Search

Introduction: There is a minimal amount of published data regarding to Emergency Medical Services (EMS) fellowship programs. The purpose of this study was to obtain program characteristics and diversity data regarding EMS fellowship programs. Methods: A survey was sent to program directors at all EMS fellowship programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). Data collected included: year program started, year program accredited, unfilled fellow positions, number of EMS faculty, gender, and race/ethnicity. Gender and race/ethnicity data from EMS fellowships were compared to emergency medicine (EM) residencies using data from the American Association of Medical Colleges. Data were analyzed using IBM SPSS with descriptive statistics, and Chi-square tests. Results: The response rate for the survey was 88% (45/51) of all EMS fellowship programs that were accredited at the time of this survey. Most programs (71%) offer a one-year EMS fellowship, with the remaining offering an optional second year. The median number of physician response vehicles per program was 1.0 (IQR 0.0–2.0), with 24% (11/45) not having a dedicated physician response vehicle. This survey identified that 118 EMS fellows have graduated since inception of the accreditation process, while 34 positions went unfilled. The median number of EMS fellow positions per program was 2.0 (IQR 1.0–2.0), with a range of 1 to 4. It was noted that 31% of programs had no female EMS faculty, and 48% of programs had no under-represented minority EMS faculty. There was a significantly larger proportion of female faculty in EM residency programs (30.5%; 949/3,107) compared to EMS fellowships (19%; 53/274), OR = 1.8, 95% CI:1.3–2.5, p < 0.0001. There was a significantly larger proportion of female fellows in EMS (56%; 66/118) vs. female residents in EM (38%; 2,193/5,777), OR" = 2.1, 95% CI:1.4–3.0, p < 0.0001. There was a significantly larger proportion of under-represented minority faculty in EM residency programs (19.7%; 786/3,978) vs. EMS fellowships (12.0%, 33/274), OR = 1.8, 95% CI:1.2–2.6, p < 0.002. Conclusion: A significant number of EMS fellowship positions have remained unfilled since implementation of an accreditation process for EMS fellowships. The percentage of females and under-represented minority faculty in EMS programs was much lower than for EM residency programs. [ABSTRACT FROM AUTHOR]

Objectives: Previous investigations comparing intraosseous (IO) and intravenous (IV) epinephrine delivery in out-of-hospital cardiac arrest (OHCA) suggest that epinephrine is oftentimes more expeditiously administered via the IO route, but this temporal benefit doesn't always translate to clinical benefit. However, very few studies adequately controlled for indication and resuscitation time biases, making the influence of first epinephrine route on OHCA outcomes unclear. To determine the association between first epinephrine route and return of spontaneous circulation (ROSC) while controlling for resuscitation time bias and other potential confounders., Methods: We conducted a retrospective analysis using the 2020 ESO Data Collaborative dataset. Adult patients with a witnessed, non-traumatic OHCA prior to EMS arrival were included. Logistic regression was used to determine the association between medication route and ROSC. Linear regression was then used to calculate the probability of ROSC for each route across all call receipt-to-drug delivery intervals. Using these linear equations, the call receipt-to-drug delivery intervals were calculated that would yield equivalent probabilities of ROSC between the IV and IO routes., Results: Data were available for 10,350 patients, of which 27.4% presented with a shockable rhythm, 29.7% received bystander CPR, and 39.6% experienced ROSC. After controlling for confounders, IO epinephrine was associated with decreased likelihood of ROSC (OR = 0.77, p  < 0.001). The linear regression models provided differing slope coefficients for ROSC between each route, with the IV route associated with a higher likelihood of ROSC for any given call receipt-to-drug-delivery interval. From these equations, the additional time allowed to establish an IV and administer epinephrine intravenously beyond the time required for IO delivery, yet with an equivalent predicted probability of ROSC via the IO route, was calculated. This additional time interval for intravenous administration declined linearly from 9 min at a call receipt-to-intraosseous epinephrine interval of 4 min to no additional time at a call receipt-to-intraosseous epinephrine interval of 29 min., Conclusions: This retrospective analysis of a national EMS database revealed that IO epinephrine was negatively associated with ROSC. Additionally, there appears to be a finite time window during which intravenous epinephrine remains superior to the intraosseous route even if there are brief initial delays in IV drug delivery.