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A prehospital treat-and-release protocol for supraventricular tachycardia

  • Rajan Minhas (a1) (a2), Gregory Vogelaar (a2), Dongmei Wang (a3), Wadhah Almansoori (a2), Eddy Lang (a3) (a4), Ian E. Blanchard (a2) (a5), Gerald Lazarenko (a2) and Andrew McRae (a3) (a4)...

Abstract

Objective

Paroxysmal supraventricular tachycardia (SVT) is a common dysrhythmia treated in the prehospital setting. Emergency medical service (EMS) agencies typically require patients treated for SVT to be transported to the hospital. This retrospective cohort study evaluated the impact, paramedic adherence, and patient re-presentation rates of a treat-and-release (T+R) protocol for uncomplicated SVT.

Methods

Data were linked from the Alberta Health Services EMS electronic patient care record (EPCR) database for the City of Calgary to the Regional Emergency Department Information System (REDIS). All SVT patients treated by EMS between September 1, 2010, and September 30, 2012, were identified. Databases were queried to identify re-presentations to EMS or an emergency department (ED) within 72 hours of T+R.

Results

There were 229 confirmed SVT patient encounters, including 75 T+R events. Of these 75 T+R events, 10 (13%, 95% confidence interval [CI] [7.4, 23]) led to an EMS re-presentation within 72 hours, and 4 (5%, 95% CI [2.1, 13]) led to an ED. All re-presentations were attributed to a single individual. After excluding 15 records that were incomplete due to limitations in the EPCR platform, 43 of 60 (72%) T+R encounters met all protocol criteria for T+R.

Conclusion

The T+R protocol evaluated in this study applied to a significant proportion of patients presenting to EMS with SVT. Risk of re-presentation following T+R was low, and paramedic protocol adherence was reasonable. T+R appears to be a viable option for uncomplicated SVT in the prehospital setting.

Objectif

La tachycardie supraventriculaire paroxystique (TSV) est un trouble du rythme fréquent, traité en milieu préhospitalier. Les organismes de services médicaux d’urgence (SMU) demandent généralement que les patients traités pour de la TSV soient transportés à l’hôpital. Il sera question ici d’une étude de cohortes, rétrospective, qui visait à évaluer la portée d’un protocole de traitement préhospitalier seul (TPHS), sur place, de TSV simple; le respect de ce protocole par les ambulanciers paramédicaux et le taux de deuxième consultation par les patients ainsi traités.

Méthode

Un lien a été établi entre la base de données de l’Alberta Health Services EMS Electronic Patient Care Record (EPCR), située à Calgary, et le système Regional Emergency Department Information System (REDIS). Ont ainsi été dégagés tous les cas de TSV traités par les SMU, entre le 1er septembre 2010 et le 30 septembre 2012. La recherche dans les bases de données visait à relever les deuxièmes appels aux SMU ou les nouvelles consultations dans des services d’urgence (SU) dans les 72 heures suivant l’application du protocole TPHS.

Résultats

Il y a eu 229 cas confirmés de TSV, dont 75 traités selon le protocole TPHS. Sur ces derniers, 10 (13 %, CI à 95 %: 7,4–23) se sont soldés par un deuxième appel aux SMU dans les 72 heures et 4 (5 %; CI à 95 %: 2,1–13]), par une consultation dans des SU. Toutes ces nouvelles consultations ne concernaient qu’une seule personne. Après le rejet de 15 dossiers incomplets en raison de restrictions de la plateforme EPCR, 43 consultations sur 60 (72 %) répondaient à tous les critères du protocole TPHS.

Conclusions

Le protocole TPHS évalué dans l’étude décrite ici a été appliqué à une proportion importante de patients ayant appelé les SMU pour de la TSV. Le risque de nouvelle consultation après le protocole TPHS était faible, et les ambulanciers paramédicaux ont fait preuve d’une application judicieuse du protocole. Bref, le protocole TPHS semble une solution viable pour les cas simples de TSV en milieu préhospitalier.

Copyright

Corresponding author

Correspondence to: Dr. Andrew McRae, Emergency Department, Foothills Medical Centre, Rm C231 1403 29 St NW, Calgary, AB T2N 2T9; Andrew.McRae@albertahealthservices.ca

References

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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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