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Farcas AM, Crowe RP, Kennel J, Little N, Haamid A, Camacho MA, Pleasant T, Owusu-Ansah S, Joiner AP, Tripp R, Kimbrell J, Grover JM, Ashford S, Burton B, Uribe J, Innes JC, Page DI, Taigman M, Dorsett M. Achieving Equity in EMS Care and Patient Outcomes through Quality Management Systems: A Position Statement. PREHOSP EMERG CARE 2024:1-16. [PMID: 38727731 DOI: 10.1080/10903127.2024.2352582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Improving health and safety in our communities requires deliberate focus and commitment to equity. Inequities are differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, and unjust. Within health care in general, and Emergency Medical Services (EMS) in particular, there are demonstrated inequities in the quality of care provided to patients based on a number of characteristics linked to discrimination, exclusion, or bias. Given the critical role that EMS plays within the health care system, it is imperative that EMS systems reduce inequities by delivering evidence-based, high-quality care for the communities and patients we serve.To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians recommends that EMS systems and agencies:make health equity a strategic priority and commit to improving equity at all levels.assess and monitor clinical and safety quality measures through the lens of inequities as an integrated part of the quality management process.ensure that data elements are structured to enable equity analysis at every level and routinely evaluate data for limitations hindering equity analysis and improvement.involve patients and community stakeholders in determining data ownership and stewardship to ensure its ongoing evolution and fitness for use for measuring care inequities.address biases as they translate into the quality of care and standards of respect for patients.pursue equity through a framework rooted in the principles of improvement science.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine
| | | | - Jamie Kennel
- Oregon Health & Science University and Oregon Institute of Technology
| | | | - Ameera Haamid
- Section of Emergency Medicine; University of Chicago Medicine
| | - Mario Andres Camacho
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine
| | | | - Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine
| | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center
| | - Joshua Kimbrell
- Department of Pre-Hospital Care, Jamaica Hospital Medical Center
| | | | | | | | | | - Johanna C Innes
- Jacobs School of Medicine and Biomedical Sciences (University at Buffalo)
| | - David I Page
- Center for Prehospital Care, David Geffen School of Medicine, University of California Los Angeles
| | | | - Maia Dorsett
- Department of Emergency Medicine, University of Rochester Medical Center
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Pozner J, Winslow J, Schinde S, Patel MD, Grover JM. EMS Involvement in COVID-19 Vaccination Efforts- Results of a North Carolina Statewide Survey. PREHOSP EMERG CARE 2022; 27:293-296. [PMID: 35333663 DOI: 10.1080/10903127.2022.2053014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective. The COVID-19 pandemic has necessitated the vaccination of large numbers of people across the United States, mobilizing public health resources on a massive scale. The purpose of this study is to determine how emergency medical services (EMS) clinicians and agencies in North Carolina have been utilized in these vaccination efforts.Methods. This retrospective survey was sent to EMS medical directors and EMS system administrators for all 100 county EMS systems in North Carolina. Participation was voluntary, and survey questions asked about the contribution of EMS systems to vaccination efforts, the levels of EMS clinicians being utilized, the activities carried out by those clinicians, and any identifiable barriers to EMS involvement in COVID-19 vaccination efforts.Results. Ninety-eight of the 100 counties in North Carolina responded to the survey, with 88 contributing to vaccination efforts in the communities. Reasons cited by the 10 counties for not being involved in vaccination efforts include: county health departments not needing assistance (two counties), vaccine hesitancy amongst clinicians and the politicization of COVID (three counties), inadequate staffing (one county), and the presence of "robust vaccination clinics" in the community (one county). An additional 12 counties listed staffing shortages as limiting their vaccination efforts. Among the counties supporting vaccine efforts, activities included planning and logistics (54 counties), non-medical roles (38 counties), vaccine preparation (35 counties), medical screening pre-vaccination (41 counties), vaccine administration (74 counties), medical observation post-vaccination (79 counties), and home vaccinations (53 counties). Of the 74 counties that used EMS personnel in vaccine administration, 27 used EMTs (37%), 36 used Advanced EMTs (49%), and 73 used Paramedics (99%).Conclusion. This study demonstrates the large role that EMS clinicians and systems have played and continue to play in COVID-19 vaccination efforts in the state of North Carolina, including planning and logistics, patient screening and observation, vaccine preparation and administration, and home vaccination. Furthermore, it supports the expanded use of EMTs as a potential vaccination workforce. As the public health response to this pandemic continues, EMS clinicians and systems are a valuable resource to their communities and states.
