“Vulnerable” populations, including people on Medicare or Medicaid, the elderly and those with psychiatric or psychological problems, are among those most likely to call an ambulance for transport to emergency departments for non-urgent reasons. Use of ambulances for non-emergencies by this group also spiked after 11 p.m., “presumably at a time when patients in vulnerable populations have less access to public transit or friends and family with private vehicles,” say researchers from the University of California, San Francisco, and colleagues.
Researchers examined records on more than 16,000 adults seen in EDs between 1997 and 2008 for non-urgent reasons. Of those, about 1,140 came by ambulance. Compared to those who walked in, people who came by ambulance tended to be older, and were more likely to have public insurance, to arrive late at night, to be homeless, to be diagnosed with a psychiatric problem or with a psychiatric problem as a chief complaint, or to have toxicologic/poisoning as a chief complaint.
Researchers conducted the study to help identify which patients could benefit from alternative modes of transport to the hospital, such as taxis or paratransit services (door-to-door transport for people with disabilities who have trouble accessing regular public transit). The study is in the July–September issue of Prehospital Emergency Care.
Beware of Dehydration During Fire Service Training
Even before they start their training exercises, “an alarmingly high percentage of firefighters arrive at training in a significantly or seriously dehydrated state,” putting them at even higher risk for heat injuries, according to a new study published in the July–September issue of Prehospital Emergency Care.
Researchers from the University of Illinois Fire Service Institute and colleagues measured the hydration status of 35 firefighters before a three-hour training. About 14 percent were “minimally” dehydrated, 46 percent were “significantly” dehydrated and 32 percent were “seriously” dehydrated based on urine specific gravity, which measures chemicals in the urine. Only 9 percent were well hydrated. An analysis of urine color, another way to gauge hydration, also showed that a significant number were not well hydrated.
Even during cooler months, firefighters lose nearly 1.4 percent of their body mass during a three-hour training, the study reports. What’s worrisome is that these losses are on top of their already fluid-depleted state. To ward off dehydration-related heat injuries, researchers recommend the following:
- Encourage firefighters to hydrate properly prior to starting training.
- Have training officers request a urine sample if dehydration is suspected. “One may consider a urine specific gravity of 1.020 or a urine color less than or equal to 4 as the upper range allowable level to begin firefighter training,” the researchers write.
- Use guidelines developed for athletes and the military as a starting point to develop firefighter-specific dehydration guidelines.
Progress Report on Regional STEMI Systems
Regional systems to treat STEMI (ST-segment elevation myocardial infarction) enable patients with the deadliest type of heart attack to get treated and transferred quickly to a hospital that can perform percutaneous coronary intervention (PCI) to clear the blockage, thus increasing the chances of survival. A new nationwide survey from the American Heart Association of 381 STEMI systems, involving nearly 900 hospitals, examines some of the characteristics of those systems, defined as an integrated group that includes at least one hospital that performs PCI and at least one EMS agency.
The survey found:
- 67 percent of STEMI systems are in urban areas, and most follow standard procedures and policies.
- 97 percent admit STEMI patients even when a hospital bed is not readily available.
- About 92 percent require a single phone call to activate the catheterization lab for PCI.
- 87 percent allow ED doctors to activate the cath lab without consulting a cardiologist and allow the lab to be activated without a cardiology consultation before the patient arrives at the hospital.
- 84 percent participate in a data collection registry that reports time intervals such as door-to-balloon or door-to-needle, door-in to door-out for transferred patients.
The study appeared online May 22 in the journal Circulation: Cardiovascular Quality and Outcomes.
AEDs Too Far From Most Cardiac Arrests to Help
More than 75 percent of people who experience sudden cardiac arrest in public are more than a two-minute walk from the nearest AED. Since the chances of survival drop by about 10 percent with each minute that passes without CPR and defibrillation, researchers say this may be one reason SCA survival rates remain below 10 percent in most regions of the U.S.
Researchers from the University of Pennsylvania’s Perelman School of Medicine mapped the location of nearly 3,500 out-of-hospital SCAs, along with the locations of about 2,300 AEDs, many of which were found by members of the public who participated in a contest run by the Penn researchers to identify all of the city’s public-access AEDs. [See Quick Look on page 1 for more on this.] About 30 percent of the AEDs were found in schools and on university campuses, 22 percent were in office buildings, and 4 percent were in residential buildings.
Yet only 7 percent of SCAs occurred within a 200-foot radius of an AED (about a two-minute walk, roundtrip). Ten percent occurred within 400 feet (a four-minute walk), and 21 percent happened within 600 feet (a six-minute walk). “AEDs are an essential part of the chain of survival that’s necessary to save cardiac arrest victims,” says senior author Raina Merchant, M.D., M.S., an assistant professor of emergency medicine, who presented the findings in May at a Society for Academic Emergency Medicine meeting in Chicago. “Despite thousands of them in the community, our results show they are usually not readily available during cardiac arrests.”
