Characteristics of Statewide Protocols for Emergency Medical Services in the United States

Kupas, Douglas F.; Schenk, Ellen; Sholl, Jonathan; Kamin, Richard

doi:10.3109/10903127.2014.964891

Cited by 30 publications

(39 citation statements)

References 13 publications

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“…These systems reflect the needs and demographics of that county or region and operate under one set of medical control policies. A similar variation among protocols was seen in a recent study on statewide EMS protocols 60. In 2014, the National Association of EMS Officials published model EMS guidelines that could be used to decrease this variability.…”

Section: Discussionsupporting

confidence: 68%

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Silverman¹,

Sporer²,

Lemieux³

et al. 2017

WestJEM

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IntroductionWe sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California.MethodsWe performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately.ResultsProtocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33) of agencies for adult patients and 76% (25/33) for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33) have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33) of agencies. Forty-two percent (14/33) have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33) allow benzodiazepines to be administered.ConclusionProtocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols.

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Section: Discussionsupporting

confidence: 68%

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Silverman¹,

Sporer²,

Lemieux³

et al. 2017

WestJEM

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show abstract

“…The Commonwealth of Pennsylvania, for example, instituted regulations and statewide treatment protocols which limited the use of WLS to medically necessary situations. 26 The Commonwealth of Pennsylvania further codifies the specific operation of emergency vehicles, imposing an increase in regulation and promoting the safe operation of emergency vehicles. 27 There remains, however, no national consensus on how to address the use of WLS during transport.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Beliefs of EMS Providers toward Lights and Siren Transportation

Tennyson¹,

Maranda²,

Darnobid

2015

WestJEM

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IntroductionThe use of warning lights and siren (WLS) increases the risk of ambulance collisions. Multiple studies have failed to demonstrate a clinical benefit to the patients. We sought to investigate the degree to which providers understand the data and incorporate it into their practice.MethodsThe authors distributed an anonymous survey to prehospital providers under their medical direction at staff and quality assurance meetings. The surveys asked the providers’ degree of agreement with four statements: transport with lights and siren shortens transport times; transport with lights and siren improves patient outcome; transport with lights and siren increases the risk of collision during transport; and transport with lights and siren reduces the utilization of “mutual aid” service. We compared responses between providers who had been in prior ambulance collisions and those who had not.ResultsFew responses reached statistical significance, but respondents tended towards agreement that WLS use shortens transport times, that it does not improve outcomes, and that it increases the risk of collision. Despite the overall agreement with the published literature, respondents report >80% of transports are conducted using WLS.ConclusionThe data demonstrate the surveyed providers are aware of the risk posed by WLS to themselves, their patients, and the public. Nevertheless, their practice in the absence of rigid protocols suggests they disregard this knowledge. Despite a large number of prior ambulance collisions among the surveyed group, a high number of transports are conducted using WLS.

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“…[4][5][6] However, it is unclear if similar progress has been made in the pre-hospital setting, given variations in state-level emergency medical services (EMS) systems and lack of standardized data collection to inform process improvement. 3,7 Additionally, large areas of the country remain without timely access to definitive care due to geographic misalignment of US trauma centers with population densities. [8][9][10] Although these factors are known to contribute to significant geographic disparities in overall and in-hospital injury mortality, the impact of timely access to trauma center care on the burden of pre-hospital deaths has not been elucidated.…”

mentioning

confidence: 99%

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Hashmi

Jarman

Uribe-Leitz

et al. 2019

Journal of the American College of Surgeons

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Characteristics of Statewide Protocols for Emergency Medical Services in the United States

Cited by 30 publications

References 13 publications

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Knowledge and Beliefs of EMS Providers toward Lights and Siren Transportation

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

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