Biomedical subjects

D W Spaite

Publications and source records attributed to D W Spaite.

51 records · Page 3Linked to original sources

PubMed1990

Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool.

OBJECTIVE: To determine the completeness of data entry by paramedics after an extensive modification of the prehospital first-care form in an urban emergency medical services (EMS) system. DESIGN: Comprehensive medical information was added to the EMS data collection tool used by a metropolitan fire department. We evaluated the frequency of failure to enter data pertaining to medical assessment and/or treatment of victims of cardiac arrest after implementation of the system. RESULTS: Failure to enter data in the first month was compared with two subsequent two-month blocks. A high rate of noncompliance existed in the first month (all medical data were missing in 24.6%). However, the subsequent two months revealed a marked decline in noncompliance (4.4%, P less than .001). This decline was maintained after a three-month interim (5.0%, P less than .001). CONCLUSION: Data entry noncompliance can be a significant problem after implementation of a new prehospital data collection system. However, compliance can be markedly improved over a relatively short period. Because EMS system evaluation is based on data collected in the field. EMS researchers and administrators must be aware of the data entry compliance rate in their system when attempting to make conclusions from such information.

Adolescent↗

PubMed1990

Geriatric injury: an analysis of prehospital demographics, mechanisms, and patterns.

STUDY OBJECTIVE: To evaluate emergency medical services (EMS) system use, injury mechanisms, and prehospital assessments among elderly victims of trauma. DESIGN: We analyzed all prehospital data for injuries among patients 70 years old or older for whom 911 EMS dispatch was requested in a medium-sized metropolitan area during a 12-month period. RESULTS: A total of 1,154 cases occurred (women, 65.1%), which represented 30.3% of all 911 dispatches involving elderly patients. Injury mechanisms were fall (60.7%), motor vehicle accident (MVA; 21.5%), fight (2.4%), accidental poisoning (2.3%), and choking (2.1%). Persons in their 90s had a lower frequency of MVAs (3.4%) than did younger patients (23.0%) (P less than .005). The most frequent injuries determined by prehospital assessment were head or face (25.1%), upper extremity (17.2%), hip (14.5%), lower extremity (13.8%), back (9.8%), and chest or abdomen (5.0%). The frequency of serious neurologic injuries was less for falls or MVAs than for other mechanisms (P less than .005). Suspected hip (P less than .001) and pelvic (P less than .005) injuries occurred more frequently during falls than during other mechanisms of injury, whereas back injuries occurred most frequently in MVAs (P less than .001). Seventy-one fall victims (10.1%) had suspected medical causes of their fall. Twelve patients (1.0%) were in cardiac arrest. CONCLUSION: We report injury patterns and mechanisms among elderly victims of trauma presenting to an EMS system. A knowledge of these patterns will be useful to emergency physicians and EMS administrators.

Accidents↗

PubMed1990

Banning alcohol in a major college stadium: impact on the incidence and patterns of injury and illness.

To evaluate the effect of banning alcohol on the incidence of injuries and illness among spectators, we reviewed 4 years (1983 to 1986) of medical incident reports from a major collegiate football stadium. At no time had alcoholic beverages been sold inside the stadium, but before 1985, fans were allowed to bring alcohol into the stadium. In 1985, this practice was banned. During the study period, 340 medical incidents (M = 12.6/game) were reported. Several alterations of specific injury/illness patterns were noted after initiation of the ban: heat-related illness occurred more frequently before initiation of the ban, whereas extremity injuries and syncope (fainting from coronary insufficiency) occurred with greater frequency afterwards. The injury/illness rates per 10,000 fans were 2.95 in 1983, 2.45 in 1984, 1.92 in 1985, and 3.48 in 1986. There was no significant change in the overall incident rate after the ban. Evaluation of medical incidents revealed an alteration in specific injury/illness patterns but no change in overall incidence after institution of the ban. Future investigations are needed to elucidate more clearly the impact of banning alcohol on injury/illness rates and patterns at mass gatherings.

Adolescent↗

PubMed1989

Thermal stability of prehospital medications.

To evaluate the effect of prolonged environmental extremes on common prehospital medications, four identical sets of 23 drugs were placed in a simulated environment for up to four weeks. Subsequently, the samples were analyzed by gas chromatography-mass spectrometry for evidence of degradation byproducts. Twenty-one of the 23 samples showed no breakdown products; however, isoproterenol demonstrated 11% loss of parent compound after four weeks of environmental exposure. Epinephrine manifested a change in its ionized state after exposure to heat; the physiologic effect of this change was not determined. Our results suggest that rural and suburban emergency medical services providers, whose medications may not be replaced until they are used in patient care, must monitor their drug boxes' duration of exposure to uncontrolled conditions.

