Updated June 2015
Even in cities where trauma centers are relatively close by, patients may not always be taken to a trauma hospital according to trauma triage guidelines, finds a study published in the October–December 2012 issue of Prehospital Emergency Care.
Using the Toronto EMS field trauma triage criteria, researchers in Toronto analyzed 900 responses in which trauma patients were within 30 minutes of a trauma center and should have been taken there based on their injuries and assessment. Yet EMS transported only a little over one-half of these patients (53 percent) to a trauma center; the rest went to other hospitals.
Women, patients older than 65 and those whose injuries were caused by a fall were less likely to be taken to a trauma center. What’s more, every additional mile that responders had to drive to get to a trauma center decreased the likelihood that patients would be taken there. The findings suggest paramedics need more education about field trauma triage guidelines, researchers conclude.
Few survive cardiac arrest without prehospital return of spontaneous circulation
An analysis of data from the San Antonio Fire Department’s quality assurance/improvement program and the Cincinnati Fire Department, a participant in the CARES (Cardiac Arrest Registry to Enhance Survival) program, found that few patients survive cardiac arrest without a prehospital return of spontaneous circulation. Researchers looked at nearly 2,500 out-of-hospital resuscitation attempts from 2008 to 2010 and found an overall survival-to-hospital-discharge rate of 6.6 percent. About one-third of all patients achieved a return of spontaneous circulation (ROSC) in the field.
Survival to hospital discharge with field ROSC was 17.2 percent; without field ROSC, survival was less than 1 percent (0.69 percent). Furthermore, no asystolic patient survived to hospital discharge without field ROSC. “Transport should be reserved for patients with field ROSC or a shockable rhythm,” researchers conclude.
The study was conducted by researchers at the University of Texas Health Science Center and the University of Cincinnati and reported in the October–December 2012 issue of Prehospital Emergency Care.
San Diego frequent-user program reducing EMS transports, costs
A frequent-user intervention program offered by San Diego EMS is showing effectiveness in reducing transports and costs. Launched in 2008, the San Diego Resource Access Program (RAP) employs a full-time paramedic to do case management and referrals for frequent users to non-EMS, non-emergency department resources, such as mental health, substance abuse and social services.
The study included 51 RAP enrollees who had 10 or more EMS transports within a 12-month period. About 65 percent were male and 59 percent were homeless; approximately one-half willingly cooperated with the RAP case manager. The others received follow-up calls and referrals regardless of their attitude toward the program.
Compared to the six months prior to RAP enrollment, EMS transports declined nearly 38 percent after participants were enrolled in the program, while costs to EMS for those patients dropped from about $690,000 to $468,000. Emergency department costs also fell, with the number of ED visits dropping nearly 13 percent and charges dropping from $413,000 to $361,000. The study is in the October–December 2012 issue of Prehospital Emergency Care.
Re-arrests on way to hospital don’t bode well for survival
Cardiac arrest patients who re-arrest after a return of spontaneous circulation are more likely to die before hospital discharge, research shows.
Researchers from the University of Pittsburgh School of Medicine and colleagues analyzed nearly 11,500 out-of-hospital cardiac arrest cases from 2006 to 2008 in 10 regions in the United States and Canada that are participating in the Resuscitation Outcomes Consortium. Though only 15 percent of those who were resuscitated in the field re-arrested on the way to the hospital, it didn’t bode well for their survival: Those who re-arrested were six times more likely to die before hospital discharge. Only about 8 percent of those who re-arrested survived, compared to 33 percent of those who were resuscitated and didn’t re-arrest while in transit.
The research was presented at an American Heart Association meeting in Los Angeles in November 2012.
Videos show many elderly falls caused by incorrect weight shifting
They may be called “slip and fall” accidents, but new research shows that it’s incorrect weight shifting or getting a foot caught on a table or chair that leads to most elderly falls. Researchers analyzed videos of 130 falls that occurred in public areas of two long-term care facilities for the elderly in British Columbia. The most frequent cause of falling (41 percent) was incorrect weight shifting, leading to a center of gravity moving outside the base of support, followed by trips or stumbles (21 percent), hits or bumps (11 percent), loss of support (11 percent) and collapse (11 percent). About 25 percent of falls involved a foot getting caught on a table or chair, while slipping accounted for just 3 percent of falls.
Falls are the most frequent cause of unintentional injuries in people ages 65 and older and account for 90 percent of hip and wrist fractures and 60 percent of head injuries. The study, conducted by researchers from Simon Fraser University in Burnaby, B.C., was published Oct. 16, 2012, in the Online First edition of The Lancet.