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Affiliation(s)
- Jonathan Pozner
- Department of Emergency Medicine, UNC-Chapel Hill, Chapel Hill, NC
| | | | | | - Mehul D Patel
- Department of Emergency Medicine, UNC-Chapel Hill, Chapel Hill, NC
| | - Joseph M Grover
- Department of Emergency Medicine, UNC-Chapel Hill, Chapel Hill, NC.,Orange County Emergency Services, Hillsborough, NC
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Cui ER, Fernandez AR, Zegre-Hemsey JK, Grover JM, Honvoh G, Brice JH, Rossi JS, Patel MD. Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System. J Am Heart Assoc 2021; 10:e019305. [PMID: 34323113 PMCID: PMC8475668 DOI: 10.1161/jaha.120.019305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population‐based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS‐suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11‐minute response time benchmark and 49% met the 15‐minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12‐lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban–rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated.
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Affiliation(s)
- Eric R Cui
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.,School of Information and Library Science University of North Carolina at Chapel Hill Chapel Hill NC
| | - Antonio R Fernandez
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.,ESO Austin TX
| | | | - Joseph M Grover
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.,Orange County Emergency Services Hillsborough NC
| | - Gilson Honvoh
- Department of Biostatistics Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Jane H Brice
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC
| | - Joseph S Rossi
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill Chapel Hill NC
| | - Mehul D Patel
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC
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Cui ER, Beja-Glasser A, Fernandez AR, Grover JM, Mann NC, Patel MD. Emergency Medical Services Time Intervals for Acute Chest Pain in the United States, 2015–2016. PREHOSP EMERG CARE 2019; 24:557-565. [DOI: 10.1080/10903127.2019.1676346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Patel MD, Platts-Mills TF, Grover JM, Thomas SM, Rossi JS. Feasibility of prehospital delivery of remote ischemic conditioning by emergency medical services in chest pain patients: protocol for a pilot study. Pilot Feasibility Stud 2019; 5:42. [PMID: 30911405 PMCID: PMC6415490 DOI: 10.1186/s40814-019-0431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background Remote ischemic conditioning (RIC) is a non-invasive procedure with hypothesized therapeutic benefits for patients experiencing an acute ST-elevation myocardial infarction (STEMI). Further study of emergency medical services (EMS) delivery of RIC in the prehospital setting is needed to inform the design and methods for future clinical trials of RIC in STEMI patients. The main objective of this pilot study is to assess the feasibility of prehospital delivery of RIC by EMS providers in the United States. Methods We will conduct a single-arm study of the standard RIC procedure (i.e., up to 4 cycles of alternating 5-min inflation and 5-min deflation of an upper arm cuff) administered by EMS paramedics in 50 patients experiencing acute onset chest pain. The investigational autoRIC® device (CellAegis Devices, Inc., Toronto, Ontario) will be initiated by paramedics during ground ambulance transport. Automated RIC cycles will continue through emergency department arrival and stay. The primary endpoint will be the completion of all 4 cycles of RIC without interruption. We will also examine study procedures and collect qualitative data from study participants and paramedics. Discussion To our knowledge, this will be the first study in the United States to assess the feasibility of completing the 40-min RIC procedure when initiated during ground ambulance transport. Findings from this pilot study will be used to optimize the design and methods for a future efficacy trial of RIC in acute STEMI patients. Trial registration NCT03400579 (ClinicalTrials.gov). Registered on 17 January 2018.
