive for COVID-19. Incidence of arterial thromboemboli during hospitalization was 0.13% in patients who tested positive for COVID-19 and 0.19% in patients who tested negative. Arterial thromboemboli tended to be more common in extremities than in core organs (heart, kidney, lung, liver) in patients with COVID-19, odds ratio 2.04 (95% CI 0.707 – 5.85). Patients with COVID-19 were less likely to develop an arterial thrombus when on baseline statin medication (p=0.014). Presence of metabolic syndrome predicted presence of core arterial thrombus (p=0.001) and extremity arterial thrombus (p=0.010) in those with COVID-19. Arterial thromboemboli were less common in patients with COVID-19 than in those who tested negative for COVID-19. Conclusions: Presence of a composite metabolic syndrome profile may be associated with arterial clot formation in patients with COVID-19 infection. [ABSTRACT FROM AUTHOR]

We validated the NUE rule, using three criteria (Non-shockable initial rhythm, Unwitnessed arrest, Eighty years or older) to predict futile resuscitation of patients with out-of-hospital cardiac arrest (OHCA). We performed a retrospective cohort analysis of all recorded OHCA in Marion County, Indiana, from January 1, 2014 to December 31, 2019. We described patient, arrest, and emergency medical services (EMS) response characteristics, and assessed the performance of the NUE rule in identifying patients unlikely to survive to hospital discharge. From 2014 to 2019, EMS responded to 4370 patients who sustained OHCA. We excluded 329 (7.5%) patients with incomplete data. Median patient age was 62 years (IQR 49 − 73), 1599 (39.6%) patients were female, and 1728 (42.8%) arrests were witnessed. The NUE rule identified 290 (7.2%) arrests, of whom none survived to hospital discharge. In external validation, the NUE rule (Non-shockable initial rhythm, Unwitnessed arrest, Eighty years or older) correctly identified 7.2% of OHCA patients unlikely to survive to hospital discharge. The NUE rule could be used in EMS protocols and policies to identify OHCA patients very unlikely to benefit from aggressive resuscitation. [ABSTRACT FROM AUTHOR]

Introduction: Opioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA). Methods: We surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board. Results: Of the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA. Conclusion: This study represents an important description of EMS medical directors' approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California. [ABSTRACT FROM AUTHOR]