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.