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Biomedical subjects

N Clay Mann

Publications and source records attributed to N Clay Mann.

24 records · Page 2Linked to original sources
PubMedDate not supplied

Defining research criteria to characterize medical necessity in emergency medical services: a consensus among experts at the Neely Conference.

OBJECTIVE: Researchers interested in ensuring appropriate use of emergency medical services (EMS) resources have attempted to define safe and effective protocols for triage either at the time of dispatch or after on-scene evaluation. Published work in this area is difficult to evaluate because protocols and outcome criteria vary from study to study. The goal of the Neely Conference was to bring together EMS experts to define a set of criteria to be used in research studies evaluating dispatch triage and field triage systems. METHODS: Thirty-one experts in EMS systems and research attended a day-long workshop to assess the current literature regarding dispatch triage and field triage, and make recommendations to standardize methods used to evaluate future triage protocols. Participants were surveyed during the workshop; consensus analysis techniques were used to determine if a formal consensus was reached. A Bayesian posterior probability of 0.99 was required to consider responses a "consensus." RESULTS: Participants considered current evidence regarding the usefulness of EMS triage criteria to be "weak." However, respondents agreed on a set of research criteria that could define the need for an EMS response and/or EMS transport. Field triage criteria were considered more plausible than dispatch criteria. Valid outcome criteria for assessing the effectiveness of triage protocols included ED assessment and the need for immediate surgery. Hospital admission, final diagnosis, and expert opinion were not considered adequate outcome measures. CONCLUSION: EMS experts agreed on a standard set of triage criteria and outcome measures for evaluating triage protocols supporting alternative forms of transport and care.

Ambulances↗
PubMedDate not supplied

Public health preparedness for mass-casualty events: a 2002 state-by-state assessment.

INTRODUCTION: The ongoing threat of a terrorist attack places public agencies under increasing pressure to ensure readiness in the event of a disaster. Yet, little published information exists regarding the current state of readiness, which would allow local and regional organizations to develop disaster preparedness plans that would function seamlessly across service areas. The objective of this study is to characterize state-level disaster readiness soon after September 2001 and correlate readiness with existing programs providing an organized response to medical emergencies. METHODS: During the first quarter of 2002, a cross-sectional survey assessing five components of disaster readiness was administered in all 50 states. The five components of disaster readiness included: (1) statewide disaster planning; (2) coordination; (3) training; (4) resource capacity; and (5) preparedness for biological/chemical terrorism. RESULTS: Most states reported the presence of a statewide disaster plan (94%), but few are tested by activation (48%), and still fewer contain a bioterrorism component (38%). All states have designated disaster operations centers (100%), but few states have an operating communications system linking health and medical resources (36%). Approximately half of states offer disaster training to medical professionals; about 10% of states require the training. Between 22-48% of states have various contingency plans to treat victims when service capacity is exceeded. Biochemical protective equipment for health professionals is lacking in all but one state, and only 10% of states indicate that all hospitals have decontamination capabilities. States with a functioning statewide trauma system were significantly more likely to possess key attributes of a functioning disaster readiness plan. CONCLUSION: These findings suggest that disaster plans are prevalent among states. However, key programs and policies were noticeably absent. Communication systems remain fragmented and adequate training programs and protective equipment for health personnel are markedly lacking. Statewide trauma systems may provide a framework upon which to build future medical disaster readiness capacity.

Bioterrorism↗
PubMedDate not supplied

Evaluating state capacity to collect and analyze emergency medical services data.

BACKGROUND: Centralized emergency medical services (EMS) data collection is critical to evaluating EMS system effectiveness, yet a general lack of EMS data persists at local, state, and national levels. OBJECTIVE: To assess state capacity to collect, analyze, and utilize EMS data. METHODS: Information was gathered through state site visits and surveys from 54 states and U.S. territories in spring 2003 regarding EMS data-collection systems. Survey results were used to create 11 broad indicators that assess state data system infrastructure, collection methods, compliance with data standards, and data uses. RESULTS: States and territories on average met 59% of the EMS data system indicators, with four states meeting all 11 indicators and two states meeting none. Seventy-six percent of the states reported having state-level EMS data-collection systems, and 78% reported having authority to collect EMS data. However, most state EMS data sets were not capturing information on all EMS incidents, and only 46% of the states had data dictionaries containing at least three-fourths of nationally recommended EMS data elements. In addition, only 33% of the states had linked EMS data with other health data sets to analyze EMS system operations and patient outcomes. CONCLUSION: While EMS data systems exist in the majority of states, continued attention and resources are needed for state-level EMS data system development to improve capacity for evaluation of emergency medical services.

Data Collection↗
PubMedDate not supplied

Validation of a predictive model for automated external defibrillator placement in rural America.

OBJECTIVE: The development of Automated External Defibrillators (AEDs) to treat out-of-hospital cardiac arrest (OOHCA) has greatly expanded the availability of life saving defibrillatory shocks in various settings. However, placement of AEDs in rural areas remains perplexing since OOHCAs are rare and unpredictable. We set out to develop a cost-effective rural AED placement model and to test the validity of the resulting model using OOHCAs attended by EMS. METHODS DESIGN: A population-based cross-sectional study. Analytic Plan: An exhaustive literature search was conducted to identify community attributes correlated with successful placement of AEDs in rural regions. Identified attributes were characterized using U.S. Census and CDC heart disease mortality data to estimate the potential risk for AED use and applied this estimate to rural census tracts in all 50 states. Based upon risk, AEDS were assigned to each tract using a first responder model and cost effectiveness was assessed. Using Utah State EMS data, the predicted placement of AEDs in each tract was validated using the actual number of OOHCAs attended by EMS. RESULTS: A total of 14,586 rural census tracts in 50 U.S. states were evaluated. On average, 2,600 AEDs were situated within each state. AED placement in rural areas proved as cost effective as health screening programs. In Utah, predicted AED placement correlated with the frequency of OOHCAs attended by EMS personnel (rho= 0.55, p < 0.001). CONCLUSIONS: The resulting model illustrates one potential way to determine the most beneficial location for rural AED placement.

Adult↗
PubMedDate not supplied

The use of national highway traffic safety administration uniform prehospital data elements in state emergency medical services data collection systems.

OBJECTIVE: Although the concept of emergency medical services (EMS) has existed for 30 years, there is little scientific evidence validating its impact on morbidity and mortality. A significant barrier to conducting meaningful assessments relates to the lack of reliable and uniform EMS data. The objective of this study was to determine the extent to which states incorporate the Uniform Prehospital EMS Data Elements into statewide EMS data collection systems. METHODS: Study investigators requested and compared data elements from all states with a statewide prehospital data collection system. RESULTS: During the study period, 43 states with statewide EMS data collection systems captured, on average, 79% of the Uniform Prehospital EMS Data Set. Variables considered essential to EMS evaluation were more likely collected (84%) than variables considered desirable (72%). Only eight (10%) of the 81 uniform data elements are collected by all 43 participating states. CONCLUSIONS: Findings suggest that related EMS data variables are collected by the majority of states across the country. This degree of similarity provides a foundation for establishing common fields that can be used to develop a national EMS registry.

Accidents, Traffic↗