Payers Slow to Use Comparative Research Data

From MedPage Today:

Comparative effectiveness research is becoming more prevalent, but payers have been slow to use the data it generates, health policy experts said.

Health plans and pharmacy benefit managers are struggling to understand comparative effectiveness and the evidence that comes with it, Helen Sherman, PharmD, vice president of the consulting firm Solid Benefit Guidance in River Vale, N.J., said Tuesday.

“Other than a handful of front runners, generally payers … do not have a systematic approach to evidence,” Sherman said at the Comparative Effectiveness Summit here. “They do not have standards as to what to include in terms of evaluating medication, or they do not have standards as to what to include when evaluating what is a credible study or reliable study and what is not quality.”

No Medic Units Available During Navy Yard Shooting

From JEMS:

According to DC’s Firefighter’s Union there were a total of 9 DC Fire & EMS units that were operating on a downgraded status on Monday. In other words, there was no paramedic on board.

Of those 9 DCFEMS officials say only 1, Medic 30, was responding to the scene. It just so happens to be that this downgraded medic unit which usually has a paramedic on board was the same ambulance transporting the DC Police Officer who had been shot.

In the transmissions you can hear emergency personnel say, “We currently have a police officer that was extricated from building 197. We are currently putting him in ambulance 30.”

The transmission also have a dispatcher saying, “Communication to command 3…be advised we have no medic unit available, but we have ambulance 14 and ambulance 4 being dispatched at this time.”

Pill shoppers abusing 911 system

From the Suwanmee Democrat:

At the Sept. 9 meeting of the Lafayette County Board of County Commissioners, Emergency Medical Services Director Trevor Hicks advised the board that some local residents have been abusing the 911 system to feed their prescription drug habit.

“We’re seeing a huge increase in substance seekers abusing the 911 system in the county,” said Hicks. “There’s not a lot we can do about them calling 911. They’re tying up your ambulance is what they’re doing…for pain pills,” he told the commissioners. “They’ll tell you flat out when you get there, ‘I’m out of my pain medicine.’”

A larger number than usual of those type calls, Hicks said, have been coming in lately. He averaged about 10 a week have been calling 911 to have EMS take them to the ER to get their prescriptions filled.

“They want us to haul them to a different hospital each time,” said Hicks. “We’ve pretty much taken the stand of no, we’re not tying up the truck, we’re not going to do it.”

Simulation technology for resuscitation training: A systematic review and meta-analysis

From Resuscitation:

Objectives

To summarize current available data on simulation-based training in resuscitation for health care professionals.

Data sources

MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and reference lists of published reviews.

Study selection

Published studies of any language or date that enrolled health professions’ learners to investigate the use of technology-enhanced simulation to teach resuscitation in comparison with no intervention or alternative training.

Data extraction

Data were abstracted in duplicate. We identified themes examining different approaches to curriculum design. We pooled results using random effects meta-analysis.

Data synthesis

182 studies were identified involving 16,636 participants. Overall, simulation-based training of resuscitation skills, in comparison to no intervention, appears effective regardless of assessed outcome, level of learner, study design, or specific task trained. In comparison to no intervention, simulation training improved outcomes of knowledge (Hedges’ g) 1.05 (95% confidence interval, 0.81–1.29), process skill 1.13 (0.99–1.27), product skill 1.92 (1.26–2.60), time skill 1.77 (1.13–2.42) and patient outcomes 0.26 (0.047–0.48). In comparison with non-simulation intervention, learner satisfaction 0.79 (0.27–1.31) and process skill 0.35 (0.12–0.59) outcomes favored simulation. Studies investigating how to optimize simulation training found higher process skill outcomes in courses employing “booster” practice 0.13 (0.03–0.22), team/group dynamics 0.51 (0.06–0.97), distraction 1.76 (1.02–2.50) and integrated feedback 0.49 (0.17–0.80) compared to courses without these features. Most analyses reflected high between-study inconsistency (I2 values >50%).

