Search PubMed⌕ Search

Biomedical subjects

J J Clawson

Publications and source records attributed to J J Clawson.

14 recordsLinked to original sources
PubMed1998

Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center.

STUDY OBJECTIVE: Modern emergency medical dispatch provides appropriate resource responses with the use of an emergency medical dispatch priority reference system (EMDPRS). The EMDPRS is a systematic protocol for all aspects of the dispatch process, including interrogating the caller, matching responses with severity, and providing pre-arrival care. We tested the hypothesis that appropriate performance feedback would increase dispatcher compliance with the protocol. METHODS: We examined how emergency medical dispatchers complied with the protocols contained in the Advanced Medical Priority Dispatch System, a commercially available EMDPRS. Six key areas and overall compliance were studied. Dispatchers performed for 2 months without feedback and for a further 2 months with performance feedback. We used statistical methods to compare the dispatchers' compliance with the protocols each month. RESULTS: The mean overall compliance score improved from 76.4%+/-10.2% (mean+/-SD) in the absence of performance feedback to 96.2%+/-4.0% (n=217; P <.001) when performance feedback was provided. Five of 6 key areas showed similar improvements. CONCLUSION: Providing emergency medical dispatchers with regular and objective feedback regarding their performance dramatically improves how rigorously they follow a systematized dispatch protocol.

Emergency Medical Service Communication Systems↗
PubMed1990

Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction.

To assess the impact of a field-transmitted electrocardiogram (ECG) on patients with possible acute myocardial infarction, randomized and open trials were performed with a portable electrocardiographic system coupled with a cellular phone programmed to automatically transmit ECGs to the base hospital. Consecutive patients served by the 6 units of the Salt Lake City Emergency Rescue System were studied; 71 patients were randomized to in-field ECG (n = 34) versus no ECG (n = 37). Time on scene was 16.4 +/- 9.7 minutes for the ECG group versus 16.1 +/- 7.0 minutes for the non ECG group (difference not significant). Time of transport averaged 18.2 +/- 9.9 and 17.6 +/- 13.1 minutes, respectively (difference not significant). Six of 34 patients with in-field ECG showed acute myocardial infarction, qualified for and received thrombolytic therapy at 48 +/- 12 minutes after hospital arrival (range 30 to 60) compared with 103 +/- 44 minutes (p less than 0.01) for 51 historical control patients and 68 +/- 29 minutes for 6 concurrent control patients without in-field ECG. Thus, in-field ECG causes negligible delays in paramedic time, leads to significant decreases in time to in-hospital thrombolysis and may make in-field therapy feasible. In-field ECG may be an important addition to reperfusion strategies.

Allied Health Personnel↗
PubMed1990

Dispatch life support: establishing standards that work.

The consistency of care brought about by the AHA standards created order from the chaos that previously existed in the areas of BLS, CPR, and ACLS. But significant difficulties arise when they are applied directly to pre-arrival instructions given by EMSs.

American Heart Association↗
PubMed1989

Prehospital use of intraosseous infusion by paramedics.

Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. Patients enrolled were less than five years of age and in cardiac arrest. During a 10-month period, paramedics attempted 12 IO placements, of which 10 (85%) were successful, nine on the first attempt. Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.

Adolescent↗
PubMed1986

Prevalence of antibody to hepatitis B virus surface antigen in emergency medical personnel in Salt Lake City, Utah.

Because of the potential geographic variation in prevalence and exposure to hepatitis B virus and the high cost of hepatitis B immunization, we performed serologic screening on prehospital care personnel in Salt Lake City, Utah. All individuals screened had been in a line (street) position for at least five years. Their average age was 38.5 years. One of the 50 paramedics and none of 110 emergency medical technicians had serum antibody to hepatitis B surface antigen (0.6%; 95% confidence limits, 0.03 to 3.53%). Because the estimated annual incidence based on the observed prevalence is less than 1%, we conclude that exposure to hepatitis B virus is not a major occupational hazard for these employees in our area.

Adult↗
PubMedDate not supplied

The emotional content and cooperation score in emergency medical dispatching.

