Intravenous Access During Out-of-Hospital Emergency Care of Noninjured Patients: A Population-Based Outcome Study

Abstract

Study objective Advanced, pre-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among non-injured patients. We evaluated the association between pre-hospital, intravenous access and mortality among non-injured, non-arrest patients. Methods We analyzed a population-based cohort of adult (aged ≥18 years) non-injured, non-arrest patients transported by four advanced life support agencies to one of 16 hospitals from January 1, 2002 until December 31, 2006. We linked eligible EMS records to hospital administrative data, and used multivariable logistic regression to determine the risk-adjusted association between pre-hospital, intravenous access and hospital mortality. We also tested whether this association differed by patient acuity using a previously published, out-of-hospital triage score. Results Among 56,332 eligible patients, one half (N=28,978, 50%) received pre-hospital intravenous access from EMS personnel. Overall hospital mortality in patients who did and did not receive intravenous access was 3%. However, in multivariable analyses, the placement of pre-hospital, intravenous access was associated with an overall reduction in odds of hospital mortality (OR=0.68, 95%CI: 0.56, 0.81). The beneficial association of intravenous access appeared to depend on patient acuity (p=0.13 for interaction). For example, the OR of mortality associated with intravenous access was 1.38 (95%CI: 0.28, 7.0) among those with lowest acuity (score = 0). In contrast, the OR of mortality associated with intravenous access was 0.38 (95%CI: 0.17, 0.9) among patients with highest acuity (score ≥ 6). Conclusions In this population-based cohort, pre-hospital, intravenous access was associated with a reduction in hospital mortality among non-injured, non-arrest patients with the highest acuity.

Prehospital Systolic Blood Pressure Thresholds: A Community‐based Outcomes Study

“…We linked encounters to the Washington State Death records. Further details on this cohort and success of record linkage success are previously described . In brief, we used probabilistic matching to deduplicate and link EMS records with manual validation, followed by hierarchical deterministic matching of EMS to hospital and death records.…”

“…We calculated Z‐statistics as the beta estimate divided by the standard error of the beta, derived from multivariate models that included age, sex, prehospital vital signs (respiratory rate, SaO 2 , Glasgow Coma Scale score, heart rate), transport mode, primary diagnosis category, and paramedic care (yes/no) and fixed effects for responding fire unit, receiving hospital, and year in cohort. These variables were selected a priori as known confounders from our prior work, and parameterized as described in “additional variables.” We did not categorize any ordinal or continuous variables other than prehospital sBP. We included responding fire units and receiving hospitals as fixed effects in the model to account for the nonindependence of observations.…”

Procedures Performed by Emergency Medical Services in the United States

“…Although certain prehospital interventions such as intravenous catheter insertion are associated with a reduction in mortality, others have found that specific populations such as trauma patients are 2.63 times more likely to die for every procedure completed in the prehospital setting. 6,7 Given the conflicting data regarding the impact prehospital procedures have on patient outcomes we need to have a better understanding of national EMS patterns of procedures. Focusing the scope of practice and procedure training opportunities for prehospital responders may be further refined with a better knowledge of how often particular procedures are performed.…”

Utilisation of prehospital intravenous access

“…These patients often require immediate interventions such as defibrillation or intravenous (IV) therapy. According to Seymour et al, [1] obtaining IV access is a commonly performed prehospital procedure. However, it can potentially have a wide range of complications, including thromboembolism and sepsis.…”