Search

Background: The population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital., Methods: This is a retrospective case-control study with patient data extracted from hospital records and EMS run reports from a 911 emergency ambulance service. Patients were only included if they were transported to our level I trauma center. Inclusion in the LEP group was based on a field in EMS run reports that claimed language barrier as the sole reason for no patient signature. All LEP patients from July 1, 2012, to November 1, 2012, were reviewed. A random comparison sampling of ES patients from the same period was evaluated. The patients' demographic data, pain scores, interventions, medications, transport times, and scene times were analyzed. Patients were followed up from emergency department (ED) management through to disposition. Percentages were compared using 95% confidence intervals (CIs). Bivariate analysis used the Student t test and χ(2) test. A multivariable logistic regression model was created to determine predictive variables. A 5% random sampling was compared by 2 investigators for interrater agreement., Results: Data were collected from a total of 101 ES and 100 LEP patients. Interrater agreement was 94% between extractors. Limited English proficiency patients were significantly older (56 ± 20 years old) than ES patients (41 ± 21 years old) and more likely to be female (odds ratio [OR], 2; 95% CI, 1.1-3.3). Limited English proficiency patients had a greater mean EMS transport time of 2.2 minutes (95% CI, 0.04-4.0). The odds of LEP patients receiving electrocardiograms were greater both in the ambulance (OR, 3.7; 95% CI, 1.7-8.1) and in the ED (OR, 2.0; 95% CI, 1.1-3.3) compared to ES patients. There were no differences in additional interventions, medications administered, or pain scores obtained between the 2 groups. In a multivariable logistic regression model corrected for age, type of call, smoking history, and sex, there was no difference in transport times in LEP patients., Conclusion: Compared to ES patients, LEP patients are older and more likely to be female. When corrected for differences in age, type of call, smoking history, and sex, we found no difference in scene or transport time for LEP patients. Results of this study indicate that EMS providers should be prepared for a different patient encounter when responding to 911 calls involving LEP patients rather than language variations alone., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Antiemetics have been shown to be effective in multiple hospital settings, but few studies have been done in the prehospital environment., Objectives: Our hypotheses were 1) that the amount of normal saline administered during an emergency medical services (EMS) transport was not related to a change in nausea and vomiting and 2) that the addition of the ondansetron orally disintegrating tablet (ODT) would decrease the degree of nausea., Methods: This was a pre-post study of two cohorts of consecutive patients with nausea in the prehospital setting. During phase 1 of the study, our local EMS agency adopted a protocol form to complete whenever a patient with nausea and/or vomiting was assessed and transported to one of the area hospitals. Patients were asked to rate their nausea on a visual analog scale (VAS) and a Likert scale, and saline administration and active vomiting were documented. During phase 2, our EMS system adopted the use of ondansetron ODT for nausea and continued to complete the same forms. The nausea forms completed by EMS during phase 1 (saline only) and phase 2 (ondansetron ODT) were evaluated and compared. For both phases, the primary outcome measures were the change in VAS nausea rating (0 = no nausea, 100 = most nausea imaginable) from beginning to end of the transport and the results on the Likert scale completed at the end of the transport. Relationships were considered significant if p < 0.01., Results: Data were collected from 274 transports in phase 1 and 372 transports in phase 2. The average patient age was 50 ± 12 years. In phase 1 of the study, 178 of 274 patients (65%) received normal saline (mean volume ± standard deviation = 265 ± 192 mL). There was no significant correlation between the VAS change and the amount of fluid administration in either phase of the study. Conversely, during phase 2, patients receiving ondansetron ODT showed significant improvement in both measures of nausea. The difference in nausea improvement between phase 1 and phase 2 was significant (difference in VAS change: 24.6; 95% confidence interval 20.9, 28.3)., Conclusion: There was no improvement in patient nausea related to quantity of saline alone during an EMS transport. The addition of ondansetron ODT resulted in a significant improvement in degree of nausea.

Background: Air medical transport has had problems with its safety record, attributed in part to human error. Flight crew members (FCMs) must be able to focus on critical safety tasks in the context of a stressful environment. Flight crew members' cognitive readiness (CR) to perform their jobs may be affected by sleep deprivation, personal problems, high workload, and use of alcohol and drugs., Objective: The current study investigated the feasibility of using a computer-based cognitive task to assess FCMs' readiness to perform their job., Methods: The FCMs completed a short questionnaire to evaluate their physiologic and psychological state at the beginning and end of each shift. The FCMs then performed 3 minutes of a computer-based cognitive task called synthetic work environment (SYNWIN test battery). Task performance was compared with the questionnaire variables using correlation and regression analysis. Differences between the beginning and end of each shift were matched and compared using a paired Students t test., Results: SYNWIN performance was significantly worse at the end of a shift compared with the beginning of the shift (p = 0.028) primarily because of decrement in the memory component. The SYNWIN composite scores were negatively correlated to degree of irritability felt by the participant, both before (r = -0.25) and after (r = -0.34) a shift and were significantly correlated with amount of sleep (0.22), rest (0.30), and life satisfaction (0.30)., Conclusions: Performance by FCMs on a simple, rapid, computer-based psychological test correlates well with self-reported sleep, rest, life satisfaction, and irritability. Although further studies are warranted, these findings suggest that assessment of the performance of FCMs on a simple, rapid, computer-based, multitasking battery is feasible as an approach to determine their readiness to perform critical safety tasks through the SYNWIN task battery.