BACKGROUND: A common belief regarding scripted-protocol-driven emergency medical dispatch is that the caller is "too hysterical" or "too uncooperative" to allow a structured interrogation or to receive and act upon dispatch life support instructions. OBJECTIVES: To examine the emotional content and cooperation scores (ECCSs) of callers in more than 6,000 cases from two communication centers and to investigate the relationships between ECCS and caller party, incident nature, time of day, and geographical location. METHODS: The ECCS has five levels: 5, uncontrollable, hysterical; 4, uncooperative, not listening, yelling; 3, moderately upset but cooperative; 2; anxious but cooperative; and 1, normal conversational speech. The authors tabulated the ECCS as recorded during case review for a random sample of each center's ongoing quality assurance programs. Statistical tests were used to identify the presence of relationships between ECCS and caller party, arrest/nonarrest situations, time of day, and geographical location. RESULTS: Regardless of the caller party, the type of call, the time of day, or the geographical location, the mean ECCS of emergency callers is extremely low, indicating that most emergency callers are, in fact, very calm. The average ECCS computed from more than 3,000 cases from British Columbia was 1.05; the average score from almost 3,500 cases from New York State was 1.21. CONCLUSION: While relationships between ECCS and the different parameters were noted, the differences were so small as to be of little or no use as additional information to assist with complaint triage. The low overall ECCS shows that the typical caller who requests emergency medical assistance is calm enough to be interrogated in a scripted and structured fashion, and is cooperative enough to be responsive to dispatch life support instructions.

British Columbia↗
PubMedDate not supplied

The wake-effect--emergency vehicle-related collisions.

INTRODUCTION: Emergency medical vehicle collisions (EMVCs) occurring during initial response and with patient transport have been a long-standing problem for emergency medical services (EMS) systems. Experience suggests "wake-effect" collisions occur as a result of an EMS vehicle's transit, but do not involve the emergency medical vehicle (EMV). Substantiating the existence and magnitude of wake-effect collisions may have major implications regarding the manner of EMV response. HYPOTHESIS: Paramedics will report that wake-effect collisions do occur and that they occur more frequently than do EMVCs. METHODS DESIGN: Survey analysis. PARTICIPANTS: Thirty paramedics employed by the Salt Lake City (Utah) Fire Department and 45 paramedics employed by Salt Lake County Fire Department. Geographic Area: Service area has population of 650,000 and is urban, suburban, and rural. MEASUREMENTS: The survey consisted of three open-ended questions concerning years on the job, EMVCs, and wake-effect collisions. ANALYSIS: The mean value for the number of EMVCs and wake-effect EMVCs, along with the 0.95 confidence intervals (0.95 CI) were determined. RESULTS: Seventy-three surveys were analyzed. Sixty EMVCs and 255 wake-effect collisions were reported. Overall, the mean value for the number EMVCs per respondent was 0.82 (0.60-1.05) and for wake-effect collisions 3.49 (2.42-4.55). The mean values for EMVC's for each service were 0.86 (0.50-1.38); 0.80 (0.50-11.0). For wake-effect collisions the mean values were 4.59 (2.83-6.35); and 2.76 (1.46-4.06) respectively. CONCLUSIONS: This study suggests that the wake-effect collision is real and may occur with greater frequency than do EMVCs. Significant limitations of this study are recall bias and misclassification bias. Future studies are needed to define more precisely wake-effect collision prevalence and the resulting "cost" in regards to injury and vehicle/property damage.

Accidents, Traffic↗
PubMedDate not supplied

"Medical Miranda"--improved emergency medical dispatch information from police officers.

INTRODUCTION: Medical Miranda, also called Secondary Emergency Notification of Dispatch (SEND), is a low cost, effective, and welcome addition to emergency medical dispatching systems. The benefits are recognized by emergency medical dispatchers who receive feeder calls from associated public safety agencies that have trained both their field staff and call-takers in the Medical Miranda protocol. HYPOTHESIS: The dispatchers would be more satisfied with feeder agencies that used the SEND protocol. METHODS: A survey was conducted and analyzed, taking advantage of a situation in which two agencies (one used SEND) fed calls to the same communication center. RESULTS: Dispatchers were more satisfied with the information gained from the feeder agency that used the SEND protocol and believed that the officers and dispatchers of that agency had a far better understanding of the emergency medical dispatcher's needs. CONCLUSIONS: When the emergency medical dispatcher does not talk directly with the reporting scene personnel or caller, Medical Miranda increases the usefulness of the information the dispatcher receives, helps the dispatcher better understand the reported medical emergency, and improves response appropriateness in emergency medical service (EMS) systems where responses routinely are prioritized.

Attitude of Health Personnel↗