Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

Williams, Irene; Valderrama, Amy L.; Bolton, Patricia A.; Greek, April; Greer, Sophia; Patterson, Davis G.; Zhang, Zefeng

doi:10.3109/10903127.2011.615008

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…Although low patient volume and rural locations are reported to limit EMS stroke care capacity (7,22–25), our comparisons by patient volume and county population density did not demonstrate strong variation by these characteristics. In fact, our findings show that some systems with low patient volume in rural areas have high stroke care capacity.…”

Section: Discussioncontrasting

confidence: 53%

Emergency Medical Services Capacity for Prehospital Stroke Care in North Carolina

Patel¹,

Brice²,

Evenson³

et al. 2013

Prev. Chronic Dis.

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IntroductionPrior assessments of emergency medical services (EMS) stroke capacity found deficiencies in education and training, use of protocols and screening tools, and planning for the transport of patients. A 2001 survey of North Carolina EMS providers found many EMS systems lacked basic stroke services. Recent statewide efforts have sought to standardize and improve prehospital stroke care. The objective of this study was to assess EMS stroke care capacity in North Carolina and evaluate statewide changes since 2001.MethodsIn June 2012, we conducted a web-based survey on stroke education and training and stroke care practices and policies among all EMS systems in North Carolina. We used the McNemar test to assess changes from 2001 to 2012.ResultsOf 100 EMS systems in North Carolina, 98 responded to our survey. Most systems reported providing stroke education and training (95%) to EMS personnel, using a validated stroke scale or screening tool (96%), and having a hospital prenotification policy (98%). Many were suboptimal in covering basic stroke educational topics (71%), always communicating stroke screen results to the destination hospital (46%), and always using a written destination plan (49%). Among 70 EMS systems for which we had data for 2001 and 2012, we observed significant improvements in education on stroke scales or screening tools (61% to 93%, P < .001) and use of validated stroke scales or screening tools (23% to 96%, P < .001).ConclusionMajor improvements in EMS stroke care, especially in prehospital stroke screening, have occurred in North Carolina in the past decade, whereas other practices and policies, including use of destination plans, remain in need of improvement.

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Section: Discussioncontrasting

confidence: 53%

Emergency Medical Services Capacity for Prehospital Stroke Care in North Carolina

Patel¹,

Brice²,

Evenson³

et al. 2013

Prev. Chronic Dis.

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“…A survey of EMS practices in 9 states showed that only personnel with paramedic credentials were authorized to perform an ECG in 88% of agencies while only 23% and 37% of agencies authorized ECG performance at the EMT basic and intermediate level of licensure, respectively. 14 Although fewer than 10% of chest pain patients in our study were transported without at least 1 member of their team having paramedic certification, gaps in certification were greatest in rural areas. The 2009 EMS protocol in North Carolina authorized individuals who hold an EMT‐basic certification or above to perform an ECG.…”

Section: Discussionmentioning

confidence: 73%

Variation in the Use of 12‐Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina

Bush¹,

Glickman

Fernández

et al. 2013

JAHA

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BackgroundPrehospital 12‐lead electrocardiography (ECG) is critical to timely STEMI care although its use remains inconsistent. Previous studies to identify reasons for failure to obtain a prehospital ECG have generally only focused on individual emergency medical service (EMS) systems in urban areas. Our study objective was to identify patient, geographic, and EMS agency‐related factors associated with failure to perform a prehospital ECG across a statewide geography.Methods and ResultsWe analyzed data from the Prehospital Medical Information System (PreMIS) in North Carolina from January 2008 to November 2010 for patients >30 years of age who used EMS and had a prehospital chief complaint of chest pain. Among 3.1 million EMS encounters, 134 350 patients met study criteria. From 2008–2010, 82 311 (61%) persons with chest pain received a prehospital ECG; utilization increased from 55% in 2008 to 65% in 2010 (trend P<0.001). Utilization by health referral region ranged from 22.9% to 74.2% and was lowest in rural areas. Men were more likely than women to have an ECG performed (63.0% vs 61.3%, adjusted RR 1.02, 95% CI 1.01 to 1.04). The certification‐level of the EMS provider (paramedic vsbasic/intermediate) and system‐level ECG equipment availability were the strongest predictors of ECG utilization. Persons in an ambulance with a certified paramedic were significantly more likely to receive a prehospital ECG than nonparamedics (RR 2.15, 95% CI 1.55, 2.99).ConclusionsAcross a large geographic area prehospital ECG use increased significantly, although important quality improvement opportunities remain. Increasing ECG availability and improving EMS certification and training levels are needed to improve overall care and reduce rural‐urban treatment differences.