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Affiliation(s)
- Mehul D Patel
- 1Department of Emergency Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7594, Chapel Hill, NC 27599-7594 USA
| | - Timothy F Platts-Mills
- 1Department of Emergency Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7594, Chapel Hill, NC 27599-7594 USA
| | - Joseph M Grover
- 1Department of Emergency Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7594, Chapel Hill, NC 27599-7594 USA.,Orange County Emergency Services, Hillsborough, USA
| | - Sonia M Thomas
- 3Division of Biostatistics and Epidemiology, RTI International, Raleigh, USA
| | - Joseph S Rossi
- 4Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Grover JM, Alabdrabalnabi T, Patel MD, Bachman MW, Platts-Mills TF, Cabanas JG, Williams JG. Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large U.S. EMS System. PREHOSP EMERG CARE 2018; 22:281-289. [DOI: 10.1080/10903127.2017.1387628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evans CS, Platts-Mills TF, Fernandez AR, Grover JM, Cabanas JG, Patel MD, Vilke GM, Brice JH. Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database. Ann Emerg Med 2017; 70:506-515.e3. [PMID: 28559037 DOI: 10.1016/j.annemergmed.2017.03.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE The objective of this study is to characterize repeated emergency medical services (EMS) transports among older adults across a large and socioeconomically diverse region. METHODS Using the North Carolina Prehospital Medical Information System, we analyzed the frequency of repeated EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010 to 2015. We used multivariable logistic regressions to determine characteristics associated with repeated EMS transport. RESULTS During the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 transports (17.7%) were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeated transport within 30 days include transport from an institutionalized setting (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.38 to 1.47), blacks compared with whites (OR 1.29; 95% CI 1.24 to 1.33), a dispatch complaint of psychiatric problems (OR 1.38; 95% CI 1.25 to 1.52), back pain (OR 1.35; 95% CI 1.26 to 1.45), breathing problems (OR 1.21; 95% CI 1.15 to 1.30), and diabetic problems (OR 1.14; 95% CI 1.06 to 1.22). Falls accounted for 15.6% of all transports and had a modest association with repeated transports (OR 1.07; 95% CI 1.00 to 1.14). CONCLUSION More than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeated transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeated transport and suggest the potential for targeted interventions to improve outcomes and manage EMS use.
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Affiliation(s)
- Christopher S Evans
- Department of Emergency Medicine and School of Medicine, University of California-San Diego, San Diego, CA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
| | | | - Antonio R Fernandez
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC; EMS Performance Improvement Center, University of North Carolina, Chapel Hill, NC
| | - Joseph M Grover
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Jose G Cabanas
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC; Wake County Department of Emergency Medical Services, Wake County, NC
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Gary M Vilke
- Wake County Department of Emergency Medical Services, Wake County, NC
| | - Jane H Brice
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
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Dadoo S, Grover JM, Keil LG, Hwang KS, Brice JH, Platts-Mills TF. Prehospital Fluid Administration in Trauma Patients: A Survey of State Protocols. PREHOSP EMERG CARE 2017; 21:605-609. [PMID: 28481669 DOI: 10.1080/10903127.2017.1315202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The optimal resuscitation approach during the initial treatment of hypotensive trauma patients remains unknown, but some clinical trials have observed a survival benefit from restricting fluid administration prior to definitive hemorrhage control. We sought to characterize emergency medical services (EMS) protocols for the administration of intravenous fluids in this setting. METHODS Publicly accessible statewide EMS protocols for the treatment of hypotensive trauma patients were included and characterized by: 1) goal of fluid administration, 2) dosing strategy, 3) maximum dose, 4) type of fluid, and 5) specific protocols for head trauma, if present. RESULTS Of the 27 states with a publicly available, statewide protocol, 21 have a numeric systolic blood pressure (SBP) target for resuscitation. Of these, 16 describe a goal of maintaining SBP ≥90 mmHg with or without additional goals, three specify a goal that is less than 90 mmHg, and two specify a goal ≥100 mHg. Dosing strategies also vary and include both standard bolus strategies (200 mL, 250 mL, 500 mL, and 1 L with repeat) as well as weight-based strategies (20 mL/kg). Nine states specify a maximum dose of 2 L without medical control. Fifteen protocols recommend the use of normal saline, 1 recommends the use of lactated Ringer's, and 11 recommend the use of either normal saline or lactated Ringer's. Nine states have distinct protocols for patients with head trauma, all of which indicate maintaining a higher SBP than for trauma patients without head trauma. CONCLUSION State EMS protocols for fluid administration for hypotensive trauma patients vary in regard to SBP goal, fluid dose, and fluid type. Clinical trials to determine the optimal use of intravenous fluids for hypotensive trauma patients are needed to define the optimal approach.
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Ohri VC, Das BK, Dutta BB, Parashar SK, Naqvi S, Bhalla IP, Grover JM. Evaluation of CPK and LDH isoenzyme assays as diagnostic aids in acute myocardial infarction. INDIAN J PATHOL MICR 1988; 31:35-40. [PMID: 3169914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Rayudu GB, Grover JM. Neonatal tetanus in a military hospital. Indian J Pediatr 1974; 41:33-9. [PMID: 4847192 DOI: 10.1007/bf02761078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Grover JM, Abrol SC, Raj MD, Rao KM, Hoon RS. Bile peritonitis following needle biopsy of liver by Menghini technique. J Assoc Physicians India 1973; 21:545-7. [PMID: 4792730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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