Introduction: Ambulance diversion is a problem in many communities. When patients are diverted prompt and appropriate medical care may be delayed., Objective: Compare diversion hours and drop-off times before and after a dramatic change in diversion policy restricting each hospital to 1 hour out of every 8., Methods: This study was a retrospective study in a county of 600,000 people and 10 hospitals from September 2004 to February 2006. A countywide diversion protocol was implemented in March 2005 that limited diversion hours to 1 hour out of every 8 (maximum of 90 h/mo). No other changes were implemented during the study period. Pretrial (9/04-2/05), interim (3/05-8/05), and posttrial (9/05-2/06) periods were compared. The main outcome measures were ambulance diversion hours and emergency medical service (EMS) drop-off times. Results were compared using analysis of variance and a Tukey post hoc analysis. P < .05 was considered significant., Results: There was no significant difference in the number of monthly transports comparing the posttrial vs pretrial periods; however, a significant decrease in monthly ambulance diversion hours (difference, 251 hours; 95% CI, 136-368) and significant increase in additional time that EMS crews required to transport patients (drop-off times) (difference, 178 hours; 95% CI, 74-283) were observed. Posttrial diversion hours decreased to 18% of the pretrial values (from 305 to 54)., Conclusion: This novel ambulance diversion protocol dramatically reduced diversion hours at the cost of increasing EMS drop-off times in a large community.

Background: More than 10% of the population visit emergency departments (ED) every year. Many of these patients are not up-to-date on routine vaccinations that could prevent future illnesses. The ED could significantly impact these vaccination trends., Objectives: This study was a feasibility study to determine whether patients would be amenable to an ED-based program that provided appropriate immunizations when they were at high risk for these diseases. In addition, the authors sought to identify barriers that predict high-risk patients who did not receive immunizations before ED presentation and to identify barriers that predict those high-risk unvaccinated patients who are unwilling to receive vaccinations when offered in the ED., Methods: This study was a prospective cross-sectional study of all patients arriving in the ED at one inner-city trauma center between 10 am and 10 pm over the course of a three-week intervention period. The subjects completed a survey that included information about their risk of influenza (flu) and pneumococcal disease, their immunization history, and their perceptions of their need for immunization. Demographic information collected included insurance status, age, gender, and primary language. All high-risk patients who were not current with their immunizations were offered vaccination. The primary outcome was improvement in vaccination coverage based on an ED surveillance and treatment system for vaccinations. The secondary outcomes were barriers to successful vaccination before ED presentation and barriers to acceptance of vaccination in the ED. Results were compared using chi-square test and confidence interval analysis. Characteristics of barriers to immunization were determined using a logistic regression model. A p-value < 0.05 was considered significant., Results: A total of 674 subjects were entered into the study. Vaccination of subjects at high risk for flu increased significantly from 16% before to 83% after ED evaluation and treatment, and vaccination of subjects at high risk for pneumococcal disease increased significantly from 18% before to 84% after ED evaluation and treatment. Significant barriers to vaccination before ED presentation were lack of insurance (odds ratio [OR] = 0.31 for flu, 0.22 for pneumococcal disease), age younger than 50 years (OR = 0.18 for flu, 0.24 for pneumococcal disease), and no perceived need for vaccination (OR = 0.07 for flu). The sole significant barrier to vaccine administration in the ED was perceived need for vaccination (OR = 0.32 for flu)., Conclusions: An ED-based vaccination program is both feasible and successful. Other than a shortage of vaccine, the only ED barrier to vaccination (perceived need) might be overcome with patient education.

Objectives: To determine demographics of children in homes to which police are called for intimate-partner violence (IPV) and to compare the relative risk of perpetrator versus victim for those who, as children, witnessed or were victims of IPV and sexual assault., Methods: Data from Resources, Inc. Victim Assistance Unit yearly intake statistics for 2004 were accessed. In this city with a population of approximately 500,000 people, police will call for an on-site advocate intervention (a trained social worker) at their own discretion for the adult or child victims of IPV and for children witnessing IPV. The social worker collects data on victims, perpetrators of IPV, and child witnesses or victims at all police calls for IPV. Comparisons were made by using chi-square, relative risks (RRs), and 95% confidence intervals (95% CI)., Results: Police and advocates visited 2,038 homes for IPV calls; 2,617 children were in these homes. Of these children, 1,904 (76%) witnessed IPV, and 698 (27%) were victims themselves. Adult victims (31%) and perpetrators (41%) had high rates of having witnessed IPV when they were children. Perpetrators were more likely than victims to have witnessed IPV as a child (RR, 1.56; 95% CI = 1.37 to 1.78) and to have been a victim of IPV as a child (RR, 1.71; 95% CI = 1.49 to 1.96)., Conclusions: In this study population, 76% of IPV households include children, and one third of these children also are victims of IPV. Perpetrators often were victims and witnesses of IPV when they were children. This suggests that a history of childhood IPV is common for perpetrators of IPV. Development of and research on interventions for child witnesses or victims of IPV is needed.