Conclusions

Simulation-based training for resuscitation is highly effective. Design features of “booster” practice, team/group dynamics, distraction and integrated feedback improve effectiveness.

Biphasic versus monophasic defibrillation in out-of-hospital cardiac arrest: a systematic review and meta-analysis

From the American Journal of Emergency Medicine:

Objective

Biphasic defibrillation is more effective than monophasic one in controlled in-hospital conditions. The present review evaluated the performance of both waveforms in the defibrillation of patients of out-of-hospital cardiac arrest (OHCA) with initial ventricular fibrillation (Vf) rhythm under the context of current recommendations for cardiopulmonary resuscitation.

Methods

From inception to June 2012, Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched systemically for randomized controlled trials (RCTs) and observational cohort studies that compared the effects of biphasic and monophasic shocks on Vf termination, return of spontaneous circulation (ROSC), and survival to hospital discharge in OHCA patients with initial Vf rhythm. No restrictions were applied regarding language, population, or publication year.

Results

Four RCTs including 572 patients were identified from 131 potentially relevant references for meta-analysis. The synthesis of these RCTs yielded fixed-effect pooled risk ratios (RRs) for biphasic and monophasic waveforms on Vf termination survival to hospital discharge (RR, 1.14; 95% CI, [0.84-1.54]).

Conclusion

Biphasic waveforms did not seem superior to monophasic ones with respect to Vf termination, ROSC, or survival to hospital discharge in OHCA patients with initial Vf rhythm under the context of current guidelines. However, most trials were conducted in accordance with previous guidelines for cardiopulmonary resuscitation. Therefore, further trials are needed to clarify this issue.

Emergency Response Planning and Sudden Cardiac Arrests in High Schools after Automated External Defibrillator Legislation

From the Journal of Pediatrics:

Objective

To compare medical emergency response plan (MERP) and automated external defibrillator (AED) prevalence and define the incidence and outcomes of sudden cardiac arrest (SCA) in high schools before and after AED legislation.

Study design

In 2011, Tennessee Secondary School Athletic Association member schools were surveyed regarding AED placement, MERPs, and on-campus SCAs within the last 5 years. Results were compared with a similar study conducted in 2006, prior to legislation requiring AEDs in schools.

Results

Of the schools solicited, 214 (54%, total enrollment 182 289 students) completed the survey. Compared with 2006, schools in the 2011 survey had a significantly higher prevalence of MERPs (84% vs 71%, P < .001), annual practice (56% vs 36%, P < .001), medical emergency communication systems (80% vs 62%, P < .001), and defibrillators (90% vs 47%, P < .001). No differences were noted in the prevalence of cardiopulmonary resuscitation training (20% vs 17%, P = .58) or full compliance with American Heart Association guidelines (11% vs 7%, P = .16). Twenty-two SCA victims were identified, yielding a 5-year incidence of 1 in 10 schools.

Conclusions

After state legislation, schools demonstrated a significant increase in MERPs and on-campus defibrillators but rates of cardiopulmonary resuscitation training and overall compliance with guidelines remained low

‘Interception’: a model for specialist prehospital care provision when helicopters are not available

From the Emergency Medicine Journal:

The deployment of specialist teams to incident scenes by helicopter and the delivery of critical care interventions such as Rapid Sequence Induction of anaesthesia to patients are becoming well-established components of trauma care in the UK. Traditionally in the UK, Helicopter Emergency Medical Services (HEMS) are limited to daylight operations only. The safety and feasibility of operating HEMS services at night is a topic of debate currently in the UK HEMS community. Within the West Midlands Major Trauma Network, the Medical Emergency Response Incident Team (MERIT) provides a physician-led prehospital care service that responds to incidents by air during daylight hours and by Rapid Response Vehicle during the hours of darkness. The MERIT service is coordinated and supported by a dedicated Major Trauma Desk manned by a HEMS paramedic in the ambulance service control room. This case illustrates the importance of coordination and integration of specialist resources within a major trauma network to ensure the expedient delivery of HEMS-level care to patients outside of normal flying hours.