Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment

From Circulation:

Background—Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients.

Methods and Results—We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 Get With the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2.00; 95% confidence interval, 1.93–2.08), prompter evaluation (more patients with door-to-imaging time, ≤25 minutes; odds ratio, 1.89; 95% confidence interval, 1.78–2.00), more rapid treatment (more patients with door-to-needle time, ≤60 minutes; odds ratio, 1.44; 95% confidence interval, 1.28–1.63), and more eligible patients to be treated with tissue-type plasminogen activator if onset is ≤2 hours (67% versus 44%; odds ratio, 1.47; 95% confidence interval, 1.33–1.64).

Conclusions—Although EMS use is independently associated with more rapid evaluation and treatment of stroke, more than one third of stroke patients fail to use EMSs. Interventions aimed at increasing EMS activation should target populations at risk, particularly younger patients and those of minority race and ethnicity.

Four Dead in Ontario Medical Helicopter Crash

From JEMS:

Ontario’s air ambulance service is confirming four of its employees have died after one of its helicopters crashed in northern Ontario.

The Ornge air ambulance service says no one survived the accident near Moosonee, Ontario early Friday.

Heart Attack Woman On Plane – 15 Cardiologists On Board

From Medical News Today:

If you fall ill on a flight, you have to hope there is a doctor on board. So Dorothy Fletcher can count herself lucky.

When she suffered a heart attack on a transatlantic flight from Manchester to Florida, she turned out to be on a plane full of cardiologists.

Fifteen experts on their way to a cardiology conference responded when a stewardess asked for medical assistance.

They stood up en masse and rushed to save Mrs Fletcher, 67, from Liverpool. They fed drips into her arms and used an onboard medical kit to control the life-threatening attack.

Armed First Responders

From JEMS:

For about a year, the Bethel Township Fire and EMS Department has allowed first responders to carry concealed weapons on emergency calls as a way to protect themselves in an area where having law enforcement respond to calls in a timely manner when needed can be a challenge due to reduced staffing.

Medication non-adherence, disability contribute to Medicare ED visits

From Fierce Healthcare:

Disabled Medicare patients who have trouble affording their medication are more likely to make a trip to the emergency room at least once in a year, according to new research published in the Annals of Emergency Medicine.

Transport to a detoxification facility vs. an ED

From JEMS:

In total, 718 patient encounters were reviewed for this study. Of those, 130 (19.2%) patients were transported directly to the detox facility with the remainder being transported to an ED. Of the 29 questions on the form, the most common exclusion criteria was an inability to ambulate without difficulty. Patients had to be willing to go to the detox center voluntarily.

Study: More than two-thirds of ER visits avoidable

From EBN

More than two-thirds of the 6.5 million emergency room visits for people under age 65 are avoidable, according to a study released by Truven Health Analytics. The study examined insurance claims data for over 6.5 million emergency department visits made during the 2010 calendar year and found that just 29% of patients required immediate attention in the emergency room.

Fewer ED’s, More ED Visits

From MedPage Today:

“Although the percentage of Americans visiting the emergency department each year is stable, the total number of visits to emergency departments increased 34% between 1995 and 2010 (from 97 million to 130 million visits),” stated the agency in Health, United States, 2012.

“At the same time, the supply of emergency departments has declined by about 11% to 3,700 emergency departments in 2010,” the report noted.

Cold Symptoms Are Top Reason Kids Visit Emergency Room

From the Huffington Post:

Sneezing, runny nose and other cold-like symptoms are the top reason kids are brought to the emergency room, according to a new government report on the state of Americans’ health that includes a special section on emergency care.

The data show cold symptoms accounted for 27 percent of kids’ ER visits in 2009 and 2010, and 14 percent of adults’ ER visits.

Evaluation of ambulance offload delay at a university hospital emergency department

From the International Journal of Emergency Medicine


Ambulance offload delay (AOD) has been recognized by the National Association of EMS Physicians (NAEMSP) as an important quality marker. AOD is the time between arrival of a patient by EMS and the time that the EMS crew has given report and moved the patient off of the EMS stretcher, allowing the EMS crew to begin the process of returning to service. The AOD represents a potential delay in patient care and a delay in the availability of an EMS crew and their ambulance for response to emergencies. This pilot study was designed to assess the AOD at a university hospital utilizing direct observation by trained research assistants.


A convenience sample of 483 patients was observed during a 12-month period. Data were analyzed to determine the AOD overall and for four groups of National Emergency Department Overcrowding Scale (NEDOCS) score ranges. The AOD ranged from 0 min to 157 min with a median of 11 min. When data were grouped by NEDOCS score, there was a statistically significant difference in median AOD between the groups (p < 0.001), indicating the relationship between ED crowding and AOD.


The median AOD was considered significant and raised concerns related to patient care and EMS system resource availability. The NEDOCS score had a positive correlation with AOD and should be further investigated as a potential marker for determining diversion status or for destination decision-making by EMS personnel.