Monthly Archives: December 2013

An evaluation of emergency medical services stroke protocols and scene times

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An Evaluation of Emergency Medical Services Stroke Protocols and Scene Times

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum

Prehospital Emergency Care January-March 2014, Vol. 18, No. 1 , Pages 15-21

Acute stroke patients require immediate medical attention. Therefore, American Stroke Association guidelines recommend that for suspected stroke cases, emergency medical services (EMS) personnel spend less than 15 minutes on-scene at least 90% of the time. However, not all EMS providers include specific scene time limits in their stroke patient care protocols.

Objective. The authors sought to determine whether having a protocol with a specific scene time limit was associated with less time EMS spent on scene. Methods. Stroke protocols from the 100 EMS systems in North Carolina were collected and abstracted for scene time instructions. Suspected stroke events occurring in 2009 were analyzed using data from the North Carolina Prehospital Medical Information System. Scene time was defined as the time from EMS arrival at the scene to departure with the patient. Quantile regression was used to estimate how the 90th percentile of the scene time distribution varied by systems with protocol instructions limiting scene time, adjusting for system patient volume and metropolitan status.

Results. In 2009, 23 EMS systems in North Carolina had no instructions regarding scene time; 73 had general instructions to minimize scene time; and 4 had a specific limit for scene time (i.e., 10 or 15 min). Among 9,723 eligible suspected stroke events, mean scene time was 15.9 minutes (standard deviation 6.9 min) and median scene time was 15.0 minutes (90th percentile 24.3 min). In adjusted quantile regression models, the estimated reduction in the 90th percentile scene time, comparing protocols with a specific time limit to no instructions, was 2.2 minutes (95% confidence interval 1.3, 3.1 min). The difference in 90th percentile scene time between general and absent instructions was not statistically different (0.7 min [95% confidence interval −0.1, 1.4 min]).

Conclusion. Protocols with specific scene time limits were associated with EMS crews spending less time at the scene while general instructions were not. These findings suggest EMS systems can modestly improve scene times for stroke by specifying a time limit in their protocols.

http://informahealthcare.com/doi/abs/10.3109/10903127.2013.825354

Research into paramedic advanced airway management training

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© Gary Wilson

© Gary Wilson

Australian paramedics and ambulance officers authorised to undertake advanced airway management techniques, including Laryngeal Mask Airways (LMAs) and endotracheal intubation, are invited to participate in a research study to investigate whether Western Australian paramedics are receiving sufficient theoretical, clinical and practical training in advanced airway management techniques to be competent and effective.

Both locally and internationally, the adequacy of initial advanced airway skills training, the level of experience available during hospital placements and prevention of skill erosion once qualified has questioned as to whether the continued teaching of endotracheal intubation is appropriate. Studies have highlighted adverse events and errors associated with intubation including poor outcomes; unrecognised tube displacement; oxygen desaturation; and bradycardia. Responses to the survey will allow a picture to be developed of the current airway management education and perceptions on the effectiveness of the training and identify possible improvements to current training practice.

Australian pre-hospital care providers who have undertaken intubation or LMA insertion in the last 12 months are invited to complete a questionnaire investigating training content, experience and confidence levels when undertaking airway management techniques for the study. The study, which will also utilise focus groups to investigate further participants’ experiences and beliefs, will suggest possible improvements to current training practice.

Further information and links to either the online or pdf questionnaire can be found at: http://www.prehospitalresearchforum.net.au/paramedicairway.html