Arizona↗

PubMed1989

Evaluation of EMS management training offered during emergency medicine residency training.

Physician involvement in the provision of both direct and indirect medical control to emergency medical providers is critical to the effective operation of an emergency medical services (EMS) system. We conducted a survey of all accredited emergency medicine residency programs in the United States to determine the content of EMS instruction provided to these physicians-in-training. The majority of programs provide an introduction to direct medical control, to EMS organizational structure, and the opportunity to participate in EMS-related research. Less than 65%, however, provide formal instruction in EMS risk management or quality assurance or the opportunity to observe policy-making bodies related to EMS. The importance placed on EMS during residency training is variable. EMS is the domain of emergency medicine, and adequate training of residents for these responsibilities is imperative.

Curriculum↗

PubMed1989

Implementation of a computerized management information system in an urban fire department.

An important aspect in the effective management of an emergency medical services system is the ability to monitor system performance. To provide this information on a timely basis, a comprehensive data collection system is required. We describe the design, implementation, use, and effect of a comprehensive, computerized data retrieval system within an urban fire department. Building on a data collection system already in place, it was possible to minimize the cost and accelerate the training process. A comparison is included between the different type of systems available for use with prehospital providers. Use of prehospital data collection systems results in more in-depth understanding of system operations and the status of prehospital medical care provided to the community.

Data Collection↗

PubMed1988

A new model for providing prehospital medical care in large stadiums.

To determine proper priorities for the provision of health care in large stadiums, we studied the medical incident patterns occurring in a major college facility and combined this with previously reported information from four other large stadiums. Medical incidents were an uncommon occurrence (1.20 to 5.23 per 10,000 people) with true medical emergencies being even more unusual (0.09 to 0.31 per 10,000 people). Cardiac arrest was rare (0.01 to 0.04 events per 10,000 people). However, the rates of successful resuscitation in three studies were 85% or higher. The previous studies were descriptive in nature and failed to provide specific recommendations for medical aid system configuration or response times. A model is proposed to provide rapid response of advanced life support care to victims of cardiac arrest. We believe that the use of this model in large stadiums throughout the United States could save as many as 100 lives during each football season.

Adolescent↗

PubMedDate not supplied

Psychiatric presentation of medical illness.

A 37-year-old woman was seen in the emergency department for symptoms of depression. A careful mental status examination resulted in the discovery of an organic basis for the "psychiatric" presentation. As with any patient demonstrating behavioral abnormalities, this case illustrates the importance of an adequate history, physical, and mental status evaluation in ruling out organic etiology prior to labeling a patient's complaints as functional. Medical illnesses that can present as apparent psychiatric disease and the clinical clues that lead to the diagnosis of such cases are discussed.

Adult↗

PubMedDate not supplied

Allocation of time in three academic specialties.

A survey was done to: 1) characterize the allocation and distribution of time by tenure track emergency physicians, and 2) compare the time distribution of emergency physicians to two other academic disciplines. All emergency medicine residency programs were surveyed by telephone to determine if faculty were eligible for tenure and if tenure was available, how many hours per week were spent on clinical duties, research, and administrative tasks. Similar information was compiled from cardiology and orthopedic surgery faculty at the same universities. Data from the survey revealed that a tenure track assistant professor spends 23 hours (46%) working clinical shifts in the emergency department; 11 hours (20%) doing research and 18 hours (34%) in administrative tasks. In contrast, cardiologists spend significantly more time in clinical duties (32 hours) and research (18 hours). However, cardiologists spend significantly less time in administrative duties (10 hours). Data for orthopedic surgeons show a similar pattern. Distributions within each academic discipline were also analyzed and a significant difference in research time was found between four tenure track emergency medicine programs and the other eighteen. Data from this survey may help academic emergency physicians evaluate how they are allocating their time in comparison to other busy clinical specialties.

Cardiology↗

PubMedDate not supplied

Emergency medical services assessment and treatment of children with special health care needs before and after specialized paramedic training.

INTRODUCTION: This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management. METHODS: Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program. RESULTS: Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items. CONCLUSION: Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.

Arizona↗

PubMedDate not supplied

Physician in-field observation of prehospital advanced life support personnel: a statewide evaluation.

STUDY HYPOTHESIS: Direct physician observation of advanced life support (ALS) personnel is rare in a demographically diverse state. STUDY POPULATION: Twenty ALS agencies from throughout Arizona. METHODS: A board-certified emergency physician performed on-site interviews with the emergency medical services (EMS) supervisor of each agency to approximate the number of days per year that physicians observe ALS personnel in the field. RESULTS: Only 11 agencies (55%) reported that physicians ever observed ALS personnel. Among all agencies, an estimated total of 84 observer-days occurred per year. The agencies staffed a total of 86 ALS units, resulting in an estimated 0.98 observer-days/unit/year (84/86). On the average, it took 3.4 ALS personnel to staff a given unit over time and the probability that an ALS provider would be on a unit on any given day was 0.29 (1/3.4). The probability of a given provider being observed during one year was approximately 0.29 (0.98 x 0.29). Thus, on the average, an ALS provider would be observed by a physician approximately once every 3.5 years (1/0.29). Among urban agencies, the "average" ALS provider would be observed once every 2.9 years. This compared to a likelihood of in-field observation of only once every 6.7 years for non-urban providers (p = .036). CONCLUSIONS: The skills of ALS providers in Arizona are observed by a physician in the field very infrequently. Although an uncommon occurrence in urban agencies, observation of non-urban ALS personnel occurs even less frequently. In addition, nearly one-half of the agencies surveyed never had a physician-observer. Although a variety of skills evaluation methods exist, it remains unclear whether any method is as useful as direct observation. Future investigations are needed to evaluate whether in-field physician observation impacts skills, patient care, or outcome in EMS systems.

Arizona↗

PubMedDate not supplied

Training paramedics: emergency care for children with special health care needs.

OBJECTIVE: To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics. METHODS: A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department. RESULTS: Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics. CONCLUSION: Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs.

Child↗

PubMedDate not supplied

Use of emergency medical services by children with special health care needs.

OBJECTIVE: This study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period. METHODS: A prospective surveillance system was established to identify EMS responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness. Responses related to the special health care needs of the child were compared with unrelated responses. RESULTS: During a one-year period, 924 responses were identified. Fewer than half of the responses were related to the child's special health care need. Younger children were significantly more likely to have a response related to their special needs than older children. Among related responses, seizure disorder was the most common diagnosis, while asthma was more common for unrelated responses. Almost 58% of the responses resulted in transport of the child to a hospital. CONCLUSIONS: Emergency medical services responses related to a child's special health care needs differ from unrelated responses. The most common special health care needs of children did not require treatment beyond the prehospital care provider's usual standard of care. These results are relevant for communities providing EMS services for CSHCN.

Adolescent↗

PubMedDate not supplied

EMS Agenda for the Future: where we are...where we want to be.

During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the EMS Agenda for the Future. Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are integration of health services, EMS research, legislation and regulation, system finance, human resources, medical direction, education systems, public education, prevention, public access, communication systems, clinical care, information systems, and evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.

Delivery of Health Care, Integrated↗

PubMedDate not supplied

Development of an electronic emergency medical services patient care record.

OBJECTIVE: The need for valid and reliable emergency medical services (EMS) data has long been recognized. EMS data are useful for monitoring resources and operations, documenting patient care and outcome, and evaluating injury prevention strategies. The goal of this project was to develop a computerized data set with the capability to generate a patient care record (PCR) to overcome some of the current EMS data limitations. METHODS: The authors discuss developing an electronic PCR and analysis data set containing 233 variables. Data are collected for the following: incident, response, scene, patient, history, primary survey (including vital signs), physical examination, physiologic scores, diagnostics, plan (medications and procedures), assessment, and reevaluation. Software on a portable computer installed in an EMS response unit utilizes a graphical user interface for data collection by prehospital emergency care providers. A data set stores codes corresponding to user's selections. This data set supports data storage and analysis. The electronic PCR and data set can be useful to EMS agencies for collecting, storing, reporting, and analyzing information. RESULTS: Variables are categorized into 12 main categories to categorize the variables and to drive data collection. The system provides the user with the ability to print out a record (using a portable printer installed in an ambulance) and analyze data stored in the data set. CONCLUSION: This computerized approach overcomes many limitations inherent with using paper-based systems for research. Linked with emergency department, hospital discharge, and mortality data, EMS data can be used in systems analyses related to patient outcome.

Arizona↗