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“…[12][13][14] The practice environments for EMTs and paramedics differ, with paramedics responsible for critical tasks such as advanced airway management of critical patients and termination of resuscitation in the field at many agencies. 34 These differences appear to impact the stress levels, burnout, and other physical and mental health conditions of EMS professionals, with paramedics reporting higher levels of these negative factors. [12][13][14] These factors may result in poorer health behaviors and thus poor CVH.…”

Section: Discussionmentioning

confidence: 99%

“…In the EMS setting, measuring blood pressure in patients and potentially one's self is a common task, whereas point-of-care testing for cholesterol and fasting blood glucose is more limited. 34 The factors of blood glucose and cholesterol were excluded from the CVH score calculated, and based on the sensitivity analysis using the complete observations with data on all seven components, the risk of misclassification or bias introduced was likely low with no change in direction of association from the main analysis. Non-response bias was also a concern due to the low response rate from the electronic survey.…”

Section: Limitationsmentioning

confidence: 99%

Differences in Cardiovascular Health Metrics in Emergency Medical Technicians Compared to Paramedics: A Cross-Sectional Study of Emergency Medical Services Professionals

Cash

Crowe

Bower

et al. 2019

Prehosp. Disaster med.

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Background:Emergency Medical Services (EMS) professionals face high physical demands in high-stress settings; however, the prevalence of cardiovascular health (CVH) risk factors in this health care workforce has not been explored. The primary objective of this study was to compare the distribution of CVH and its individual components between a sample of emergency medical technicians (EMTs) and paramedics. The secondary objective was to identify associations between demographic and employment characteristics with ideal CVH in EMS professionals.Methods:A cross-sectional survey based on the American Heart Association’s (AHA; Dallas, Texas USA) Life’s Simple 7 (LS7) was administered to nationally-certified EMTs and paramedics. The LS7 components were scored according to previously described cut points (ideal = 2; intermediate = 1; poor = 0). A composite CVH score (0-10) was calculated from the component scores, excluding cholesterol and blood glucose due to missing data. Multivariable logistic regression was used to estimate odds ratios (OR; 95% CI) for demographic and employment characteristics associated with optimal CVH (≥7 points).Results:There were 24,708 respondents that were currently practicing and included. More EMTs achieved optimal CVH (n = 4,889; 48.8%) compared to paramedics (n = 4,338; 40.6%). Factors associated with higher odds of optimal CVH included: higher education level (eg, college graduate or more: OR = 2.26; 95% CI, 1.97-2.59); higher personal income (OR = 1.26; 95% CI, 1.17-1.37); and working in an urban versus rural area (OR = 1.31; 95% CI, 1.23-1.40). Paramedic certification level (OR = 0.84; 95% CI, 0.78-0.91), older age (eg, 50 years or older: OR = 0.65; 95% CI, 0.58-0.73), male sex (OR = 0.54; 95% CI, 0.50-0.56), working for a non-fire-based agency (eg, private service: OR = 0.68; 95% CI, 0.62-0.74), and providing medical transport service (OR = 0.81; 95% CI, 0.69-0.94) were associated with lower odds of optimal CVH.Conclusions:Several EMS-related characteristics were associated with lower odds of optimal CVH. Future studies should focus on better understanding the CVH and metabolic risk profiles for EMS professionals and their association with incident cardiovascular disease (CVD), major cardiac events, and occupational mortality.Cash RE, Crowe RP, Bower JK, Foraker RE, Panchal AR. Differences in cardiovascular health metrics in emergency medical technicians compared to paramedics: a crosssectional study of Emergency Medical Services professionals. Prehosp Disaster Med. 2019;34(3):288–296.

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Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

Cited by 13 publications

References 14 publications

Emergency Medical Services Capacity for Prehospital Stroke Care in North Carolina

Emergency Medical Services Capacity for Prehospital Stroke Care in North Carolina

Variation in the Use of 12‐Lead Electrocardiography for Patients With Chest Pain by Emergency Medical Services in North Carolina

Differences in Cardiovascular Health Metrics in Emergency Medical Technicians Compared to Paramedics: A Cross-Sectional Study of Emergency Medical Services Professionals

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