3 results
The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS
- Niels Tangherlini, Julian Villar, John Brown, Robert M. Rodriguez, Clement Yeh, Benjamin T. Friedman, Paul Wada
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 6 / December 2016
- Published online by Cambridge University Press:
- 19 September 2016, pp. 603-607
- Print publication:
- December 2016
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Objectives
The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.
MethodsA retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.
ResultsA total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.
ConclusionFrequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.
,Tangherlini N ,Villar J ,Brown J ,Rodriguez RM ,Yeh C ,Friedman BT .Wada P The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS . Prehosp Disaster Med.2016 ;31 (6 ):603 –607 .
Does Emergency Medical Dispatch Priority Predict Delphi Process-Derived Levels of Prehospital Intervention?
- Karl A. Sporer, Alan M. Craig, Nicholas J. Johnson, Clement C. Yeh
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- Journal:
- Prehospital and Disaster Medicine / Volume 25 / Issue 4 / August 2010
- Published online by Cambridge University Press:
- 28 June 2012, pp. 309-317
- Print publication:
- August 2010
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Objective:
The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch system widely used to prioritize 9-1-1 calls and optimize resource allocation. This study evaluates whether the assigned priority predicts a Delphi process-derived level of prehospital intervention in each emergency medical dispatch category.
Methods:All patients given a MPDS priority in a suburban California county from 2004–2006 were included. A Delphi process of emergency medical services (EMS) professionals in another system developed the following categories of prehospital treatment representing increasing acuity, which were adapted for this study: advanced life support (ALS) intervention, ALS–Stat, and ALS–Critical. The sensitivities and specificities of MPDS priority for level of prehospital intervention were determined for each MPDS category.
Results:A total of 65,268 patients met inclusion criteria, representing 61% of EMS calls during the study period. The overall sensitivities of high-priority dispatch codes for ALS, ALS-Stat, and ALS-Critical interventions were 83% (95% confidence interval 83–84%), 83% (82–84%), and 94% (92–96%). Overall specificities were: ALS, 32% (31–32%); ALS-Stat, 31% (30–31%); and ALS-Critical 28% (28–29%). Compared to calls assigned to a low priority, calls with high-priority dispatch codes were more likely to receive ALS interventions by 22%, ALS-Stat by 20%, and ALS-Critical by 32%. A low priority dispatch code decreased the likelihood of ALS interventions by 48%, ALS-Stat by 45%, and ALS-Critical by 80%. Among high-priority dispatch codes, the rates of interventions were: ALS 26%, ALS-Stat 22%, and ALS-Critical 1.5%, all of which were significantly greater than low-priority calls (p <0.05) [ALS 13%, ALS-Stat 11%, and ALS-Critical 0.2%]. Major MPDS were categories with high sensitivities (>95%) for ALS interventions included breathing problems, cardiac or respiratory arrest/death, chest pain, stroke, and unconscious/fainting; these categories had an average specificity of 3%. Medical Priority Dispatch System categories such as back pain, unknown problem, and traumatic injury had sensitivities for ALS interventions <15%.
Conclusions:The MPDS is moderately sensitive for the Delphi process derived ALS, ALS-Stat, and ALS-Critical intervention levels, but non-specific. A low MPDS priority is predictive of no prehospital intervention. A high priority, however, is of little predictive value for ALS, ALS-Stat, or ALSCritical interventions.
61 - Septic Shock
- from Part III - Special Populations
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- By Clement Yeh, Clinical Instructor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Robert Rodriguez, Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
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- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 403-408
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Summary
INTRODUCTION
The term sepsis describes a spectrum of pathophysiologic responses to infection. In the setting of advanced antibiotic therapies, sophisticated respiratory and cardiovascular support, and improved diagnosis, sepsis-associated mortality has declined in recent years, though it remains greater than 50% in some groups. Early recognition and aggressive management are critical to reducing morbidity and mortality.
EPIDEMIOLOGY
The causative organisms implicated in sepsis have changed over time, and many cases have nondiagnostic or negative cultures. The identified sites of primary infection are predominantly lung (47%), followed by unknown/other (28%), peritoneum (15%), and urinary tract (10%). Prior to 1987, gram-negative organisms were the predominant organisms identified. In the past 20 years, however, sepsis caused by gram-positive organisms has increased markedly, and gram-positives are now the predominant etiologic agents. Additionally, over the same time period, the incidence of fungal sepsis has increased by over 200%. These changes likely reflect the increased numbers of immunocompromised patients and debilitated surgical patients, and the increased use of indwelling catheters and devices.
CLINICAL FEATURES
The American College of Chest Physicians and the Society of Critical Care Medicine have developed standardized diagnostic criteria for sepsis, severe sepsis, and septic shock to describe the continuum of evolving physiologic derangement (Table 61.1). Categorization of patients in this system provides vital prognostic information and guides critical disposition and treatment decisions.