Piloting Community Paramedicine

From JEMS:

The feasibility study, which was released in July, states, “Early experiences with CP programs suggest that they may lead to more optimal use of EMS assets and offer some potential for diversification of the EMS funding base.”

The IPHI report specifies CP programs may result in more appropriate use of EMS, increased access for the underserved and additional opportunities for provider use of skills. “Expanding the role of paramedics is a very promising model of community-based care that uses existing healthcare workers in new and innovative ways,” Kizer said in a prepared statement. “It is a model of care that several other states and countries have implemented to better leverage the skills of paramedics to meet specific community needs and to help ensure that emergency departments are more appropriately utilized.”

Primary Care Technicians: A Solution To The Primary Care Workforce Gap

From Health Affairs:

Efforts to close the primary care workforce gap typically employ one of three basic strategies: train more primary care physicians; boost the supply of nurse practitioners or physician assistants, or both; or use community health workers to extend the reach of primary care physicians. In this article we briefly review each strategy and the barriers to its success. We then propose a new approach adapted from the widely accepted model of emergency medical services. Translating this model to primary care and leveraging the capabilities of modern health information technology, it should be possible to create primary care technicians who can dramatically expand the impact and reach of patient-centered medical homes by providing basic preventive, minor illness, and stable chronic disease care in rural and resource-deprived communities.

How Long Does Your Heart Have to Stop For Before You Can’t Be Treated?

From Gizmodo:

The question of how long someone’s heart would have to be stopped for before you can safely say that regardless of what you do, you’re not going to be able to revive them is a very tricky question. It’s not as simple as saying after 10 or even 20 minutes there’s no hope. For instance, there are countless people who have been subject to hypothermia, have their heart stopped for over 45 minutes, and still have been successfully revived. So many, in fact, that the current guideline set by the American Heart Association (AHA) is that you continue trying to revive the person until their core body temperature is above 95 degrees Fahrenheit- 95 degrees, because below that is the technical definition of hypothermia. The mantra in that situation is, “They’re not dead until they’re warm and dead.”

Bowing, kneeling and ‘prostration’: athlete’s collapse patterns during sudden cardiac arrhythmia/arrest on the field of play

From the Emergency Medicine Journal:

Background Sudden cardiac arrest (SCA) on the field of play remains one of the most tragic and challenging events for a team physician. Even with robust regular preparticipation cardiac screening we cannot prevent all cases of SCA. Ability to recognise imminent cardiac arrest occurring on the field of play remains an important step in managing this condition without delay.

Methods You Tube was searched for video clips clearly depicting the sequence of an athlete’s collapse of cardiac origin. A pattern of collapse was subsequently analysed.

Results 13 cases were available for public viewing on You Tube and demonstrated the final position of collapse. 12 collapses had full video footage of athlete’s fall. All athletes were men. 84.6% (11) cases were from football (soccer). 15.4% (2) of cases were from martial arts. In 10 out of 12 cardiac event cases (83.3%) bowing and/or kneeling were followed by decubitus position. 58.3% (7) of cases demonstrated bowing at the beginning of collapse. 58.3% (7) cases had kneeling as an element of collapse. 61.5% (8 out of 13 cases) of casualties adopted position of ‘prostration’ (ie, prone) as final stage of collapse.

Conclusions When on the field of play, in the absence of head injury, athletes displaying bowing and/or kneeling positions followed by collapse should be assumed to have a life-threatening cardiac event. Final position of ‘prostration’ was adopted in over half of cardiogenic collapses. A sports medicine professional should bear this in mind and target his/her assessment and treatment accordingly. When attending such casualties, a defibrillator must be taken to the collapsed player.

The Trauma Log Roll is Dead

From Emergency Medicine Literature of Note:

The theoretical risks to log-roll – lack of true thoracolumbar stability, possibility of disturbing internal hemostasis – if there is no benefit, are appropriate considerations if physical examination does not change clinical evaluation.  It is, however, excessive to universally posit, as the letter authors do, “Log-rolling a blunt major trauma patient is inappropriate in the primary survey.”

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study

From the Emergency Medicine Journal:

Background Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.

Objective Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.

Methods This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message.

Results 151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital.

Conclusions This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist.