Stroke victims receive clot-busting medications more quickly when EMS notifies hospitals that such patients are on the way, but advance notification doesn’t happen in one-third of cases.
UCLA researchers and colleagues examined 372,000 cases of ischemic stroke that occurred between 2003 and 2011. The patients were taken by EMS to one of nearly 1,600 hospitals participating in the American Heart Association/American Stroke Association’s “Get With the Guidelines—Stroke” quality improvement program.
Hospitals were given advance notice in 67 percent of cases in 2011, up from 58 percent in 2003, according to the study, which was published online July 10 in Circulation: Cardiovascular Quality & Outcomes.
A second study by the same researchers in the Journal of the American Heart Association found that rates of hospital prenotification vary widely, ranging from 93 percent in Montana to 20 percent in the District of Columbia, and from 0 percent at some hospitals to 100 percent at others. “These results support the need for initiatives targeted at increasing EMS prenotification rates as a mechanism for improving quality of care and outcomes in stroke,” the researchers write.
Distance From Trauma Center Predicts Likelihood of Dying at Scene
The farther from a Level 1 or 2 trauma center that a crash occurs, the more likely victims will be coded as having died on scene, according to a NHTSA study released in March. Researchers analyzed national crash data from 2009 in the Fatality Analysis Reporting System.
Victims of crashes that occurred within a 45- to 60-minute “response time coverage area” of a trauma center were 13 percent more likely to be coded as “died at scene” than drivers who were 45 minutes or less from a trauma center; victims who were an hour or more from a trauma center were 23 percent more likely to die at the scene. Drivers who had a high blood alcohol concentration, who were ejected from the vehicle, whose vehicle rolled over, who crashed at night, or who crashed in areas where the speed limit was 55 mph or above were also more likely to die at the scene.
“The study reinforces the need to provide effective medical response and care in outlying areas,” the researchers report.
BLS Providers Use CPAP Properly
BLS-trained EMS providers know how and when to use a continuous positive airway pressure (CPAP) device as well as ALS providers, a Canadian study finds.
Researchers from Sunnybrook Centre for Prehospital Medicine in Toronto analyzed 300 consecutive cases in which CPAP was used by EMS in two regions of Ontario. Researchers wanted to know if providers with BLS training—who are not trained to intubate—could use CPAP properly. Researchers found no significant difference in the ability of BLS-trained providers to use CPAP safely and properly compared to ALS-trained providers.
The study was published online June 11 in Prehospital Emergency Care.
Paramedics Struggle to Recognize Atypical Anaphylaxis
A survey of 3,500 paramedics found nearly all could recognize the signs of classic anaphylaxis, but only 3 percent identified an atypical presentation of the potentially fatal allergic reaction.
Researchers from the University of Missouri–Kansas City School of Medicine and colleagues got the idea for the survey after treating a patient who had a sudden onset of gastrointestinal complaints, including vomiting, diarrhea, abdominal pain, severe low blood pressure and loss of consciousness. The patient didn’t have more typical signs of anaphylaxis such as itching, hives or swelling, and prehospital providers didn’t recognize the symptoms as anaphylaxis.
In the survey, providers were asked how they would treat various scenarios that had nothing to do with anaphylaxis. The purpose was to blind them to the intent of the survey.
Nearly all respondents (98 percent) said they were “confident” in their ability to recognize anaphylaxis, yet even in a classic anaphylaxis scenario, only 46 percent correctly identified epinephrine as the initial medication of choice; 40 percent incorrectly chose diphenhydramine. Given an atypical anaphylaxis scenario, many paramedics misidentified it as an aortic aneurysm, appendicitis or food poisoning.
EMS providers were also confused about how and where to administer epinephrine. Fifty-eight percent chose the subcutaneous route; 61 percent chose the deltoid, “despite years of expert consensus showing that delivering epinephrine intramuscularly given in the thigh is the preferred method of epinephrine delivery,” the researchers write. Only about 40 percent of respondents carried epinephrine autoinjectors in their vehicles. The study was published online June 19 in Prehospital Emergency Care.
Racial Disparities in CPR, Defibrillation
Black cardiac arrest victims are less likely than whites to receive bystander CPR or shocks from an AED by a bystander or professional responder, research shows.
Researchers from the University of Pennsylvania Perelman School of Medicine analyzed 4,900 out-of-hospital cardiac arrests in Philadelphia between 2008 and 2012. About 34 percent of white patients were shocked by an AED, compared with 27 percent of blacks; bystanders performed CPR on 7.5 percent of whites, compared with 5.6 percent of blacks. Blacks were also less likely than whites to have regained a pulse before arrival at the hospital (14.7 percent vs. 17.1 percent).
The study was presented at a Society for Academic Emergency Medicine meeting held in Chicago in May.
In a separate study, researchers found that fewer patients who suffered cardiac arrest at night (between 8 p.m. and 8 a.m.) regained a pulse before hospital arrival. They were also less likely to receive bystander CPR and took longer to be transported to the hospital. Location of the victims at the time of the arrest (at home vs. in public) may explain the differences, researchers report.
